🧠 Cranial Nerves

Memory Tricks

Proven Mnemonics & Acronyms — fast to learn, hard to forget.

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⭐ Most Tested

Oh, Oh, Oh, To Touch And Feel Very Good Velvet, AH!

THE 12 CRANIAL NERVES IN ORDER

Classic Mnemonic for All 12 Cranial Nerve Names

Each capitalized word gives you the first letter of each nerve: Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal.

I — Oh

Olfactory — Smell

II — Oh

Optic — Vision

III — Oh

Oculomotor — Eye movement

IV — To

Trochlear — Eye movement (superior oblique)

V — Touch

Trigeminal — Face sensation & chewing

VI — And

Abducens — Lateral eye movement

VII — Feel

Facial — Facial expression & taste

VIII — Very

Vestibulocochlear — Hearing & balance

IX — Good

Glossopharyngeal — Swallowing & taste

X — Velvet

Vagus — Heart, lungs, digestion

XI — AH

Accessory — Head/shoulder movement

XII — !

Hypoglossal — Tongue movement

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Maya runs through all 12 cranial nerves in order — 2:06.

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🃏 ⭐ Most Tested

Oh, Oh, Oh, To Touch And Feel Very Good Velvet, AH!

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🃏 Answer

I — OhOlfactory — Smell

II — OhOptic — Vision

III — OhOculomotor — Eye movement

IV — ToTrochlear — Eye movement (superior oblique)

V — TouchTrigeminal — Face sensation & chewing

VI — AndAbducens — Lateral eye movement

VII — FeelFacial — Facial expression & taste

VIII — VeryVestibulocochlear — Hearing & balance

IX — GoodGlossopharyngeal — Swallowing & taste

X — VelvetVagus — Heart, lungs, digestion

XI — AHAccessory — Head/shoulder movement

XII — !Hypoglossal — Tongue movement

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🧠 Alternative

On Old Olympus Towering Top A Fin And German Viewed Some Hops

CLASSIC ALTERNATIVE MNEMONIC

Traditional Cranial Nerve Name Mnemonic

Another widely used classic — each word starts with the first letter of a cranial nerve in order. Great for students who find the imagery of Old Olympus easier to visualize.

On — CN I

Olfactory — sense of smell

Old — CN II

Optic — vision

Olympus — CN III

Oculomotor — eye movement, pupil constriction

Towering — CN IV

Trochlear — superior oblique eye muscle

Top — CN V

Trigeminal — face sensation, chewing

A — CN VI

Abducens — lateral eye movement

Fin — CN VII

Facial — facial expression, taste anterior 2/3 tongue

And — CN VIII

Auditory/Vestibulocochlear — hearing and balance

German — CN IX

Glossopharyngeal — taste posterior 1/3, gag reflex

Viewed — CN X

Vagus — heart, lungs, GI tract, parasympathetic

Some — CN XI

Spinal Accessory — head and shoulder movement

Hops — CN XII

Hypoglossal — tongue movement

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🃏 🧠 Alternative

On Old Olympus Towering Top A Fin And German Viewed Some Hops

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🃏 Answer

On — CN IOlfactory — sense of smell

Old — CN IIOptic — vision

Olympus — CN IIIOculomotor — eye movement, pupil constriction

Towering — CN IVTrochlear — superior oblique eye muscle

Top — CN VTrigeminal — face sensation, chewing

A — CN VIAbducens — lateral eye movement

Fin — CN VIIFacial — facial expression, taste anterior 2/3 tongue

And — CN VIIIAuditory/Vestibulocochlear — hearing and balance

German — CN IXGlossopharyngeal — taste posterior 1/3, gag reflex

Viewed — CN XVagus — heart, lungs, GI tract, parasympathetic

Some — CN XISpinal Accessory — head and shoulder movement

Hops — CN XIIHypoglossal — tongue movement

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⚡ Function Type

Some Say Marry Money, But My Brother Says Big Brains Matter More

SENSORY / MOTOR / BOTH

Remember Sensory, Motor or Both for Each Nerve

S = Sensory, M = Motor, B = Both. This mnemonic gives you the function type for each nerve in order: S, S, M, M, B, M, B, S, B, B, M, M.

