Short answer
Toward the side of the lesion. The weak genioglossus on that side can’t push the tongue forward, so the stronger side pushes it toward the damaged nerve (a lower motor neuron sign).
Abnormal Cranial Nerve Findings
- CN III palsy: eye “down and out,” ptosis and a dilated pupil. A compressive cause is an emergency.
- CN IV palsy: trouble looking down and in, such as going down stairs.
- CN VI palsy: can’t move the eye outward, causing double vision on sideways gaze.
- Peripheral CN VII (Bell’s palsy): the whole side of the face is weak, including the forehead.
- Central (UMN) facial weakness, e.g. stroke: the lower face is weak and the forehead is spared.
- CN X lesion: the uvula deviates away from the lesion.
- CN XII lesion: the tongue deviates toward the lesion.
The cranial nerve exam is often documented alongside the mental status exam in a full neuro assessment. Nursing students will see these on the NCLEX.
USA Cranial Nerve Exam: Quick Facts
- Number of nerves
- 12 pairs
- Sensory only
- I, II, VIII
- Eye movement
- III, IV, VI
- Gag reflex
- IX (sensory) and X (motor)
- Tongue deviates
- Toward a CN XII lesion
- Uvula deviates
- Away from a CN X lesion
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