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Introduces self
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Confirms name & age of patient
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Explains & gains consent
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Washes hands
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Exposes & positions patient
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Asks if patient is in pain
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General inspection: asymmetry, ptosis, tremor, scars (particularly
behind ear)
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Asks patient if they have experienced any numbness/paraesthesia of
face
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Tests light touch in 3 divisions of V nerve
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Offers to test sharp touch via pin prick
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Washes hands
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Inspects muscles of mastication for weakness or fasciculations
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Palpates bulk of masseters and temporalis. Tests strength of
Pterygoids
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Offers to do corneal reflex, jaw jerk reflex
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Inspects for asymmetric wrinkling of the forehead
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Asks patient to raise eyebrows, close eyes against resistance
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Asks patient puff out cheeks against resistance and show their teeth
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Asks about changes in taste and hearing. Offers formal testing of
taste
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Performs gross hearing assessment by whispering in one ear whilst
distracting the other
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Offers to do Rinnie's and Webbers test and auroscopy
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Thanks patient and offers help to redress
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Washes hands
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Requests a full neurological exam for completion of
exam
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Summarises appropriately with only key findings
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Offers appropriate differential diagnoses
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Patient global score
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2
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Potential differentials
- CN5 - abnormalities in sensation can be caused by facial trauma or local cancer invasion
- CN7 - Bell's palsy if lower motor neurone lesion (forehead muscles affected)
- Differential Ramsay Hunt syndrome for varicella zoster
- Acoustic neuroma particularly if CN8 also affected
- Stroke if forehead muscles spared (upper motor neurone lesion)
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