I — Some (S)

Olfactory — Sensory

II — Say (S)

Optic — Sensory

III — Marry (M)

Oculomotor — Motor

IV — Money (M)

Trochlear — Motor

V — But (B)

Trigeminal — Both

VI — My (M)

Abducens — Motor

VII — Brother (B)

Facial — Both

VIII — Says (S)

Vestibulocochlear — Sensory

IX — Big (B)

Glossopharyngeal — Both

X — Brains (B)

Vagus — Both

XI — Matter (M)

Accessory — Motor

XII — More (M)

Hypoglossal — Motor

📖 Full Lesson →Difficulty: Medium

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Maya decodes Sensory, Motor, or Both for all 12 cranial nerves — 2:11.

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🃏 ⚡ Function Type

Some Say Marry Money, But My Brother Says Big Brains Matter More

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🃏 Answer

I — Some (S)Olfactory — Sensory

II — Say (S)Optic — Sensory

III — Marry (M)Oculomotor — Motor

IV — Money (M)Trochlear — Motor

V — But (B)Trigeminal — Both

VI — My (M)Abducens — Motor

VII — Brother (B)Facial — Both

VIII — Says (S)Vestibulocochlear — Sensory

IX — Big (B)Glossopharyngeal — Both

X — Brains (B)Vagus — Both

XI — Matter (M)Accessory — Motor

XII — More (M)Hypoglossal — Motor

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🏛️ Visual

Memory Palace Technique

VISUAL ASSOCIATION METHOD

Place Each Nerve in a Familiar Location

Walk through a familiar place in your mind and associate each nerve with a vivid image. Olfactory (I) = old person smelling flowers at the front door. Optic (II) = giant camera lens in the hallway.

Stop 1 — Olfactory bulb

CN I — smell; enters at cribriform plate of ethmoid bone

Stop 2 — Optic chiasm

CN II — vision; partial crossing of fibers here

Stop 3 — Midbrain

CN III and IV — eye movement and pupil; trochlear exits posteriorly

Stop 4 — Pons

CN V, VI, VII, VIII — sensation, abduction, face, hearing and balance

Stop 5 — Medulla

CN IX, X, XI, XII — swallowing, vagal, shoulder, tongue

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🃏 🏛️ Visual

Memory Palace Technique

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🃏 Answer

Stop 1 — Olfactory bulbCN I — smell; enters at cribriform plate of ethmoid bone

Stop 2 — Optic chiasmCN II — vision; partial crossing of fibers here

Stop 3 — MidbrainCN III and IV — eye movement and pupil; trochlear exits posteriorly

Stop 4 — PonsCN V, VI, VII, VIII — sensation, abduction, face, hearing and balance

Stop 5 — MedullaCN IX, X, XI, XII — swallowing, vagal, shoulder, tongue

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🔗 Association

Pegword Method

RHYME & OBJECT ASSOCIATIONS

Link Each Nerve to a Rhyming Word or Object

Associate each nerve with a rhyming or visually memorable object. Olfactory = Oldman with a big nose. Facial = Face mask. Vagus = Vague, wandering traveler.

CN I — Olfactory

Smell = Olfactory; imagine smelling a peg on a clothesline

CN II — Optic

2 eyes = 2 = Optic

CN III — Oculomotor

3 = motor for most eye muscles

CN IV — Trochlear

4 looks like a fishhook — superior oblique wraps like a pulley

CN V — Trigeminal

5 fingers on face = TRIgeminal with 3 branches

CN VI — Abducens

6 = ABducens moves eye OUTward

CN VII — Facial

7 = SMILING has 7 letters = Facial nerve

CN VIII — Vestibulocochlear

8 sideways = infinity = sound waves

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🃏 🔗 Association

Pegword Method

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🃏 Answer

CN I — OlfactorySmell = Olfactory; imagine smelling a peg on a clothesline

CN II — Optic2 eyes = 2 = Optic

CN III — Oculomotor3 = motor for most eye muscles

CN IV — Trochlear4 looks like a fishhook — superior oblique wraps like a pulley

CN V — Trigeminal5 fingers on face = TRIgeminal with 3 branches

CN VI — Abducens6 = ABducens moves eye OUTward

CN VII — Facial7 = SMILING has 7 letters = Facial nerve

CN VIII — Vestibulocochlear8 sideways = infinity = sound waves

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❤️ Clinical

The Wanderer

VAGUS NERVE — CN X

Remember What the Vagus Nerve Does

Vagus means "wandering" in Latin — it wanders from the brainstem all the way to the abdomen controlling heart rate, breathing, and digestion. The longest and most influential cranial nerve.

