Chapter 26 - Part E: Cranial Nerves & The Two Reflexes Everyone Confuses: Menace vs PLR

In this BoardsCast episode, we continue our deep dive into Tobias Chapter 26: Neurologic Examination & Neuroanatomic Diagnosis, focusing on cranial nerve testing and the two most commonly misunderstood neurologic responses: the menace response and the pupillary light reflex (PLR).

These two tests look similar — bright light, hand wave, eyeball reaction — but they assess completely different pathways. And boards LOVE to exploit that.

You’ll learn:

• The functional roles of all 12 cranial nerves (in surgeon-friendly language)
• How to perform and interpret each cranial nerve test
• Why the menace and PLR rarely “match” — and why that's normal
• What afferent/efferent pathways each reflex evaluates
• How to use discordant findings to localize forebrain, brainstem, retinal, or nerve lesions
• The classic exam traps and how to avoid mislocalization

If you've ever mixed up which reflex needs a cortex or why a blind dog still has a normal PLR — this episode fixes that forever.

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