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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)
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…
Often, as a consequence of severe head injury, there may be haemorrhage within various intracranial compartments. In these 2 cases (Patient 1 – Figure 1, Patient 2 – Figures 2 to 11), both patients sustained a severe head injury. A combination of subdural , parenchymal and subarachnoid haemorrhage could be seen. In the second case,…
a) Principles of CT scan Computed Tomography (CT) is an imaging modality that uses computer-generated analysis ( i.e. computed ) of the x-ray attenuation through a section of the body tissue to produce cross-sectional images ( i.e. tomography ) with great anatomical details. Unlike plain X-ray images which are projected images of one plane, CT…
The MRI images shown here (Figures 1 to 5) are from a patient with cerebral amyloid angiopathy (CAA). CAA is caused by the accumulation of aggregated amyloid-β (Aβ) plaques in the walls of small to medium-sized arteries and penetrating arterioles. Such aggregates are due to an imbalance between Aβ production and clearance. Whilst Aβ40 (40 meaning…
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…
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…
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