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Cranial nerve testing is integral to the general neurologic exam to help identify and localize neurologic pathology. This testing is widely applicable to emergency and clinical situations and can be performed relatively quickly with equipment readily available in the hospital or ambulatory environment. Cranial nerve testing is helpful in monitoring for the progression or worsening of neurologic disease processes, particularly neurotrauma. However, patients suffering from strokes or other intracranial pathologies routinely require frequent monitoring for worsening function or condition. This activity describes cranial nerve testing and explains the role of the interprofessional team in utilizing this testing modality to evaluate and monitor patients for pathologic processes and disease progression. Objectives: Identify indications for cranial nerve testing in the prehospital, outpatient, and inpatient settings. Accurately and efficiently performe cranial nerve testing in prehospital, outpatient, or inpatient settings. Correlate the typical physical exam findings of each cranial nerve palsy with potential underlying disease processes. Effectively utilize interprofessional team strategies to implement cranial nerve testing to monitor the progression of underlying pathology. Access free multiple choice questions on this topic.

Cranial nerve (CN) testing is the physical functional assessment of the nerves arising from the brain and innervating the head, neck, and trunk. This testing is widely applicable to emergency and clinical situations and can be performed relatively quickly with equipment readily available in the hospital or ambulatory environment.[1] Abnormalities discovered during the examination can be valuable harbingers of neurologic pathologies such as mass lesions or disease progression requiring urgent intervention (ie, enlarging intracranial aneurysm). CN testing is particularly useful in the continuous evaluation of unconscious patients. Patients with sequelae from neurotrauma, strokes, or intracranial pathology require frequent monitoring for worsening function or condition. Higher-level tests such as brainstem auditory evoked potentials (BAEP) typically require a referral to a tertiary care center; they can be performed if abnormalities are revealed on initial CN testing.[2]

The cranial nerve examination is a detailed procedure that requires practice and vigilance to master. Deficits found during the cranial nerve examination may require further evaluation and involvement of otolaryngology, radiology, and neurophysiologic testing professionals. Instances such as intracranial hemorrhage, coma, or stroke necessitate serial testing as part of the overall neurologic examination to evaluate for worsening or progression of pathology.[5] Assistance from the nursing and intensive care unit staff is vital in discovering changes in conditions that require further evaluation or urgent intervention. An interprofessional approach is suggested to lower morbidity, reduce unnecessary imaging, and improve outcomes.[4] [Level 5]