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General Inspection
During the general inspection of the cranial nerves, we should look for whether the patient has any ptosis, abnormal eye movements and facial asymmetry. We should also inspect for whether there are any neuro-cutaneous features (for example in patients with tuberous sclerosis and neuro-fibromatosis), syndromal features etc.
Cranial Nerve I (Olfactory Nerve)
Cranial Nerve II (Optic Nerve)
Visual Acuity
Visual Fields
Inspection of the Pupils
Direct and Consensual Light Reflexes
The Swinging Torch Test
Accommodation Reflex
Cranial Nerves III (Oculomotor Nerve), IV (Trochlear Nerve) and VI (Abducens Nerve)
Cranial Nerve V (Trigeminal Nerve)
Cranial Nerve VII (Facial Nerve)
Cranial Nerve VIII (Vestibulocochlear Nerve)
Cranial Nerves IX (Glossopharyngeal Nerve) and X (Vagus Nerve)
This patient did not have any recent ocular symptoms but was noted to have significant right eye ophthalmoplegia during examination, whilst the left eye movements were completely normal. There was no double vision upon testing. Whilst one would need to consider a combined third, fourth and sixth nerve palsy in a patient with unilateral opthalmoplegia,…
Normal Cerebrospinal Fluid The photos shown here is that of normal cerebrospinal fluid after a lumbar puncture. Normal cerebrospinal fluid is colourless and odorless. Xanthochromia The cerebrospinal fluid here shows xanthochromia (Figure 1), meaning of yellow discolorization. Presence of xanthrochromia means that there is presence of red cells in the cerebrospinal fluid. With time, the red…
The neurological examination is an important skill to acquire for all medical students. If performed correctly, it can help tremendously to narrow down the differential diagnoses which would subsequently guide investigations and management plan. One important aspect of the neurological examination is to help localise the lesion. For example, in patients presenting with unilateral limb…
A. Clinical manifestations The clinical features of CSF shunt infection can be quite variable and depend on the pathogenesis of the infection, organism virulence and type of shunt. The most frequent symptoms are headache, nausea, lethargy, fever and change in mental status. Pain, often related to infection at the peritoneal or pleural endings of the…
This is a video from a middle-aged man with myotonic dystrophy type 1, an autosomal dominant multi-systemic disorder that not only affects the muscles, but also causes other problems such as cataracts, arrhythmias and diabetes mellitus. The video shown here is typical of myotonia which can be seen in these patients. The tone is usually…
The major clinical syndromes of central nervous system infections include the following: Meningitis: inflammation of the leptomeninges (arachnoid and pia mater) Encephalitis: inflammation of brain parenchyma Brain abscess Subdural empyema and epidural abscess Suppurative intracranial thrombophlebitis Shunt infection
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