CN X origin

Vagus = wanderer in Latin; longest cranial nerve, reaches abdomen

Heart rate

Vagus slows heart rate — vasovagal syncope = vagus overactivation

Breathing and GI

Controls swallowing, speaking, breathing depth, GI motility

Assessment

Hoarse voice + dysphagia + bradycardia = suspect vagal involvement

NCLEX tip

Bradycardia + hypotension after cervical procedure = vagal response

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🃏 ❤️ Clinical

The Wanderer

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🃏 Answer

CN X originVagus = wanderer in Latin; longest cranial nerve, reaches abdomen

Heart rateVagus slows heart rate — vasovagal syncope = vagus overactivation

Breathing and GIControls swallowing, speaking, breathing depth, GI motility

AssessmentHoarse voice + dysphagia + bradycardia = suspect vagal involvement

NCLEX tipBradycardia + hypotension after cervical procedure = vagal response

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🔺 Branches

Standing Room Only

TRIGEMINAL BRANCHES — V1, V2, V3

Remember the 3 Branches of CN V

The Trigeminal has 3 branches — Ophthalmic (V1), Maxillary (V2), Mandibular (V3). Think: top of face, middle of face, bottom of face — like three floors of a building from top to bottom.

V1 — Ophthalmic

Forehead, scalp, upper eyelid, cornea — sensation only

V2 — Maxillary

Cheek, upper lip, upper teeth, palate — sensation only

V3 — Mandibular

Lower lip, jaw, lower teeth + chewing muscles — sensation AND motor

Standing

S = sensory only for V1 and V2

Room Only

R = motor for V3 only — chewing muscles

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🃏 🔺 Branches

Standing Room Only

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🃏 Answer

V1 — OphthalmicForehead, scalp, upper eyelid, cornea — sensation only

V2 — MaxillaryCheek, upper lip, upper teeth, palate — sensation only

V3 — MandibularLower lip, jaw, lower teeth + chewing muscles — sensation AND motor

StandingS = sensory only for V1 and V2

Room OnlyR = motor for V3 only — chewing muscles

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👁️ Eye Nerves

LR6SO4 — All Others 3

EYE MOVEMENT NERVES

Which Nerves Control Eye Movements

Lateral Rectus = CN VI (Abducens). Superior Oblique = CN IV (Trochlear). All other eye muscles = CN III (Oculomotor). Eye cannot move laterally — think CN VI. Drooping eyelid — think CN III.

LR6

Lateral Rectus = CN VI Abducens — moves eye outward

SO4

Superior Oblique = CN IV Trochlear — moves eye down and inward

All Others 3

All other extraocular muscles = CN III Oculomotor

Clinical pearl

CN III palsy = eye down and out + dilated pupil + ptosis

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🃏 👁️ Eye Nerves

Eye muscles — which cranial nerve controls each?

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🃏 Answer

LR6SO4 — All Others 3

LR6Lateral Rectus = CN VI Abducens — moves eye outward

SO4Superior Oblique = CN IV Trochlear — moves eye down and inward

All Others 3All other extraocular muscles = CN III Oculomotor

Clinical pearlCN III palsy = eye down and out + dilated pupil + ptosis

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🩺 Clinical

DAFFS — Drooping, Asymmetry, Food (taste), Forehead, Salivation/Tears

CN VII (FACIAL NERVE) DAMAGE SIGNS

Bell's Palsy and CN VII — the facial nerve and what happens when it fails

CN VII controls facial expression, lacrimation, salivation, and taste (anterior 2/3 of tongue). Bell's Palsy = unilateral CN VII damage. Key signs: drooping of entire one side of face (including forehead — distinguishes peripheral from central lesion), inability to close eye, asymmetric smile, loss of taste on affected side, dry eye or excessive tearing. NCLEX tip: central (stroke) spares the forehead — peripheral (Bell's) does not. Nursing care: eye lubrication, patch at night, protect cornea.

