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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)
Positioning For general examination, examining the cortical function and upper limbs, the optimal position would be to sit the patient upright at an approximate 45-60º angle to the bed (Figure 1). Of course, if the patient is ambulatory, the patient can also be examined whilst sitting comfortably on a chair (Figure 2). The optimal position…
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…
A lumbar puncture (LP, also known as a spinal tap) is a diagnostic and at times, therapeutic medical procedure. Diagnostic indications The main diagnostic indications of performing a LP is for collection and evaluation of cerebrospinal fluid (CSF) for diagnosis and exclusion of infectious, inflammatory and neoplastic diseases affecting the central nervous system. For example,…
In the first video, the patient has both horizontal nystagmus and vertical “down-beat” nystagmus. In the second video, the patient has a torsional nystagmus when looking to her right hand side. Discussion of the sign Nystagmus is defined as a rhythmic oscillation of the eyes. It usually consists of a slow drifting phase in one direction and a…
In this photo, there is apparent leg-length discrepancy and wasting of the lower limb muscles – the left side relatively more severe. Typical pes cavus (high-arched foot) are seen on both sides. Clawing of the toes can also be seen. This sign is postulated to be due to a different degree of wasting – the…
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