Version June 2024
| Focused cranial nerve examination | ||||
| Nerve | Test | Results | ||
| I – Olfactory | Subjective | |||
| Objective | Normal | Abnormal | ||
| With eyes closed, have patient plug one nostril and smell distinctive scent (eg, coffee grounds), then repeat on other side. | Normal | Abnormal | ||
| V – Trigeminal | With patient's eyes closed, touch the patient on each side of their forehead, cheek, and jaw. Ask if sensations are felt and if they are symmetric. | Normal | Abnormal | |
| VII – Facial | Ask the patient to smile, puff out their cheeks, wrinkle their forehead, and close their eyes tightly. | Normal | Abnormal | |
| IX – Glossopharyngeal | Ask the patient to open their mouth and say "ahhh." | Normal | Abnormal | |
| X – Vagus | Ask the patient to swallow. | Normal | Abnormal | |
| XI – Accessory | Push down lightly on the patient's shoulders while the patient shrugs them. | Normal | Abnormal | |
| XII – Hypoglossal | Ask the patient to stick out their tongue. | Normal | Abnormal | |
| Oculomotor/ophthalmologic evaluation | ||||
| Test | Results | Findings | ||
| Fundoscopy | Performed | Normal | ||
| Not performed | Other:
| |||
| Pupil reactivity (CN II) | Normal | Abnormal | ||
| Visual acuity (with glasses if worn) | Left _____ | |||
| Right _____ | ||||
| Both _____ | ||||
| Visual fields | Normal | Abnormal | ||
| Visual tracking (CN III, IV, VI) | Normal | Abnormal | ||
| Smooth pursuits (10 repetitions and then stop, horizontal and vertical) | Normal | Nystagmus* (sign) | ||
| Abnormal horizontal | Saccadic movement (sign) | |||
| Abnormal vertical | Dizziness/nausea (symptom) | |||
| Worse headache (symptom) | ||||
| Other:
| ||||
| Repetitive saccades (30 repetitions horizontal, 30 repetitions vertical) | Normal | Nystagmus* (sign) | ||
| Abnormal horizontal | Saccadic movement (sign) | |||
| Abnormal vertical | Dizziness/nausea (symptom) | |||
| Worse headache (symptom) | ||||
| Other:
| ||||
| Vestibulo-ocular reflex (CN VIII) (10 repetitions horizontal, 10 repetitions vertical) | Normal | Does not maintain fixation (sign) | ||
| Abnormal horizontal | Dizziness/nausea (symptom) | |||
| Abnormal vertical | Worse headache (symptom) | |||
| Other:
| ||||
| Near-point convergence and accommodation (glasses may be worn) | ||||
| Trial | Convergence (diplopia) | Convergence recovery (single image) | Accommodation – Right (blurry) | Accommodation – Left (blurry) |
| 1 | cm | cm | cm | cm |
| 2 | cm | cm | cm | cm |
| Best | cm | cm | cm | cm |
| Limb tone | ||||
| Upper limbs | L | Normal | Abnormal | |
| R | Normal | Abnormal | ||
| Lower limbs | L | Normal | Abnormal | |
| R | Normal | Abnormal | ||
| Strength | ||||
| Upper limbs | L | Normal | Abnormal | |
| R | Normal | Abnormal | ||
| Lower limbs | L | Normal | Abnormal | |
| R | Normal | Abnormal | ||
| Deep tendon reflexes (0-4) | ||||
| Tendon | Left | Right | ||
| Biceps | ||||
| Triceps | ||||
| Brachioradialis | ||||
| Patellar | ||||
| Achilles | ||||
| Upper limb co-ordination (nose-to-finger) | ||||
| Sensation | ||||
| Eyes open | L | Normal | Abnormal | |
| R | Normal | Abnormal | ||
| Eyes closed | L | Normal | Abnormal | |
| R | Normal | Abnormal | ||
| Reaction time with tendon hammer/ruler __________ (seconds) | ||||
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