Peripheral (Bell's)

Entire face droops including forehead — CN VII at fault

Central (Stroke)

Forehead spared — upper face has bilateral cortical input

Priority nursing

Eye care — cannot close lid, corneal abrasion risk

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🃏 🩺 Clinical

DAFFS

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🃏 Answer

DAFFS — Drooping, Asymmetry, Food (taste), Forehead, Salivation/Tears

Peripheral (Bell's)Entire face droops including forehead — CN VII at fault

Central (Stroke)Forehead spared — upper face has bilateral cortical input

Priority nursingEye care — cannot close lid, corneal abrasion risk

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👃 CN I

No smell = no CN I — anosmia after head trauma can mean skull base fracture

CN I — OLFACTORY NERVE

Olfactory nerve damage — the smell test and why it matters clinically

CN I (Olfactory) is purely sensory — smell only. Test: occlude one nostril, ask patient to identify familiar scent (coffee, vanilla) with eyes closed. Anosmia (loss of smell) after head trauma = possible cribriform plate fracture — report immediately. Also lost in: Parkinson's disease (early sign), Alzheimer's, COVID-19. Not commonly tested on NCLEX directly, but anosmia + head injury is a classic red flag. CN I does NOT travel through the brainstem — it synapses directly in the olfactory bulb.

Olfactory nerve

Only cranial nerve that bypasses the thalamus — goes directly to cortex

Anosmia

Loss of smell after head trauma = possible cribriform plate fracture — report

Testing CN I

Test each nostril separately with coffee or vanilla — not ammonia

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🃏 👃 CN I

CN I — what does loss of smell after head trauma suggest?

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🃏 Answer

No smell = no CN I — anosmia after head trauma can mean skull base fracture

Olfactory nerveOnly cranial nerve that bypasses the thalamus — goes directly to cortex

AnosmiaLoss of smell after head trauma = possible cribriform plate fracture — report

Testing CN ITest each nostril separately with coffee or vanilla — not ammonia

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👁️ CN II

PERRL — Pupils Equal, Round, Reactive to Light — tests CN II and CN III together

CN II — OPTIC NERVE & PUPIL REFLEX

The pupillary light reflex — how CN II and CN III work together and what changes mean

The pupil reflex tests two nerves: CN II carries the afferent signal (light detected), CN III carries the efferent signal (pupil constricts). Shine light in one eye — BOTH pupils should constrict (consensual reflex). Blown pupil (fixed, dilated) = CN III compression — classic sign of uncal herniation, a neurological emergency. Pinpoint pupils = opioid toxicity or pontine lesion. Unequal pupils (anisocoria) may be normal in 20% of people — compare to baseline. NCLEX: fixed dilated pupils after head injury = notify provider immediately.

Fixed & dilated

CN III compression — herniation emergency

Pinpoint

Opioids or pontine hemorrhage

Consensual reflex

Both pupils constrict when one is illuminated

PERRL normal

2–5 mm, brisk reaction, equal bilaterally

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🃏 👁️ CN II

PERRL

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🃏 Answer

PERRL — Pupils Equal, Round, Reactive to Light — tests CN II and CN III together

Fixed & dilatedCN III compression — herniation emergency

PinpointOpioids or pontine hemorrhage

Consensual reflexBoth pupils constrict when one is illuminated

PERRL normal2–5 mm, brisk reaction, equal bilaterally

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👂 CN VIII

VANNA — Vertigo, Ataxia, Nystagmus, Nausea, Acoustic loss — vestibular and cochlear signs

CN VIII — VESTIBULOCOCHLEAR NERVE

CN VIII damage — hearing loss, vertigo, and the Rinne and Weber tests

CN VIII has two branches: cochlear (hearing) and vestibular (balance). Cochlear damage: sensorineural hearing loss — common with aminoglycosides (gentamicin, tobramycin — ototoxic!), loop diuretics (furosemide), cisplatin. Vestibular damage: vertigo, nystagmus, ataxia, nausea. Rinne test: tuning fork on mastoid vs air — air conduction should be louder (AC>BC = normal). Weber test: fork on skull midline — should be equal in both ears. NCLEX: monitor hearing with ototoxic drugs. Meniere's disease = classic CN VIII vestibular disorder — tinnitus + vertigo + hearing loss.

