[0:14]What's up, Ninja Nerds. In this video today, we're going to be talking about how to perform a cranial nerve exam. Before we get started, make sure you guys go down to the description box where I've links to our Patreon. On our Patreon, we'll have comprehensive notes on the physical exam that we're going to be doing on Q today, going through all the cranial nerves in a sequential order.
[0:32]So go check that out. Also, if you guys like this video and benefit from it, please hit that like button, comment down in the comment section, and please most importantly, subscribe. So let's go ahead and get into it.
[0:42]So Q, today, I'm going to be performing a cranial nerve exam on you. Is that okay?
[0:46]Yeah, that's great. All right, so what I'm going to do now is I'm just going to go over, wash my hands, make sure that we're being clean.
[0:53]And so, when we're doing a cranial nerve exam, we're going to start, it's first important to remember that we have total of 12 cranial nerves.
[1:00]We're going to start from cranial nerve one and work our way down to cranial nerve 12. The first cranial nerve that we're going to evaluate is the olfactory nerve.
[1:09]The function of the olfactory nerve is primarily for smell or olfaction. So we need to know how do we evaluate that here on Q.
[1:17]So the first thing I need to do is make sure that Q's nasal passages are patent. That there's no obstruction that could alter the reliability of my test.
[1:25]So Q, what I'm going to have you do is plug your right nose here for me, and I'm going to have you take a breath in through your nose and out through your nose.
[1:32]Good. And I'm going to do the same thing for the other one.
[1:36]Good. And I hear complete patency of that nasal airway, so I know that there's not going to be anything that's altering my actual test. Now that I know that, what I'm going to have Q do is I'm going to have you close your eyes and again, cover and include your right nostril.
[1:50]And what I'm going to do is I'm going to present a particular smell to him. And I want him to be able to identify what that particular smell is.
[1:57]So Q, can you tell me what you smell here?
[2:00]Smells like coffee. Perfect. So that is perfect intactness of that olfactory nerve. We're going to do the other side.
[2:07]Keep your eyes closed, and again Q, I'm going to present a smell to you. Can you tell me what you smell?
[2:13]That's cinnamon. Perfect. So the olfactory nerve is intact, beautiful. Now, here's something that we got to be thinking about.
[2:20]If the olfactory nerve wasn't working properly and they weren't able to identify those smells, that could be indicative of something called anosmia. Now, anosmia can have various causes.
[2:30]It could be acquired, and think about it, if there was an infection of the nasal mucosa, like in a rhino sinusitis, like COVID-19, or there was damage to those nerves, like in Parkinson's disease, or compression of that nerve, like in a tumor, like a meningioma, or damage to the nerve from like a fracture of the ethmoid bone.
[2:47]Those could be potential causes of anosmia. But it also could be congenital where you don't form that olfactory nerve in something called Kallmann syndrome. Now, the olfactory nerve, we don't commonly test this, unless Q came in today complaining of some decreased or loss of smell.
[3:04]That covers cranial nerve one. Let's now move on to the second cranial nerve, also known as the optic nerve. The optic nerve is primarily responsible for vision, and we can test this in many different ways.
[3:15]The first way we're going to test this is by the visual acuity test using our good old Snellen chart. So let's go ahead and do that.
[3:22]All right, so we're going to be assessing visual acuity on Q. The best way to do that is just your good old Snellen chart. And on the bottom it'll tell you the distance that you generally want to be away from the patient to examine that. It's about six feet.
[3:34]So what I'm going to do is I'm going to go ahead and have Q read some letters off for me. So Q, what I want you to do is cover your right eye. And Q, can you read these letters here all the way at the bottom from left to right?
[3:44]Yep, uh, E, C, T, P, N, L.
[3:49]Beautiful. So his left eye OS 2020, good stuff. We're going to cover the other eye, so now we're going to be testing his right eye. Same thing Q, at the bottom here, can you read the letters from left to right?
