neurologic disorders
How to Assess the Cranial Nerves
9th and 10th Cranial nerves
The 9th (glossopharyngeal) and 10th (vagus) cranial nerves are usually evaluated together. Whether the palate elevates symmetrically when the patient says "ah" is noted. If one side is paretic, the uvula is lifted away from the paretic side. A tongue blade can be used to touch one side of the posterior pharynx, then the other, and symmetry of the gag reflex is observed; bilateral absence of the gag reflex is common among healthy people and may not be significant. In an unresponsive, intubated patient, suctioning the endotracheal tube normally triggers coughing. If hoarseness is noted, the vocal cords are inspected. Isolated hoarseness (with normal gag and palatal elevation) should prompt a search for lesions (eg, mediastinal lymphoma, aortic aneurysm) compressing the recurrent laryngeal nerve. 