V — Vertigo

Spinning sensation — vestibular branch damage

A — Ataxia

Unsteady gait — loss of vestibular input from inner ear

N — Nystagmus

Involuntary eye movement — hallmark of vestibular dysfunction

N — Nausea

Accompanies vertigo — CN VIII connection to vomiting center

A — Acoustic loss

Hearing loss — cochlear branch damage

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🃏 👂 CN VIII

VANNA

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🃏 Answer

VANNA — Vertigo, Ataxia, Nystagmus, Nausea, Acoustic loss — vestibular and cochlear signs

V — VertigoSpinning sensation — vestibular branch damage

A — AtaxiaUnsteady gait — loss of vestibular input from inner ear

N — NystagmusInvoluntary eye movement — hallmark of vestibular dysfunction

N — NauseaAccompanies vertigo — CN VIII connection to vomiting center

A — Acoustic lossHearing loss — cochlear branch damage

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😮 CN IX & X

Say "AHH" — CN IX and X work together for the gag reflex and swallowing

CN IX & X — GAG REFLEX & SWALLOWING

Glossopharyngeal and Vagus — the gag reflex, swallowing, and aspiration risk

CN IX (Glossopharyngeal): sensation to posterior pharynx, taste to posterior 1/3 tongue, afferent limb of gag reflex. CN X (Vagus): motor to pharynx/larynx, efferent limb of gag reflex, controls heart rate (bradycardia with stimulation), major parasympathetic nerve. Test together: touch posterior pharynx — patient should gag. Absent gag reflex = aspiration risk — sit upright for eating, thickened liquids, aspiration precautions. Vagus stimulation risk: suctioning can cause bradycardia — monitor HR during/after. Hoarse voice after thyroid or neck surgery = possible vagus or recurrent laryngeal nerve damage.

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🃏 😮 CN IX & X

Which two cranial nerves control the gag reflex and swallowing?

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🃏 Answer

Say "AHH" — CN IX and X work together for the gag reflex and swallowing

CN IX & X — GAG REFLEX & SWALLOWING

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💪 CN XI

Shrug against resistance — weak shrug = CN XI damage

CN XI — ACCESSORY NERVE

Spinal Accessory nerve — testing and what weakness means after neck surgery

CN XI (Spinal Accessory) controls the sternocleidomastoid (SCM) and trapezius muscles. Test SCM: ask patient to turn head against your resistance — note strength. Test trapezius: ask patient to shrug shoulders against downward pressure — note symmetry. Damage after: radical neck dissection, carotid endarterectomy, lymph node biopsy. Signs of damage: shoulder drop, difficulty turning head, winging of scapula, chronic shoulder pain. NCLEX relevance: post-op neck/head surgery — assess shoulder strength and symmetry. Shoulder sling or physical therapy may be needed.

Muscles controlled

Sternocleidomastoid turns head; Trapezius shrugs shoulders

Assessment

Shrug against resistance AND turn head against resistance

Damage signs

Weak shrug on affected side; difficulty turning head away from lesion

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🃏 💪 CN XI

CN XI — how do you test it, and what does damage look like?

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🃏 Answer

Shrug against resistance — weak shrug = CN XI damage

Muscles controlledSternocleidomastoid turns head; Trapezius shrugs shoulders

AssessmentShrug against resistance AND turn head against resistance

Damage signsWeak shrug on affected side; difficulty turning head away from lesion

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👅 CN XII

Stick out tongue — it deviates TOWARD the side of damage

CN XII — HYPOGLOSSAL NERVE

Hypoglossal nerve testing — tongue deviation and swallowing complications

CN XII controls all tongue movements (extrinsic and intrinsic muscles). Test: ask patient to stick out tongue — a damaged CN XII causes the tongue to deviate toward the weak (damaged) side. This is because the intact side pushes harder. Clinical relevance: stroke, ALS, brainstem tumors. Impacts speech (dysarthria) and swallowing (dysphagia) — aspiration risk. Post-stroke nursing: assess tongue symmetry before feeding. Differentiate: CN VII affects face, CN XII affects tongue. Memory trick: "the tongue falls toward the problem."

Tongue movement

Hypoglossal controls all tongue muscles

Deviation rule

Tongue deviates TOWARD the side of damage — weak side wins

Clinical

Cortical stroke (UMN): tongue deviates away from lesion, toward weak side

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🃏 👅 CN XII

CN XII — which way does the tongue deviate with damage?