[4:01]E, C, T, P, N, L.
[4:05]Beautiful. So his right eye OD 2020. Now we're going to test both eyes. Can you read the last line left to right here?
[4:12]E, C, T, P, N, L.
[4:16]Good. So both eyes OU 2020 visual acuity is on point. Let's now move on to the next test which is going to be visual fields.
[4:26]All right, so we've tested Q's visual acuity. His was perfect 2020, right eye, left eye, both eyes. Now, if he did have those higher numbers, it wasn't 2020, maybe 2070, 20100 in one or both eyes, then I'm thinking that there's something going on.
[4:40]And there could be various reasons for this. There could be some retinopathy, maybe diabetic retinopathy, hypertensive retinopathy. If he was older, which he's not, I might be thinking about macular degeneration, or maybe just a general astigmatism of some kind.
[4:53]So that's what I would be thinking about if there was something going on with his visual acuity. Now, if we're going to assess visual fields, that's the next thing that we're going to test on him.
[5:01]The best way to do that is by doing a finger counting method. There's many different ways. We're going to use the finger counting method on him.
[5:08]So Q, what I'm going to have you do is kind of turn your kind of like uh, yep, perfectly straight line with me.
[5:14]And now what I'm going to do is I'm going to have you cover your right eye. What I want to do is I want to test Q's peripheral field and his central visual field.
[5:24]So he's covering his right eye. I'm going to close my left eye to keep my visual fields similar to his. And I'm going to have my arms about equidistant between me and him, and I'm going to come up so I'm in kind of like a superior quadrants of his central and peripheral fields.
[5:40]And Q, what I'm going to do is I'm going to put some numbers up. I want you to tell me what numbers you see, okay?
[5:46]Two. Good. Two. Good. And I'm going to come down to my inferior quadrants. Same thing Q, tell me how many fingers I'm pointing.
[5:54]One. Good. Two. Good. And so both visual fields, the peripheral and central on the right eye are beautifully intact and there's no field cuts.
[6:40]What would I be worried about? If I was doing this and Q lost his vision, his peripheral visual fields on both eyes, I'd be thinking about something called bitemporal hemianopia.
[6:50]And that's a very, very common, uh when there's a pituitary tumor sitting on that optic chiasm because it it affects the fibers that are crossing. If there was something where, let's say he couldn't see the visual fields on his left peripheral and his right central, then I'm thinking that he's losing his field cuts, there's field cuts on the left visual fields.
[7:16]And that's called left homonymous hemianopia, which means that there could be a right optic tract lesion or a right occipital lobe lesion.
[7:28]So these are things to be thinking about when you're assessing someone's visual fields. One more thing to remember is when you're assessing visual fields, we were doing the counting finger kind of method.
[7:35]There is other ways to do it. You can do the wiggling finger method, which is a kinetic target. And so those are easier to identify than something like static, like just your fingers, okay, like counting.
[7:46]So I would highly suggest do the counting fingers method and if there was a field cut, then do the wiggle finger method afterwards. But in this case, Q's visual fields are full on confrontation.
[7:56]So the next thing that we'll assess for Q is we're going to go ahead and assess his pupillary reflexes.
[8:04]All right, so when we're going to be examining Q's pupil responses, the first thing that we need to do before we even go and shine a light in those beautiful green eyes is we need to take and look at his pupils.
[8:16]And so I just want to kind of notice really quickly just looking at them in an ambient light, are they pretty much symmetrical?
[8:20]So I want to make sure that one side is not bigger than the other if they're dilated. Okay? The next thing I want to make sure that they're not pinpoint.
[8:28]And I want to make sure that they're nice and round. So by looking at them, they look nice and equal, they look round. Now I need to determine if they're reactive to light.
[8:38]So this is where we test the pupil reflex. It's important to know the pathway of the pupil reflex. You shine a light into his eye, it hits the optic nerve.
