Say "may I examine the nerves in your head and neck"
Get the patient sat up if this is possible (e.g. on the side of the bed)
CN I: Olfactory
Say "have you noticed any changes in your sense of smell or taste"
CN II: Optic
Inpect their pupils for symmetry (e.g. Horner's syndrome). Shine a
torch in to their eye for accommodation to light. Swing a torch from
eye to eye to look for relative afferent pupillary defect. Get them to
fixate on a distant then close object for accommodation to distance.
Ask the patient to put on their glasses if they have any
Fields: Ask the patient to put one hand over an eye. Get the patient to
read something (e.g. your badge). Next then (if you can) close your eye
facing theirs (if you can't close one eye at a time then put your hand
over your eye). Get them to look in to your eye. Bring one hand to the
upper outer quadrant outside of their field of view (may involve
sitting very close to the patient). Ask them to tell you when they see
your hand. When they do see it, continue forward until your finger is
directly between your's and their eyes (i.e. it will obscure their eye
from you) and ask them if it disappears. This will pick up a arcuate
scotomas in glaucoma. Continue in all 4 quadrants.
"I am going to leave fundoscopy until the end"
Repeat with the other eye.
CN III, IV, VI: Occulomotor, Trochlear, Abducens
Eye movements in an "H" shape. Say first "keeping your head still
follow my finger with your eyes, tell me if you see double."
Perform movements fast in vertical and horizontal planes looking for nystagnus
CN V: Trigeminal
Say "Please close your eyes. I am going to touch your face, tell me
when you feel me touching you." On both sides: start on forehead, then
below eyes, then lower cheek.
Palpate their parotid region both sides and ask them to clench their teeth. Repeat for masseter and temporalis.
Get them to open their mouth and stop you closing it.
CN VII: Facial
"Lift your eyebrows up"
"Screw your eyes tightly shut"
"Show me your teeth"
"Puff out your cheeks, stop me from pushing the air out of them"
CN VIII: Vestibulocochlear
"Do you have any trouble with your hearing."
Whisper a number and ask them to repeat it in both ears.
If hearing loss then perform Rinne and Weber's tests.
CN IX, X: Glossopharyngeal, Vagus
Shine a torch in their mouth and watch their uvula move whilst the patient says "ahhhh."
CN XI: Accessory
"Shrug shoulders, Stop me from pushing them down"
"Turn head to left and stop me from turning it back." Repeat on right side.
XII: Hypoglossal
Observe their tongue inside their mouth for fasciculation (use a torch).
