Pediatrics: Cranial Nerve Examination

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Oculomotor (III), trochlear (IV), Abducens (VI) cranial nerves Although each of these nerves control separate extraocular muscles, they are normally examined together due to their close functional interrelationships. • Look Similar to other cranial nerve examination, start with inspection of the eyes. Look at - The position of the head position: If diplopia is present, the head turned or tilted to minimize double vision. - Inspect for ptosis and eye position. - Ask the child to look at an object about five feet away. Examine the pupils for size, shape, and symmetry. Oculomotor nerve palsy causes mydriasis. Sympathetic palsy leads to miosis. Ciliary ganglion malfunction within the orbit produces Adie’s pupil with middilated pupils and poor responds to convergence. • Ocular alignment The eyes are normally parallel in all positions of gaze except convergence. Squints can be either paralytic (paresis of one of the extraocular muscles) or non-paralytic (defective binocular vision). Congenital paralytic squints result in abnormal head postures, while the acquired ones cause diplopia. Non-paralytic (concomitant) squints are not associated with diplopia. - Looking at light: Sit in front of the child about 1 metre away. Shine a light source and ask the child to look at the light. Observe the position of the light reflexes on the cornea. Normally, the light reflex is symmetrical and slightly nasal to the centre of each pupil. - Cover test is a good test of eye alignment and is helpful to determine the presence of both manifest and latent strabismus o Unilateral cover test: Ask the child to concentrate on an object that is ten feet away as if “their eyes are glued to the object”. For testing of the right eye, cover the child... ... middle of paper ... ...mpare the nasolabial grooves, which are smooth on the weak side) - Bell's phenomenon: Ask the child close the eyes. In lower motor neuron VII nerve palsy, the upward movement of the eyeball is seen due to incomplete closure of the eyelid. • Taste Sensation - Examine for taste on the anterior two-thirds of the tongue, only in those with facial palsy. - Ask the child to protrude the tongue and not to speak during the test. - Apply a small sample of sugar, vinegar, salt and quinine solutions (sweet, sour, saline and bitter) with cotton buds to one side of the anterior two-thirds of the tongue one at a time. - Ask the child to point to the taste on a pre-prepared card to point out the response. - Rinse the mouth with water between each specimen. - Between each test ask the patient to rinse his mouth with water. - Repeat test on the other side of the tongue

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