[8:47]The optic nerve will send that information to your brainstem, particularly the midbrain, activating the third cranial nerve.
[8:53]The third cranial nerve will then send out supply to his actual uh, his muscles of the uh, around the pupil and cause them to constrict. So I should be able to examine a direct response and then a consensual response.
[9:07]Let me show you what that looks like. So if I took a light here, I'm shining it into his right eye.
[9:11]As we come here, I'm going to bring the light in. Look at that constriction right there when for me shining light into this eye. That's called the direct response.
[9:20]I'm going to shine the light into the right eye, but look at his left eye. It should constrict. That is called the consensual response.
[9:29]I'm going to do the same thing on the other eye because I want to notice that they're both, it's reactive similarly on both eyes.
[9:35]So I'll come over here. Shine the light into his left eye. Look for that direct response, nice constriction. And then again, focus on his right eye, and look for that nice constriction of the right eye, that's the consensual response.
[9:50]So that's going to tell me my pupillary reflex. Now, it's important to remember, if there was an issue where the pupils didn't respond the way you wanted them to, they didn't react, in other words, they didn't constrict or there was an unequal constriction.
[10:04]You got to think about the parts in that pathway. Is there something wrong with the optic nerve? Is there something wrong with the midbrain? Or is there something wrong with my oculomotor nerve?
[10:14]The easy one to kind of just test really quickly while you already have your light here is what's called a relative afferent pupillary defect, or an RAPD.
[10:23]This is testing to see if there's something wrong with his optic nerve sensing the light. So what I would do is is I would shine a light in, let's say he has a right optic nerve lesion.
[10:35]So he's not going to be able to pick up the sensations as well when I shine that light into his right eye. That's going to lead to decreased signals going to his midbrain, decreased signals going through the oculomotor nerve, and it's not going to be causing constriction of those pupils now.
[10:50]If they don't constrict, they may dilate a little bit. And that's called a relative APD, also sometimes referred to as a Marcus Gunn pupil.
[11:00]So, if I were to do the swinging light test to look for a relative APD, I'm just going to focus on one eye at a time.
[11:05]I would shine a light, look at the constriction in that pupil, note it very, very interestingly, then come to the other one, shine the light into that, and what I'm looking for is I'm looking for that constriction to be the same amplitude in both eyes.
[11:21]And I'm looking for them to constrict and not dilate. Okay? If I shine the light into that right eye that was damaged, what would happen then? He would dilate, both eyes would dilate because there's an issue with his optic nerve, the afferent pathway.
[11:37]If there was problems with the midbrain, there could be a stroke. If there's problem with the third nerve, maybe there's a herniation that's compressing it or a communicating artery aneurysm, the posterior cerebro communicating artery that's compressing it as well.
[11:51]The last thing that I could test is after I've done the pupillary and the swinging light test, as I could do what's called a blink to threat test. This also tests the second cranial nerve, as well as another nerve called the facial nerve.
[12:04]So what I would do to test the blink to threat is I would take my hands. I would have them look straight forward and I would come like I'm going to hit him. I obviously wouldn't, but I get close enough that it would trigger his optic nerve to sense that. Send that to his brain stem, activate the facial nerve, come out and the facial nerve will cause the orbicularis oculi to contract.
[12:21]So do the same thing on that one and on that one. And he has a blink to threat on both sides. So it means that that is intact with respect to his optic and his facial.
[12:32]After we have completed the pupil, looking at it through the pupil reflex, the swinging light and the blink to threat. Now what we can do is is we can do a funduscopic exam.
[12:42]All right, so now what we're going to do is we're going to do what's called fundoscopy. We're going to take a look at a bunch of different stuff in Q's eye. And so we're going to be looking at the retina. We're going to be looking at the optic disc. We're going to be looking at some of the blood vessels in that area and we're also going to be looking for something really, really quick called a red reflex.
