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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)
Herpes simplex encephalitis Viral encephalitis is a serious neurological disorder associated with relatively poor outcome. Herpes simplex virus (HSV) encephalitis is the most common causative agent for viral encephalitis. More than 95% of HSV encephalitis is caused by HSV type 1. HSV 1 is transmitted primarily via saliva which subsequently enters the oral mucosa and spreads…
This is a non-contrast cranial CT from a middle-aged man with multiple cardiovascular risk factors who suffered a severe ischaemic stroke involving the left middle cerebral artery territory. There was significant cytotoxic cerebral oedema as a result of the extensive infarction. The patient was operated on by the Neurosurgeons and a left hemi-craniectomy was performed…
Subdural haematomas are far more common than epidural haematomas and acute subdural haematomas are one of the leading causes of death and disability in patients with severe traumatic brain injury. Subdural haematomas are due to an accumulation of blood between the dura and arachnoid. This is most often due to head injury resulting in a…
This middle-aged man was admitted after a generalized tonic-clonic seizure that occurred at home. Physical examination did not reveal any significant external wounds as a result of the seizure and there were no focal neurological signs. However, examination of the oral cavity showed presence of a haematoma at the side of the tongue. This occasionally…
By palpating onto the iliac crest and spinal processes of the back, the site of needle puncture for lumbar puncture (LP) is identified. As the spinal cord ends at the level of L2 in adults, the spinal needle can be inserted safely between the L3/4 or L4/5 levels. The highest point of the iliac crest…
The set of cranial MRIs shown here are from a young woman with a known history of relapsing-remitting multiple sclerosis. In the first scan (T2W axial cut), we can see multiple T2 hyperintense lesions involving bilateral cerebral cortices (Figure 1). These lesions are noted to be of a juxta-cortical and also peri-ventricular distribution, which are classical of multiple sclerosis. In the next…
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