神经病学英文课件:01--Neuroexam.ppt
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神经病学英文课件:01--Neuroexam.ppt
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NeurologicalExamination,IMPORTANTCE!
Despiterecentadvancesinneuroscienceandthecontinuingdevelopmentofsensitivediagnosticprocedures,theessentialskillrequiredforthediagnosisremainstheclinicalneurologicexaminationMostneurologicdiagnosiscanbemadeonthebasisofthehistoryalone,SIXPARTSOFTHENEUROEXAM,MentalState&CognitiveFunctionCranialNervesMotorSystemSensorySystemReflexesGait,MENTALSTATUS&COGNITIVEFUNCTION,MentalStatus&CognitiveFunction-Levelofconsciousness(MentalStatus),NORMAL:
patientawakeandalert,attentivetosurroundingandtotheexaminerDEPRESSED:
SomnolenceStuporous-arousingonlybrieflyinresponsetopainstimulationComatose-notarousablebyverbalandpainstimulation,GlasgowComaScale,MentalStatus&CognitiveFunction-Cognitivefunctionchecklist,A.Orientationtoperson,place,andtime.B.Commonknowledgesuchas“whoisthepresident”C.Memory:
Shortterm-namethreecommonobjects,thenrecallthemagainafter5minutes;Longterm-verifiableeventsfromthepast,MentalStatus&CognitiveFunction-Cognitivefunctionchecklist,D.Calculations:
Serialsevens:
countbackwardfrom100,takingaway7eachtime.Real-lifeproblemE.Abstractthough:
“HowisanappledifferentfromorthesameasanorangeF.Other:
Insightandjudgment,concentration,verbalfluency,patientsmood,contentofthough,appropriatenessofbehavior,andsoon.,MMSE,MentalStatus&CognitiveFunction-Languagefunctioningcheck-up,BrocasAphasiasexpressiveaphasiasWernickesAphasiasreceptiveaphasiasConductionalAphasias,CRANIALNERVES,CRANIALNERVES-Olfactory(I),Askthepatienttoidentifycommonscentssuchascoffee,vanilla,etc,witheyesclosed.Donotuseirritants.Intestingolfactorynervefunction,itislessimportanttodeterminewhetherthepatientcancorrectlyidentifyaparticularodorthanwhetherthepresenceorabsenceofthestimulusisperceived,CRANIALNERVES-Optic(II),VisualAcuity-pocketcardorwallchartoranyreadingmattersuchasnewspaperVisualFieldConfrontationTesting-Patientandexaminerstandateyelevelataboutarmslength.HavethepatientcoverhisowneyeThreatTesting-appliedwhenthepatientislessthanfullyalertorisuncooperativeFundus(Ophthalmoscopic)Examination,CRANIALNERVES-PupillaryReflexes(II,III),Anormalpupilwillconstrict
(1)inresponsetodirectlight,
(2)asaconsensualresponsetolightintheoppositeeye,and(3)toaccommodation(convergencetofocusonacloseobject),CRANIALNERVES-ControlofExtraocularMuscleMovements(III,IV,VI),Extraocularmusclemovementsarecontrolledbytheoculomotor(III),trochlear(IV),andabducens(VI)nervesVolitionaleyemovement-followmyfinger,justwithyoureyes.TracingtheLetterHAskaboutdiplopiaNystagmusisrthythmicoscillationoftheeyes,UnilateralptosisoccursinHornerssyndrome,withasmallpupil;orinaIIIcranialnervelesion,withalargepupilandlossofadductiveandverticaleyemovement,CRANIALNERVES-TrigeminalNerve(V),FacialSensationCornealReflex-Sweepawispofcottonlightlyacrossthelateralsurfaceoftheeye(outofthedirectvisualfield)fromscleratocornea-V,VIIMotorVTesting-Observethesymmetryofopeningandclosingofthemouth.AskthepatienttoclenchtheteethandthenattempttoforcejawopeningJawjerk-briskindicatesUNL,CRANIALNERVE-FacialStrength(VII),FacialSymmetry-observethepatientsfaceforsymmetryofthepalpebralfissuresandnasolabialfoldsatrest.Askthepatienttowrinkletheforehead,thentosqueezetheeyestightlyshut,thentosmileorsnarl,sayingshowyourteethSupernuclearlesionNucleusorperipherallesionBilateralFacialWeakness,CRANIALNERVE-Auditory(VIII),Auditoryacuitycanbetestedcrudelybyrubbingthumbandforefingertogetherabout5cmfromeachear.Ifthepatientcannotheartherub,proceedtothefollowtestsRinneTest-holdthebaseoftuningfolkonthemastoidprocessuntilthesoundisnolongerperceived,thenbringthestillvibratingforkupclosetotheear.SensorineurallossConductivelossWeberTest,CRANIALNERVE-Auditory(VIII),WeberTest-lightlystrikeatuningforkandplacethehandleonthemidlineoftheforeheadConductivelossSensorineurallossVestibularFunction-needtobetestedonlyiftherearecomplaintsdizzinessorvertigoorevidenceofnystagmusNylen-Barany(Dix-Hallpike)maneuvertestforpositionalnystagmus,CRANIALNERVE-Glossopharyngeal(IX)&Vagus(X),Testthefunctionofthepalate,pharynx,andlarynx1.Palatalelevation-say“ah”2.Gagreflex(afferentIX,efferentX)-gentlytoucheachsideoftheposteriorpharyngealwallwithacottonswab3.Sensoryfunction-lightlytoucheachsideofthesoftpalatewiththetipofacottonswab4.Voicequality-listenforhoarsenessor“breathiness”,suggestinglaryngealweakness,CRANIALNERVE-Accessory(XI),Sternocleidomastoid-pressahandagainstthepatientsjawandhavethepatientrotatetheheadagainstresistance.PressingagainsttherightjawteststheleftsternocleidomastoidandviceversaTrapezius-havethepatientshrugshouldersagainstresistanceandassessweakness,CRANIALNERVE-Hypoglossal(XII),Testsforhypoglossalnervefunctionincludethefollowing1.AtrophyorFasciculations-withthepatientstonguerestinginthefloorofthemouth,firstinspectforatrophyorfasciculations.Thenaskthepatienttoprotrudethetongue,andobservefordeviationtotheweakside2.SubtleWeakness-havethepatientpushthetongueintoeachcheekagainstexternalresistance(oppositehypoglossalm.)3.SubtleDysarthria-Askthepatienttorepeatdifficultphrases,MOTORSYSTEM,MotorFunction,MuscleToneDecreased(floppy,flaccid,hypotonic)NormalIncreased(Spasticvs.Rigid)MuscleBulkAtrophy(orwithfasciculation)MuscleStrength-Theclassicgradingsystemscoresasfollows:
5,fullstrength;4,movementagainstgravityand0,nocontractionMotorCoordination&Gait,Tibialisanteriorwillbeweakinuppermotorneuronlesions,inpolyneuropathy,incommonperionealnervelesions,andinL5/S1rootlesionsduetoprolapsedintervertebraldisc,MotorCoordination&Gait,Cerebellarhemisphereareresponsibleforcoordinatingandfine-tuningmovements(ipsilateral)1.Finger-to-Nose2.RapidAlternatingMovements3.Rebound4.Heel-Knee-Shin,Rombergstestisaquickandexcellentscreenforlossofproprioceptivefeedbackneuropathyorspinalcorddisease,SENSORYSYSTEM,SensoryFunction,Large-fiber&DorsalColumnFunctionVibrationSenseJointPositionSenseRombergsTestSmall-fiber&SpinothalamicFunctionTemperatureSensationSuperficialPainSensationLightTouchSensation,Inthelesionofthesomatosensorycortexjointpositionperceptionislossbutvibrationsensationisnot,REFLEXS,Reflexes,DeepTendonReflexesBicepReflex(C5-6)TricepReflex(C7-8)Quadiceps(Patellar,KneeJerk)Reflex(L3-4)Achilles(AnkleJerk)Reflex(S1-2)PathologicReflexesBabinskiSignFrontalReleaseSignGraspSignSuckSignSnoutSignGlabellarSign,Brisktendonreflexessignifyuppermotorlesions,absencereflexesoccurinperipheralnerveornerverootlesions,AnextensorplantarorBabinskiresponseisadefiniteimmediatesignofanuppermotorneuronlesion,presentswellbeforeclonusorhyperreflexia,Ankleclonus,whensustainedorunsustainedbutofmorethansixbeatsduration,providesdefiniteevidenceforanuppermotorneuronlesion,Thankyou!
Thankyouforyourattention!
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