[13:00]So what we're going to do is is I'm going to take here my ophthalmoscope. I'm going to kind of brace my hand over here on Q's head. And then I'm going to take my light here and I'm just going to kind of look through it to see if I find the red reflex.
[13:13]And then once I find that, I'm going to follow it in and take a look at his retina. And what I'm noting here is I'm noting his optic disc. I'm looking to see if it's pale, if it's cupped, if it's blurred margins around it.
[13:30]I'm looking at the retina to see if there's any what's called drusen or microhemorrhages or cotton wool spots. I'm looking at the blood vessels as well to see if there's any AV nicking or if there is any copper wiring.
[13:42]Um, and just seeing if there's any signs of retinopathy there. And then if I can, I'll look a little bit towards the macula and see if I see any lesions there as well.
[13:48]After I've done that on the right eye, I'm going to do the same thing. Except I'm just going to come over here on this side.
[13:56]Again, brace my hand here, have my light kind of zooming in there. And with my left eye, find his red reflex and follow it all the way in, noting all the things that we just talked about in his right eye.
[14:16]After we've performed the funduscopic exam, that would pretty much conclude our cranial nerve two. Things that I could be looking for that would be abnormal, if you really get a good look at it, is sometimes if the optic disc is really blurred and the margins are a little hard to see, it could be indicative of what's called papilledema, which could be indicative of high intracranial pressure.
[14:34]If the vessels look a little odd, there's AV nicking, there's copper wiring. That could be indicative of maybe some retinopathy. Same thing, hypertensive or diabetic. And again, looking for any macular degeneration or any microhemorrhages in the retina as well.
[14:52]After we've performed the second cranial nerve exam, we've pretty much finished everything in that. We're going to move on to three cranial nerves in tandem.
[14:59]The third cranial nerve, which is known as the ocular motor, the fourth, which is known as the trochlear, and the sixth, which is known as the abducens nerve. These are really, really good at moving our muscles of the eye, what's called the extraocular muscles, and there are so many of them.
[15:15]Easiest way that I find you guys to remember them is LR6. Lateral rectus is supplied by the sixth cranial nerve abducens. The superior oblique SO4 is supplied by the trochlear nerve and all the rest of them, superior rectus, inferior rectus, inferior oblique, medial rectus, and even the levator palpebrae superioris is supplied by the third cranial nerve.
[15:39]So when we're noting extraocular movements, what I like to do before I even have him follow my finger and fixate and track is I just want to him to kind of look at me. Q, can you have you kind of look straight at my nose here? And I'm looking at his gaze. This is very, very important to note.
[15:52]Because I want to know if his gaze is midline, meaning that all the muscles are working kind of nicely that not one's pulling or not one's weak and it's deviating anywhere. I want to make sure that they're midline and that there's no disconjugate gaze, not one wonky eyes looking out this way or looking in a different direction than it should be.
[16:11]After I've noted that his gaze is midline, then I'm going to assess his ability to fixate on my finger. So Q, what I want you to do is just look at my finger.
[16:19]And I want you to only follow my finger with your eyes, not your head, okay? And what I'm going to do is I'm going to make an H. So I'm going to move this way towards the right.
[16:29]As I move to the right, think about what muscles I'm activating. I'm activating the right lateral rectus and the left medial rectus. I'm going up.
[16:38]I'm testing his superior rectus and the inferior oblique, coming down, testing the inferior rectus and the superior oblique. And again, we can come back to midline.
[17:04]All of those movements were beautiful. There was no weakness or paresis towards one side. He didn't have a preference, they were moving nice and smooth.
[17:14]Other things that you'd want to ask is while he was doing that, did you develop any double vision at all Q while I was moving my fingers around? No, so that's good as well.
[17:22]The other thing that you want to look for is if you really can sometimes see it. Sometimes if you move your your finger in one direction, it can trigger like a little beating of the eyes, called a nystagmus.
[17:33]And sometimes that's something that you'd want to further evaluate as well. But in Q's case, extraocular movements were intact, they were full, nice pursuit, smooth movements.
