A2. Examination of first and second cranial nerves (smell sensation, vision)

From greek.doctor
  • CN I – olfactory nerve
    • Only tested if patient has complaints regarding smell (rare)
    • Procedure
      • Close patient’s eyes and one nostril
      • Let patient smell a non-irritating fragrance
    • Negative:
      • Patient can recognize that there is a smell (primary perception normal)
      • Patient can recognize the smell (cognitive function normal)
  • CN II – optic nerve
    • Examination of visual acuity
      • Stand 5 meters from the patient
      • Hold up a number of fingers with your hand and ask the patient to say the number
      • If patient can’t see: repeat at 4 meter distance, and so on
      • Document: “patient can count fingers at X meter distance”
    • Examination of fundus
      • With ophthalmoscopy
    • Examination of visual field
      • Stand an arm’s length away from patient
      • Have your finger outside the visual field and move it slowly towards the visual field
      • Instruct patient to tell you when they see your finger
      • Examine the temporal, nasal, upper, and lower edges of the visual fields of each eye separately
    • Examination of pupillary light reflex
      • Direct pupillary reflex
        • Shining light into one eye causes myosis of that eye
      • Indirect pupillary reflex
        • Shining light into one eye causes myosis of the contralateral eye
    • Examination of oculopalpebral reflex
      • An object quickly approaching the eye elicits blinking
      • Used in unconscious patients (see topic 17)