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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)
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…
Dr Gilberto Leung and Dr Gary Lau Subtitles in English for this video can be displayed by clicking on (first button on the bottom right hand corner of the video). Our level of consciousness is governed by our cerebral cortex as well as the subcortical ascending reticular formation. Patients with normal consciousness have a high level…
A lumbar puncture (LP) is contraindicated in the following scenarios: Patients with bleeding diathesis, e.g. severe coagulopathy (INR >1.4) and thrombocytopenia (platelet <50 x 109/L). If coagulopathy or thrombocytopenia is not corrected prior to the procedure, spinal hematomas resulting in spinal cord compromise may result. Patients with increased intracranial pressure due to an intracranial lesion…
These are the cranial CT scans from a patient with a recent left cerebellar infarct . Due to the significant cytotoxic oedema as a result of the cerebellar infarct, the fourth ventricle is being compressed , thus obstructing the normal CSF flow. The CT scan shows features of obstructive hydrocephalus and there is dilatation of the third ventricle (now…
This cranial MRI is from a young woman who presented with low-grade fever, confusion, visual hallucinations and status epilepticus. Significant orofacial dyskinesias and autonomic dysfunction was also noted. Lumbar puncture was performed and cerebrospinal fluid (CSF) revealed mild lymphocytic predominant leukocytosis and slightly elevated protein. CSF glucose was within normal range and CSF for microbiological…
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