Patient Problems - Response from the Clinical Expert

The patient from problem one would not require a cranial nerve examination as part of an initial evaluation.

The patient from problem two would require a cranial nerve examination as part of an initial evaluation. My rationale is based on the presence or absence of possible neurological signs or symptoms and the knowledge that even soft symptoms or a mechanism indicative of central neurogenic involvement minimally suggests the need to perform a screening of cranial nerves. In the case of patient case number two, the patient reported that he hit his head during the fall and had a headache and “muscle pain in the back of the neck” at the time of the fall.

In general terms and based on my clinical experience, general medical symptoms such as lethargy, headaches, or dizziness, if associated with cranial nerve abnormalities, may suggest brain stem dysfunction, and the need for comprehensive examination is identified.

The attached document contains my abbreviated list of the most common neurological signs and symptoms that clinicians should pay attention to and that necessitate targeted examination.