[17:44]The next thing I would do is I would test something called saccades. And these are your nice reflexive eye movements. These kind of are coordinated by your frontal eye fields, in your frontal lobe, and your perimedian pontine reticular formation in your brain stem.
[17:56]And so what I like to do with this is I'm going to test his volitional saccades. So Q, can you go ahead and look to the right, and look back at me? Look to the left, look back at me. Look up, look back at me.
[18:09]And then I'm going to have you go ahead and look down, and then look back at me. All those movements were really, really quick. They weren't slow. There wasn't any nystagmus, and they were nice and smooth. So the saccades, this saccadic eye movement was perfect and it's moving perfectly well.
[18:26]The last thing that I would do for his extraocular, well his third, fourth and sixth cranial nerves, is I would look at his eyelids, particularly the upper eyelids.
[18:36]There's a muscle called the levator palpebrae superioris, which helps to pull the eyelids up. Sometimes if there's injury to the third cranial nerve, or the sympathetic plexus, that can droop.
[18:47]And that can cause something called ptosis. So I just want to take a look at his eyelids. Can you look straight at me, Q? And I don't notice any drooping of one eyelid or the other. So that's perfect. No ptosis present.
[19:00]So that's how we would test our third, fourth and sixth cranial nerve. The next cranial nerve that we would go and test is the trigeminal nerve, which is the fifth cranial nerve.
[19:09]The fifth cranial nerve is responsible for a couple different functions. One is sensations of the face. So how would I test sensations of the face?
[19:18]Well, there's two types of sensations that I want to test. One is light touch, and the other one is more of like a pinprick type of sensation. So what I'm going to do is is I'm going to go over here and get my cotton swab and I'm going to get the broken end of my cotton tip applicator.
[19:35]And we're going to go ahead and test Q's ability to identify light touch of the face.
[19:42]So Q, what I want you to do is close your eyes. And what we're going to do is we're going to test this top division here. So Q, whenever you, I want you to tell me if you feel this, okay?
[19:50]Can you feel that, Q? Yes. Good. Can you feel this? Yes. Good. Did they feel the same on both sides? Yes. Good. So his first division V1, the ophthalmic division, he picks up light touch sensations equally on both sides.
[20:04]Now, I'm going to come down to the middle. Can you feel this, Q?
[20:07]Yes. Can you feel this? Yes. Does it feel the same? Mhm. Good. And then that's the V2 division or the maxillary and I'll come down to the mandibular V3. Can you feel this, Q?
[20:16]Yes. And can you feel this? Yes. Does it feel the same? Yep. Good. Another thing that we could do, if we really wanted to determine if he could discriminate the differences is I could go back and forth and I could say, can you tell me what this feels like? Is it a soft or cotton swab sensation or is it the pinprick sensation? We're going to defer that at this point, but that's the way that you could go about kind of determining the discrimination in this aspect. But in this case, right here, V1, V2, V3 sensations of the trigeminal nerve are beautifully intact.
[21:24]The next thing we would do is we would test the motor function, okay, which he the the trigeminal controls the mastication muscles, the muscles that are involved with chewing.
[21:32]Three primary muscles that we'll examine. The first one that we'll examine is the temporalis muscles. The second one is our masseter muscle, and then the other one's really deep called the pterygoids.
[21:40]So the first thing that we'll do is is I'm just going to go ahead and take a look at Q. I'm going to notice any asymmetry. If maybe one muscle is a little bit more hypertrophied and thicker than the other.
[21:52]And I don't notice anything obvious on this kind of examination. Then what I'll do is I'll have him clench his jaw, okay?
[21:58]When he clenches, he's going to activate two muscles, temporalis and the masseter. I just want to go ahead and palpate and see if I feel those muscles kind of like contracting. And the same thing, oh yeah, these are, he's got a jaw of steel. So when you're feeling those, you're feeling for the tone.
