As-salamu alaykum. My name is Dr. Talha and today we'll be doing a cranial nerve examination. So first off, we'll start off by washing our hands. We've already introduced ourselves to the patient.
We've made sure that the environment that we've provided is private and comfortable. I will ask permission from the patient. Can I begin the examination?
That's great. So now, we'll be testing for the glossopharyngeal and the vagus nerve. For that, firstly, we need to inspect the uvula with a torch, right? So ask the patient to open their mouth and say, ah.
Ah. Okay, and now we're looking at the uvula for any sort of deviation. Normally, the uvula should be centralized. After that, you will also ask the patient to speak, so you can assess for hoarseness of the voice. You can also ask the patient to cough to exclude other pathologies.
After you're done with these two things, you will also ask the patient to make a high-pitched noise to also assess the vocal cords. Lastly, you will ask the patient to swallow some water, right? You can just... Alright, and then you're assessing for any sort of regurgitation through the nose, right?
That's what you're assessing. So now we'll be testing for the accessory nerve. For the accessory nerve, we'll be testing two muscles mainly.
We'll be testing the trapezius muscle and the sternocleidomuscular muscle. For the trapezius muscle, first you will feel the bulk at the shoulders, and then ask the patient to shrug their shoulders, and then you will push them down against resistance to check for their strength. After this, you need to check The bulk for the sternocleidomastoid muscle. So you're looking at the sternocleidomastoid muscle like this on both sides, obviously. After you've checked for the bulk, you'll ask the patient to turn against your resistance.
So the right sternocleidomastoid muscle will turn the patient's head towards the left side, and the left sternocleidomastoid muscle will turn the head towards the right side. So now we'll be testing for the right sternocleidomastoid muscle. So keep your hand here and ask the patient to turn against resistance.
Similarly, you keep your hand here and ask the patient to turn against the resistance. Now you're done with the accessory nerve. Then we'll move on towards the hypoglossal nerve. For the hypoglossal nerve, firstly, you ask the patient to open their mouth, and you're looking at the tongue for any wasting or fasciculation.
Then you ask the patient to protrude the tongue. So can you protrude the tongue? Okay, you're looking at the tongue for any sort of deviation. or any sort of fasciculations that may be there. So any sort of deviations of the tongue will indicate a pathology.
Normally, the tongue should be centralized. That concludes our examination. Cover the patient, thank the patient, and that's all.