![]() Scrunch up eyes (try to prise each open in turn with your thumbs).Inspect: forehead wrinkles, nasolabial folds, angles of mouth for facial asymmetry.Others: ‘I would also consider testing the corneal reflex (afferent = CN 5 efferent = CN 7) and jaw jerk (afferent and efferent = CN 5).’.Ask them to open the jaw against resistance. Motor: ask the patient to clench their jaw and feel the bulk of the temporalis and masseter muscles.Ask the patient to tell you when they feel it and if it feels the same on each side. With the patient’s eyes closed, use a cotton wool ball ± a neurological pin to test sensation over the ophthalmic, maxillary and mandibular distributions of the trigeminal nerve. Sensory: ask the patient if they have any areas of pins and needles or numbness.Inspect: temporalis/masseter muscle wasting.If pupils become more dilated when the light is shone in one eye, then that eye is less sensitive to light and, hence, there is a relative afferent pupillary defect in that eye ( partial optic nerve lesion on that side). Swinging light test: swing the light between the two eyes – the pupil size should stay the same regardless of which eye the light is shone in.Efferent defect (affected pupil is persistently dilated, whilst other is reactive to light being shone in either eye) = CN3 lesion.pupils are symmetrical but when light is shone in the affected eye, neither pupil constricts) = CN2 (optic nerve) lesion Observe for direct and consensual papillary constriction. Shine the light at each pupil in turn from about 45°. Direct and consensual papillary reflexes: in a dimmed room, ask the patient to hold an open hand between their eyes and focus on a distant point in the room. ![]() Pupils should constrict and eyes should converge. ![]()
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