This is why you should perform Cranial Nerve Exam

It never “stuck” with me to include this in daily clinical practice examination until I followed through with my Fellowship Program and specifically used it in a manner to rule-out conditions, specific conditions at that.

You may ask what led to performing cranial nerve exam. Here you go:

Here are the paper highlights:

Subjective

• After a patient went to chiropractor for 3 visits 1 month prior, she self-admitted to ENT office for painful swelling in jaw .
• She had several bouts of dizziness associated with turning her head to her left.
• She had bouts of light-headiness.
• She also developed loss of hearing in her left ear.

Objective

• Odd sensation with swallowing
• Marked tongue deviation to the right side with tongue protrusion

So how does this relate to Cervicogenic Dizziness?

• The subjective findings above could mean mechanical or non-mechanical source of symptoms but objective findings indicate a cranial nerve palsy response to cranial nerve testing (specifically hypoglossal and glossopharyngeal).
• Patient could have self-admitted to a physical therapy office instead of ENT, so ultimately we need to be able to fully examine someone with initial thoughts of non-mechanical symptoms unless proven otherwise.
• Positional dizziness, such as turning head to the left, are typical symptoms associated with the diagnosis of Cervicogenic Dizziness.
• Lightheadiness is a typical symptom associated with the diagnosis of Cervicogenic Dizziness.
• She had a recent minor trauma, which in this case, was a trip to the chiropractor with assumption of a manipulation performed.
  • Instead of seeing another clinician, she could have simply had a recent minor trauma from looking up, played golf, or even had a concussion or in a car accident.

Even though the authors suggest there was a correlation with chiropractic manipulation prior to patient seeing ENT, it cannot be proven that the procedure was the cause of her cranial nerve palsy. In fact, her attacks of lightheadiness and pain worsened after initial visit to the ENT, who prescribed anti-biotics!  Another post on this coming in the future.