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🃏 Answer

Stick out tongue — it deviates TOWARD the side of damage

Tongue movementHypoglossal controls all tongue muscles

Deviation ruleTongue deviates TOWARD the side of damage — weak side wins

ClinicalCortical stroke (UMN): tongue deviates away from lesion, toward weak side

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🧠 Neuro Assessment

GLOVES — Gag, Light reflex, Oculomotor, Vision, Extraocular, Sensation (face)

RAPID CRANIAL NERVE BEDSIDE SCREEN

Rapid bedside cranial nerve screen — what nurses assess and when to escalate

A focused CN assessment takes under 2 minutes: Vision (CN II) — can patient see fingers in each quadrant? Pupils (CN II/III) — PERRL? Eye movement (CN III/IV/VI) — follow finger in H pattern, any diplopia or nystagmus? Face sensation and symmetry (CN V/VII) — feel light touch on forehead, cheek, chin each side; smile, raise eyebrows. Hearing (CN VIII) — whisper test or finger rub. Gag and swallow (CN IX/X) — safe to eat? Tongue (CN XII) — protrude, note deviation. Document any asymmetry, new deficits, or changes from baseline — these are reportable findings in stroke, head trauma, post-op neuro patients.

G — Gag reflex

CN IX and X — present = intact brainstem at medullary level

L — Light reflex

CN II afferent and CN III efferent — pupil constricts to light

O — Oculomotor

CN III — eye moves normally, no ptosis, no blown pupil

V — Vision

CN II — visual acuity and visual fields by confrontation

E — Extraocular

CN III, IV, VI — follow my finger in H-pattern

S — Sensation

CN V — light touch and pain on forehead, cheek, jaw

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🃏 🧠 Neuro Assessment

GLOVES

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🃏 Answer

GLOVES — Gag, Light reflex, Oculomotor, Vision, Extraocular, Sensation (face)

G — Gag reflexCN IX and X — present = intact brainstem at medullary level

L — Light reflexCN II afferent and CN III efferent — pupil constricts to light

O — OculomotorCN III — eye moves normally, no ptosis, no blown pupil

V — VisionCN II — visual acuity and visual fields by confrontation

E — ExtraocularCN III, IV, VI — follow my finger in H-pattern

S — SensationCN V — light touch and pain on forehead, cheek, jaw

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CN III Damage Pattern

Down and Out — Blown Pupil

Eye points down and out · Ptosis · Fixed dilated pupil

Classic CN III (Oculomotor) Palsy Sign

When CN III is compressed (e.g., by a posterior communicating artery aneurysm or uncal herniation), the eye points "down and out" because the lateral rectus (CN VI) and superior oblique (CN IV) are unopposed. The pupil is fixed and dilated because parasympathetic fibers run on the outside of CN III and are compressed first. This is a neurological emergency.

Ptosis — levator palpebrae (eyelid lifter) is CN III

Eye down and out — only CN IV and VI still working

Fixed dilated pupil — parasympathetic fibers compressed

Blown pupil = herniation until proven otherwise — emergency

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🃏 CN III Damage Pattern

CN III damage — what does the eye look like?

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🃏 Answer

Down and Out — Blown Pupil

1Ptosis — levator palpebrae (eyelid lifter) is CN III

2Eye down and out — only CN IV and VI still working

3Fixed dilated pupil — parasympathetic fibers compressed

!Blown pupil = herniation until proven otherwise — emergency

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CN VII — Central vs Peripheral

Forehead Spared = Central (Stroke)

Forehead involved = Peripheral (Bell's) · Forehead spared = Central (Stroke)

The One CN VII Fact That Separates Good Nurses

Peripheral CN VII palsy (Bell's palsy) affects the ENTIRE face including forehead — patient can't wrinkle forehead or raise eyebrows. Central lesion (stroke) spares the forehead because it has bilateral cortical representation. So: forehead involved = peripheral; forehead spared = central. This distinction is tested repeatedly on NCLEX and in clinical practice.

Peripheral (Bell's palsy) — forehead INVOLVED, whole face droops

Central (stroke) — forehead SPARED, lower face only droops

Always test forehead wrinkling and eye closure to differentiate

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🃏 CN VII — Central vs Peripheral

Facial droop — what does a spared vs involved forehead mean?

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🃏 Answer

Forehead Spared = Central (Stroke)

PPeripheral (Bell's palsy) — forehead INVOLVED, whole face droops

CCentral (stroke) — forehead SPARED, lower face only droops

!Always test forehead wrinkling and eye closure to differentiate

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CN X — Vagus Nerve

VEST

Voice · Esophagus · Stomach · Ticker (heart rate)

The Wanderer — Controls More Than You Think

The Vagus nerve wanders from brainstem to colon — the main parasympathetic nerve of the body. Vagal stimulation drops heart rate (vasovagal syncope). Damage causes hoarseness (recurrent laryngeal branch), dysphagia, absent gag reflex, and tachycardia. Vagal stimulation (e.g., Valsalva, carotid massage, suctioning) slows HR.

