医学课件图解神经科查体.ppt

1、1Preparing the patient and the physician 2Six basic tools nThe reflex hammer nThe 256 hertz tuning fork nThe ophthalmoscope nVisual acuity card nA large Q-tip nSoap 3The reflex hammer4The 256 hertz tuning fork nthe 512 is better for auditory evaluation nthe 126 is optimal for vibratory examinationnt

2、he 256 hertz fork is adequate for an initial examination of both modalities 5Visual acuity cardnHand held card Snellen chart 6Q-tips7nGeneral Appearance nMental Status Examination nTesting Cranial Nerves nSensation Examination nMotor Examination nDeep Tendon Reflexes Examination nCoordination Examin

3、ation 8General Appearance nLevel of consciousness nPersonal Hygiene and Dress nPosture and Motor Activity nHeight, Build and Weight nVital Signs 9vital sign acquisition 10Mental Status Examination 11Examination of the Cranial Nerves nI - Smell nII - Visual acuity, visual fields and ocular fundi nII,

4、III - Pupillary reactions nIII,IV,VI - Extra-ocular movements, including opening of the eyes nV - Facial sensation, movements of the jaw, and corneal reflexes nVII - Facial movements and gustation nVIII - Hearing and balance nIX,X - Swallowing, elevation of the palate, gag reflex and gustation nV,VI

5、I,X,XII - Voice and speech nXI - Shrugging the shoulders and turning the head nXII - Movement and protrusion of tongue 12Cranial Nerve I 13Cranial Nerve II 14Normal findings15Pathology found on opthalmologic examination 1nPapilledema nOptic Atrophy 16Pathology found on opthalmologic examination 2nCe

6、ntral Retinal Artery Occlusion nCentral Retinal Vein Occlusion 17Pathology found on opthalmologic examination 3nProliferative Diabetic Retinopathy nCytomegalovirus Retinitis 18Cranial Nerves II and III 19Cranial Nerves III, IV and VI 20 nRight CN3 Lesion nleft CN6 lesion 21CN3 palsynRight CN3 Lesion

7、22CN6 palsy left CN6 lesion 23Horners sign24Adies pupilnRecovered ability to focus up close25Cranial Nerve V 26Cranial Nerve V27Cranial Nerve VII 28Cranial Nerve VII29 Cranial Nerve VIInCentral paralysisnRight central CN7 dysfunction 30Cranial Nerve VIInPeripheral paralysisnLeft peripheral CN7 dysfu

8、nction 31Jaw Jerk 32Cranial Nerve VIII33Cranial Nerves IX and X 34nnormalnLeft CN9 Dysfunction 35Cranial Nerve XI 36Cranial Nerve XII 37 Cranial Nerve XIIntongue deviationnLeft CN 12 Dysfunction Lower Motor Neuron Syndrome38Dysarthria nPa： CN7nKa：CN10nLa：CN1239The Motor System Examination nbody posi

9、tioningninvoluntary movementsnthe appearance or muscularity of the muscle (wasted, highly developed, normal). nmuscle tonenmuscle strength . 40AppearancenWinging of scapula41muscle strengthnParesis：weakness, partial loss of movement, or impaired movement .nParalysis (- Plegia) ：complete loss of musc

10、le function for one or more muscle groups42 The major muscle groupsnThe deltoid musclenC5 nthe axillary nerve 43The major muscle groups Shoulder Abduction 44 The major muscle groupsnShoulder Adduction nC 5 thru T1 nthe Pectoralis Major nthe Latissiumus 45 nPronator46 nThe biceps muscle nC5 and C6 nt

11、he musculocutaneous nerve nElbow Flexion 47 nThe triceps muscle nC6 and C7 nthe radial nerve nElbow Extension 48 nThe wrist extensors nC6 and C7 nthe radial nerve nWrist flexion nC 7, 8, T 1 nthe Median and Ulnar Nerves 49 nFinger flexion nC8 nthe median nerve50 nFinger abduction nT1 nthe ulnar nerv

12、e 51 Finger adduction 52 nThumb opposition nC8 and T1 nthe median nerve53 nHip flexion nL2 and L3 nthe femoral nerve 54 nAdduction of the hip nL2, L3 and L455 nHip Abduction nL4, L5 and S1 56 nHip extension nL4 and L5 nthe gluteal nerve57 nKnee extension nL3 and L4 nthe femoral nerve 58 nKnee flexio

13、n nL5 and S1 nthe sciatic nerve59 nAnkle dorsiflexion nL4 and L5 nthe peroneal nerve 60nAnkle plantar flexion nS1 and S2 nthe tibial nerve61 nmove the large toe up towards the patients face nL5 62The Sensory System Examination nPain sensation (pin prick)nLight touch sensation (brush)nPosition sensen

14、StereognosianGraphesthesianExtinction. 63 Pain and Light Touch Sensation 64The corresponding nerve root for each area n1. posterior aspect of the shoulders (C4)2. lateral aspect of the upper arms (C5) 3. medial aspect of the lower arms (T1)4. tip of the thumb (C6)5. tip of the middle finger (C7)6. t

15、ip of the pinky finger (C8)7. thorax, nipple level (T5)8. thorax, umbilical level (T10)9. upper part of the upper leg (L2)10. lower-medial part of the upper leg (L3)11. medial lower leg (L4)12. lateral lower leg (L5)13. sole of foot (S1)65 nPosition Sense 66nvibratory sensation 67 nStereognosia68 nG

16、raphesthesia69 nExtinction70Deep Tendon Reflexes4+ Very brisk, hyperreflexive, with clonus 3+ Brisker or more reflexive than normally 2+ Normal 1+ Low normal, diminished 0 No response 71 Deep Tendon Reflexes nThe biceps and brachioradialis reflexes nC5 and C6 72 nThe triceps reflex nC6 and C7 , pred

17、ominantly by C773 nThe Brachioradialis Reflex 74 nThe knee jerk reflex nL3 and L4 , mainly L4 75 nThe ankle jerk reflex nS1 76Ankle clonus 77Patella clonus 78Hoffman response79Abdorminal reflex80Cremasteric reflex nL1 and L2 81 Babinskis sign 82Chaddocks reflex nThe plantar reflex (Chaddock)83Oppenh

18、eim sign 84Gorden sign 85Primitive reflex nGlabellar reflex nPalmomental reflex nSuckling reflex nSnouting reflex nGrasp reflex 86 CoordinationnRapidly Alternating Movement Evaluation 87 Coordinationnfinger-to-nose testnheel-knee-tibia test88tandem gait 89tandem gait90 CoordinationnRomberg Test 91Me

19、ningeal irritation nneck stiffness 92Meningeal irritationnKernigs test Lasegues Test 93Meningeal irritationnBrudzinskis test 94GaitnParkinsons95 nrising from the sitting position 96The Examination of a Comatose or Stuporous Patient Glascow Coma Scale I. Motor Response 6 - Obeys commands fully 5 - Lo

20、calizes to noxious stimuli 4 - Withdraws from noxious stimuli 3 - Abnormal flexion, i.e. decorticate posturing 2 - Extensor response, i.e. decerebrate posturing 1 - No responseII. Verbal Response 5 - Alert and Oriented 4 - Confused, yet coherent, speech 3 - Inappropriate words, and jarbled phrases consisting of words 2 - Incomprehensible sounds 1 - No soundsIII. Eye Opening 4 - Spontaneous eye opening 3 - Eyes open to speech 2 - Eyes open to pain 1 - No eye openingGlascow Coma Scale = I + II + III. A lower score indicates a deeper coma and a poorer prognosis.97Thank you!