[22:11]And the other thing you can ask is, did it feel tender when I palpated around that area there?
[22:15]No. Good. So that means that the trigeminal nerve, which is supplying the masseter and the temporalis is working well. Next thing we'll do is the pterygoids. So with the pterygoids, what I'm going to have you do is open up your mouth and don't let me push it close.
[22:29]And that's nice and strong, uh good, uh strength against the resistance. And so the pterygoids are working well too.
[22:36]The next thing that we could do is there's the reflexes. So we could test reflexes, and one of the really, really big ones to test, especially in a comatose patient or an altered patient is what's called the corneal reflex.
[22:48]This is one of the first reflexes or first types of things on the trigeminal nerve if it's damaged to go. And so the corneal reflex, it's important to know the sensory afferent, efferent pathway.
[23:00]Afferent is going to be the trigeminal nerve. It supplies the cornea, goes into the brainstem and activates what nerve?
[23:09]In this case, it would activate the facial nerve, which would come and cause the orbicularis oculi to contract. So what I would do is I would have Q, I'd have you kind of look straight here. And what I would do is I would just come here and tap over that cornea area and it should trigger a blink. Sorry, buddy.
[23:49]Tap that area and we were able to trigger kind of a gag reflex. I won't do it again. I don't want to be mean. But I could try to do that near the tonsillar pillars on both sides or the pharynx. But either way, his gag reflex is intact.
[24:06]Now, here's something to remember. If someone has a negative gag reflex, does that mean that there is a lesion? It could, but it also may not be something that you have to worry about.
[24:16]Gag reflexes should be something that if they had it previously and they lost their gag reflex, that would be something that you want to be concerned with, but generally, someone could have a negative gag reflex and everything be totally fine.
[24:30]The next thing that we want to do is we've test the sensation of glossopharyngeal. We've tested some of the functions of the vagus. What else do we have to do? Well, the vagus nerve, we obviously know it controls the movements of the soft palate, the uvula, but it also controls the contraction of some of the muscles that are involved in swallowing or deglutition.
[24:40]You can just ask the patient to swallow. But let's be a little bit more dramatic. And we can ask the patient to sip some water to take a drink of water, and then go ahead and swallow. And again, we're just examining that, making sure that there's no difficulty in that process.
[24:50]And which Q's case, no issues. And so there is no signs of dysphagia in that case, meaning that the vagus nerve is being well propagated, there's normal action potentials down it, controlling all the deglutition process, all the muscles that are involved in swallowing.
[25:05]So in his case, no dysphagia. The other thing is that the vagus nerve not only controls the muscles of the pharynx and some of the muscles that are involved in swallowing, but it also involves the muscles of the larynx that involved in speech.
[25:19]And so one of the particular nerves is the recurrent laryngeal nerve. And so what we can do is we can just ask the patient to communicate with us. Ask them a question. Q, what brings you in today?
[25:26]I'm here for my annual physical exam.
[25:29]Good. And so just by listening to the communication between me and Q, I didn't notice any hoarseness in his voice. I don't notice any strider.
[25:39]And good communication, no aphonia or dysphonia. So the speech in this case is well intact. The other thing that I could go and do is I could test a cough reflex.
[25:47]The cough reflex is basically activating the sensory fibers of the vagus nerve, going to the brain stem, coming out via the efferent fibers of the vagus nerve. In his case, he's able to communicate, he's able to swallow. I don't really need to do that.
[26:07]But if I did ask him to cough, and he wasn't able to cough, or he had a non-explosive cough, that may make me think about something going on with that vagus nerve. Now, this is a really important test in someone who is comatose or intubated where you would want to do a cough reflex.
[26:24]And you would generally take a suction and push that down the endotracheal tube to trigger some irritation there and a cough reflex. That's very, very important in comatose or intubated patients.
