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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 complained of on and off tingling sensation over the lateral 3 ½ fingers of the right hand. There was wasting of the thenar muscles as noted in this photo. Further testing showed that the thumb abduction and opposition was weak. Tinel’s sign and Phalen’s test was positive. A nerve conduction study was performed,…
These two photos (Figures 1 and 2) show wasting of the left small hand muscles including the interosseous muscles, 3rd and 4th lumbricals and hypothenar muscles. The picture also shows an ulnar claw hand in which there is extension of the metacarpophalangeal joints and flexion of the proximal and distal interphalangeal joints of the 4th…
Intracranial calcifications are frequently seen in non-contrast CT scans. These are often due to age-related physiological changes of the brain but can occasionally be mistaken as an intra-cerebral hemorrhage. The most common sites of intracranial calcifications include the basal ganglia (often bilateral, Figure 1), pineal gland (Figure 1), choroid plexus (often bilateral, Figure 1), dentate…
Patient Position A lumbar puncture (LP) can be performed with the patient in the lateral recumbent position or sitting upright. The lateral recumbent position is preferred because it allows accurate measurement of the opening pressure. The patient shown in the photo here is in the left lateral recumbent position. Positioning of the patient is crucial…
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…
One can appreciate from this photo that there is significant lower limb wasting (or muscle atrophy) of the right leg compared to the left. The right leg is also shorter compared to the left. Muscle wasting (or atrophy) is due to denervation of the muscle supplied by the motor nerve and occurs in lower motor…
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