醫(yī)學(xué)課件圖解神經(jīng)科查體

1、Preparing the patient and the physician 1Six basic tools The reflex hammer The 256 hertz tuning fork The ophthalmoscope Visual acuity card A large Q-tip Soap 2The reflex hammer3The 256 hertz tuning fork the 512 is better for auditory evaluation the 126 is optimal for vibratory examinationthe 256 her

2、tz fork is adequate for an initial examination of both modalities 4Visual acuity cardHand held card Snellen chart 5Q-tips6General Appearance Mental Status Examination Testing Cranial Nerves Sensation Examination Motor Examination Deep Tendon Reflexes Examination Coordination Examination 7General App

3、earance Level of consciousness Personal Hygiene and Dress Posture and Motor Activity Height, Build and Weight Vital Signs 8vital sign acquisition 9Mental Status Examination 10Examination of the Cranial Nerves I - Smell II - Visual acuity, visual fields and ocular fundi II,III - Pupillary reactions I

4、II,IV,VI - Extra-ocular movements, including opening of the eyes V - Facial sensation, movements of the jaw, and corneal reflexes VII - Facial movements and gustation VIII - Hearing and balance IX,X - Swallowing, elevation of the palate, gag reflex and gustation V,VII,X,XII - Voice and speech XI - S

5、hrugging the shoulders and turning the head XII - Movement and protrusion of tongue 11Cranial Nerve I 12Cranial Nerve II 13Normal findings14Pathology found on opthalmologic examination 1Papilledema Optic Atrophy 15Pathology found on opthalmologic examination 2Central Retinal Artery Occlusion Central

6、 Retinal Vein Occlusion 16Pathology found on opthalmologic examination 3Proliferative Diabetic Retinopathy Cytomegalovirus Retinitis 17Cranial Nerves II and III 18Cranial Nerves III, IV and VI 19 Right CN3 Lesion left CN6 lesion 20CN3 palsyRight CN3 Lesion21CN6 palsyleft CN6 lesion 22Horners sign23A

7、dies pupilRecovered ability to focus up close24Cranial Nerve V 25Cranial Nerve V26Cranial Nerve VII 27Cranial Nerve VII28 Cranial Nerve VIICentral paralysisRight central CN7 dysfunction 29Cranial Nerve VIIPeripheral paralysisLeft peripheral CN7 dysfunction 30Jaw Jerk 31Cranial Nerve VIII32Cranial Ne

8、rves IX and X 33normalLeft CN9 Dysfunction 34Cranial Nerve XI 35Cranial Nerve XII 36 Cranial Nerve XIItongue deviationLeft CN 12 Dysfunction Lower Motor Neuron Syndrome37Dysarthria Pa： CN7Ka：CN10La：CN1238The Motor System Examination body positioninginvoluntary movementsthe appearance or muscularity

9、of the muscle (wasted, highly developed, normal). muscle tonemuscle strength . 39AppearanceWinging of scapula40muscle strengthParesis：weakness, partial loss of movement, or impaired movement .Paralysis (- Plegia) ：complete loss of muscle function for one or more muscle groups41 The major muscle grou

10、psThe deltoid muscleC5 the axillary nerve 42The major muscle groupsShoulder Abduction 43 The major muscle groupsShoulder Adduction C 5 thru T1 the Pectoralis Major the Latissiumus 44 Pronator45 The biceps muscle C5 and C6 the musculocutaneous nerve Elbow Flexion 46 The triceps muscle C6 and C7 the r

11、adial nerve Elbow Extension 47 The wrist extensors C6 and C7 the radial nerve Wrist flexion C 7, 8, T 1 the Median and Ulnar Nerves 48 Finger flexion C8 the median nerve49 Finger abduction T1 the ulnar nerve 50Finger adduction 51 Thumb opposition C8 and T1 the median nerve52 Hip flexion L2 and L3 th

12、e femoral nerve 53 Adduction of the hip L2, L3 and L454 Hip Abduction L4, L5 and S1 55 Hip extension L4 and L5 the gluteal nerve56 Knee extension L3 and L4 the femoral nerve 57 Knee flexion L5 and S1 the sciatic nerve58 Ankle dorsiflexion L4 and L5 the peroneal nerve 59Ankle plantar flexion S1 and S

13、2 the tibial nerve60 move the large toe up towards the patients face L5 61The Sensory System Examination Pain sensation (pin prick)Light touch sensation (brush)Position senseStereognosiaGraphesthesiaExtinction. 62 Pain and Light Touch Sensation 63The corresponding nerve root for each area 1. posteri

14、or 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. tip of the pinky finger (C8)7. thorax, nipple level (T5)8. thorax, umbilical level (T10)9. upper part of the upper leg (L2)10. low

15、er-medial part of the upper leg (L3)11. medial lower leg (L4)12. lateral lower leg (L5)13. sole of foot (S1)64 Position Sense 65vibratory sensation 66 Stereognosia67 Graphesthesia68 Extinction69Deep Tendon Reflexes4+ Very brisk, hyperreflexive, with clonus 3+ Brisker or more reflexive than normally

16、2+ Normal 1+ Low normal, diminished 0 No response 70 Deep Tendon Reflexes The biceps and brachioradialis reflexes C5 and C6 71 The triceps reflex C6 and C7 , predominantly by C772 The Brachioradialis Reflex 73 The knee jerk reflex L3 and L4 , mainly L4 74 The ankle jerk reflex S1 75Ankle clonus 76Pa

17、tella clonus 77Hoffman response78Abdorminal reflex79Cremasteric reflex L1 and L2 80 Babinskis sign 81Chaddocks reflex The plantar reflex (Chaddock)82Oppenheim sign 83Gordensign 84Primitive reflex Glabellar reflex Palmomental reflex Suckling reflex Snouting reflex Grasp reflex 85 CoordinationRapidly

18、Alternating Movement Evaluation 86 Coordinationfinger-to-nose testheel-knee-tibia test87tandem gait 88tandem gait89 CoordinationRomberg Test 90Meningeal irritation neck stiffness 91Meningeal irritationKernigs test Lasegues Test 92Meningeal irritationBrudzinskis test 93GaitParkinsons94 rising from the sitting position 95The Examination of a Comatose or Stuporous Patient Glascow Coma Scale I. Motor Response