[26:36]But in this case, we're just going to defer that and saying that his communication, his all the other functions of his vagus nerve were beautifully intact. So that covers our glossopharyngeal and our vagus kind of in tandem. Now, let's move on to the next one, which is the accessory nerve.
[26:50]The accessory nerve is the 11th cranial nerve, and it's primarily going to be a motor nerve. And there's two muscles that you guys want to remember.
[27:00]The first one is the sternocleidomastoid muscles, and then the other one is going to be the trapezius muscle. And what we got to do is test the strength of these muscles against resistance.
[27:12]And so what I'll do is I'll test the right style. I'll test his sternocleidomastoid, particularly we'll test his left one. So I'm going to have him look to the right. And what I'm going to do is I'm going to take my hand. I'm going to have my hand kind of palpating this muscle here. And I'm going to ask him to resist me pushing his head in the opposite direction, this way, which he is.
[27:30]This muscle is contracting really nice. And I could also palpate here and ask him, did you have any tenderness when I palpated over that area there? And I do the same thing.
[27:37]Now we're going to test the right one. So I'll have him look to the left here. Again, I take my hand here, kind of brace it, have my hand kind of on the sternocleido and have him resist that movement here. And I palpate, normal strength. He's jacked. And again, no tenderness to palpation in that area there.
[27:52]Good. And so that sternocleidomastoids are working really, really well. Next thing I could do is I could test the trapezius muscles. And so what we do is just have him shrug his shoulders. And when I shrug, have him shrug those shoulders, my job is to try to push him down and not let him push me down.
[28:09]And he had good resistance, normal strength against me trying to push down on those shoulders. And so that tells me that the accessory nerve supplying the trapezius and the sternocleidomastoids are working well. There's no weakness on those sides.
[28:23]That covers the accessory nerve. We're down to our last cranial nerve, Ninja Nerds, which is the hypoglossal nerve. The hypoglossal nerve, cranial nerve 12, is responsible for movement of the tongue.
[28:34]Now, before we even ask him to start sticking his tongue out at us and moving it all around, we just want to get a look at the tongue. Because the reason why is in certain lesions of the hypoglossal nerve, you want to determine if there's any atrophy or fasciculations, because that may be more indicative of like a lower motor neuron lesion.
[28:50]So what I'll do is I'll just have him kind of open his mouth, and I'm just going to look at that tongue. I'm going to look to see if there's any uh atrophy, hypertrophy or any fasciculations in this case, and I don't notice any. So that's good. The next thing we'll do is we'll test his ability to protrude his tongue out. So can I have you stick your tongue out?
[29:07]Good. And then I'll have you move it to the right, move it to the left. Good. And then you can go back in the mouth there. What I would be looking for is if he stuck his tongue out, and it kind of like deviated to one side.
[29:19]That may make me think about a hypoglossal nerve lesion, okay? So what I would be thinking about is, let's say it deviated towards the left in that case. I would might be thinking that maybe there's like a left hypoglossal nerve lesion, okay?
[29:33]So in this case, his tongue was midline. He was able to move it left and right. Full movements there. Beautiful. Last thing that we would do with the hypoglossal nerve is I would have him go ahead and stick his tongue in the corner of his mouth here like he's going to push it against his cheek. And I'm just going to push against it. Normal strength there. Same thing for the other side, push against it, normal strength there. And that would conclude my examination of the 12th cranial nerve, as well as all the cranial nerves in this physical exam video.
[29:58]All right, Ninja Nerds. In this video today, we talk about the cranial nerves. I hope it made sense and I hope that you guys did enjoy it.
[30:04]Also, down in the description box, please go check out our Patreon. There you guys will find all the notes that cover this physical exam in detail and you guys will be able to follow along with us as we go through to help your learning process. Also, big shout out to our man Q for being our patient today in this cranial nerve exam.
[30:20]You guys want to check him out, connect with him, we'll have a link down in the description box to his Twitch, Q Dirty Baby. All right, Ninja Nerds, we love you, we thank you, and as always, until next time.