Voice — recurrent laryngeal branch; damage = hoarseness

Esophagus — swallowing, peristalsis

Stomach/gut — parasympathetic GI motility control

Ticker — slows heart rate; vasovagal = Brady/syncope

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🃏 CN X — Vagus Nerve

VEST

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🃏 Answer

VVoice — recurrent laryngeal branch; damage = hoarseness

EEsophagus — swallowing, peristalsis

SStomach/gut — parasympathetic GI motility control

TTicker — slows heart rate; vasovagal = Brady/syncope

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CN VI — Abducens

ABducens ABducts — Long Course = Most Vulnerable

Lateral Rectus only · Eye turns IN when damaged · False localizing sign of high ICP

Why CN VI Palsy Means Check ICP

CN VI has a long subarachnoid course and bends sharply over the petrous apex — making it vulnerable to raised ICP. CN VI palsy = eye turns inward (medial deviation) = diplopia on lateral gaze. It's a "false localizing sign" — CN VI palsy from raised ICP doesn't mean the lesion is at CN VI nucleus itself. Always consider ICP when you see new CN VI palsy.

Only nerve to lateral rectus — abducts eye outward

Long course over petrous apex = easily stretched by raised ICP

Palsy = eye turns IN, diplopia looking to that side

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🃏 CN VI — Abducens

CN VI — what does it do, and why is it first hit by raised ICP?

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🃏 Answer

ABducens ABducts — Long Course = Most Vulnerable

!Only nerve to lateral rectus — abducts eye outward

!Long course over petrous apex = easily stretched by raised ICP

!Palsy = eye turns IN, diplopia looking to that side

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Trigeminal Neuralgia

Tic Douloureux

Sudden · Severe · Stabbing · Seconds · Triggered by light touch

The Most Painful Condition Known — CN V

Trigeminal neuralgia is described as the most severe pain in medicine — electric shock-like, lasting seconds, triggered by light touch (eating, talking, a breeze). It follows CN V branches: V1 forehead, V2 cheek, V3 jaw. First-line treatment: carbamazepine (Tegretol) — monitor CBC and liver function. Nursing priority: protect triggers, ensure nutrition since eating triggers pain.

Ophthalmic — forehead, scalp, upper eyelid

Maxillary — cheek, upper lip, upper teeth

Mandibular — lower jaw, lower teeth, tongue sensation

Carbamazepine first-line — monitor CBC, liver function

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🃏 Trigeminal Neuralgia

Tic Douloureux

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🃏 Answer

V1Ophthalmic — forehead, scalp, upper eyelid

V2Maxillary — cheek, upper lip, upper teeth

V3Mandibular — lower jaw, lower teeth, tongue sensation

RxCarbamazepine first-line — monitor CBC, liver function

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Bedside CN Screen

5-Step Rapid CN Check

Smell · See · Track · Smile/Blink · Hear

Full CN Assessment in Under 2 Minutes

A rapid bedside CN screen covers the most clinically important nerves in sequence: (1) Smell test = CN I. (2) Vision + pupil reaction = CN II + III. (3) H-pattern tracking = CN III, IV, VI. (4) Smile, raise brows, close eyes = CN V + VII. (5) Whisper test = CN VIII. Add: gag (IX/X), shrug (XI), tongue protrusion (XII) for the full 12-nerve screen.

Smell coffee/soap → CN I (Olfactory)

Read newsprint + pupil response → CN II + III

Track finger in H → CN III, IV, VI

Facial movement → CN V (sensation) + VII (motor)

Finger rub/whisper test → CN VIII (cochlear)

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🃏 Bedside CN Screen

5-Step Rapid CN Check

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🃏 Answer

1Smell coffee/soap → CN I (Olfactory)

2Read newsprint + pupil response → CN II + III

3Track finger in H → CN III, IV, VI

4Facial movement → CN V (sensation) + VII (motor)

5Finger rub/whisper test → CN VIII (cochlear)

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🎓 Common Exam Questions

Memory tricks for cranial nerves

Memory Tricks