Neurological Examination-课件.pptx
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Neurological Examination-课件.pptx
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NeurologicalExamination,Consciousness&HighCorticalfunction,Consciousness,Consciouslevel:
(GCS,drowsiness,AscendingReticularactivatingsystem(ARAS):
upperbrainstemtegmentumandmidlineandintralaminarnucleiofthethalamus,Corticalandsubcorticalstructure,GlasgowComaScale,OrientationPersonPlaceTime,Whattodowhensmelledsmokeintheater?
Orientation&Judgement,Immediatememory&Digitspan:
Normalsevenforward,fivebackwardRecentmomoryRecallthreeitemsorabriefstoryafteradelayof3to5minuteshistoricalorverifiablepersonalevents,Memory,Calculation(1007)x7times(20-3)x5timesAdjusttopremorbid姚明比馬英九高,且馬英九比陳水扁高,誰最高?
甚麼叫覆水難收?
車子跟飛機有甚麼共通點嗎?
你覺得空位該填甚麼:
AZBYCXD_?
Calculation&Abstractthinking,Cranialnerve,選擇有特定氣味,例如:
肥皂,薄荷,香煙及一有刺激性的物品,如ammonia.將這些物品置於相似瓶中,請病人指明這些氣味.一鼻孔受試時另一鼻孔應用手遮擋.Normal:
allidentifiedOnlyrecognisedAmmonia:
CNIimpaired,CNVpartlyintactAllnotrecognised:
Notorganic,CranialnerveI:
Olfactorynerve,exophthalmosorenophthalmosSize,outlineLightreflex請病人眼直視前方,CranialnerveII:
Opticnerve,Wallorhandchart(SnellensmovementlightRefractiveerror:
Ifacuityimprovedpinholecard,CranialnerveII:
Opticnerve,Saccade(Frontal)FrontalgazecentertoPPRF(paramedianforrapideyemovementstoviewnewPursuit(Occipitallobe)Convergence(Midbrain)Vestibulo-ocularreflex(Cerebellarvestibularnuclei),CranialnerveIII:
OculomotornerveCranialnerveIV:
TrochlearNerveCranialnerveVI:
AbducensNerve,PositionSaccadePursuit握一筆於病人前50cm在空氣中劃一個大大的ConvergenceVestibulo-ocularreflex(Cerebellarvestibularnuclei),CranialnerveIII&IV&VI,Extraocularmovement,Inspection:
看有無肌肉消瘦(temporal&masseter請病人把下巴張開,觀察下巴有無偏向某邊Palpation:
讓病人把下巴張開,手放在下巴施力將下巴闔上,Cranialnervev:
Trigeminalnerve,Inspection:
看臉是否對稱,觀察nasolabialfolds,及兩邊嘴角frontalis)-請說:
一嗚-用力鼓起臉頰(看Palpation:
請病人用力閉緊你的雙眼,CranialnervevII:
Facialnerve,Inspection:
看臉是否對稱,觀察nasolabialfolds,及兩邊嘴角frontalis)-請說:
一嗚-用力鼓起臉頰(看Palpation:
請病人用力閉緊你的雙眼,CranialnervevII:
Facialnerve,CranialnervevIII:
Vestibulocochlearnerve,Webertest,Ifdysarthriaissuspected,Pa:
若此類聲音有異常,應為顏面肌肉無力“Ta:
若此類聲音有異常,應為舌下神經病變Ka:
若此類聲音有異常應為迷走神經病變dysphagia,Gagreflex,CranialnerveIX:
GlossopharyngealNerveCranialnerveX:
VagusNerve,觀察Trapeziusmuscle有無-請病人用力聳肩,沒有哪一邊比較無力。
Sternocleidomastoidmuscle,CranialnerveXI:
AccessoryNerve,Atrophyorfasciculation-請病人把舌頭伸出來,看有沒有deviationside),CranialnerveXII:
HypoglossalNerve,Motor,Observation觀察病人Postures、一邊肩膀低等,有沒有InvoluntarymovementsInspection,Palpation,Muscletonetesting(ModifiedAshworthScale,MAS)NoincreaseintoneSlightincreaseintone,minimaloftheROM1+Slightincreaseintone,minimal,Musclestrength,DeltoidmuscleC5,PronatorDrift,BicepsmuscleC5andC6nerve,TricepsmuscleC6andC7nerverootsnerve.,WristextensorsareinnervatedC6andC7nerverootsviatheradial,FingerflexionC8nerve,FingerabductionorfanninginnervatedT1nerveroottheulnar,ThumboppositionisinnervatedtheC8andT1nerverootsvia,L2,HipflexionandL3nerveroots,AbductionofthehiptheL4,L5andS1,HipextensionisinnervatedbyL4andL5nerverootsvia,KneeextensionL3andL4nerveroots,AnkledorsiflexiontheL4andL5nerverootsperoneal,AnkleplantarflexionisinnervatedbytheS1andS2nerverootsvia,ExtensorhalucislongusL5nerveroot,MusclePower,5,5,5,55,Reflex,Deeptendonreflex,BicepsandbrachioradialisreflexesareC5andC6nerve,TricepsreflexismediatedbytheC6andC7nerveroots,predominantly,PositiveHoffmanresponseuppermotorneuronlesion,KneejerkreflexL3andL4Pendular,AnklejerkreflexismediatedbyS1nerveroot.,PositiveBabinskissignuppermotorneuron,DeepTendonReflex,+,+,+,Sensory,Sensory,評估感覺系統應包含:
震動覺(Vibration)and位置覺(Proprioception)-Posteriorcolumn痛覺(Pain)and溫度覺(Temperature)-Spinothalamictract(Lighttouch)-(DiscriminativeSensations),Pain,Lighttouch,Jointpositionsense,Discrimination,Stereognosia,Graphesthesia,Coordination,Coordination,SensoryfeedbackMotoroutputVestibularsystem,Coordination,Armbounce:
請病人手臂平舉,檢查者施予一股向下的力量,當力量消失時,病人手臂呈現上下擺動的現象。
Finger-nosetest:
Dysmetria,intentionaltremorHeel-shin-kneetest:
cerebellarorsensoryataxiaPastpointing:
RapidalternatingmovementDysdiadochokinesia,Coordination,Rombergtest睜眼和閉眼都搖晃cerebellar睜眼正常,閉眼搖晃(positiveproprioceptivedeficit(sensoryTandemgait:
Thankyouforyourattention!
Unconsciouspatient,NEandPE
(1),LightreflexCorneareflex,Dollseye,Gagreflex,BrainstemsignsareakeytolocalizationofthelesionincomaComaassociatedwithnormalbrainstemfunctionindicateswidespreadandbilateralhemispheraldecreaseordysfunction,),NEandPE
(2),Pupil:
Oneenlarged,unreactiveorpoorlesionorherniationSmallreactivepupil(1-2.5mm)hydrocephalusVerysmallreactivepupil(1mm),NEandPE(3),Respiratorypattern:
Slowbreathing:
opiateintoxication,hypothyroidism,NEandPE(4),Respiratorypattern:
Cheyne-stokesbreathing:
CHF,COPDDeep,bilateralhemispheral,NEandPE(5),Bloodpressure:
Hypertension(crisis):
HerpertensivehydrocephalusHypotension:
MI,seps
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