神經(jīng)系統(tǒng)體查與腰椎穿刺課件

神經(jīng)系統(tǒng)體查與腰椎穿刺神經(jīng)系統(tǒng)體查與腰椎穿刺1（優(yōu)選）神經(jīng)系統(tǒng)體查與腰椎穿刺（優(yōu)選）神經(jīng)系統(tǒng)體查與腰椎穿刺2神經(jīng)系統(tǒng)體格檢查NeurologicalExamination神經(jīng)系統(tǒng)體格檢查NeurologicalExaminati3神經(jīng)系統(tǒng)體格檢查檢查順序病房臥位坐位立位門診坐位立位臥位體格檢查時檢查者一般在病人的右邊神經(jīng)系統(tǒng)體格檢查檢查順序病房臥位坐位立位4神經(jīng)系統(tǒng)體格檢查概述神經(jīng)病學研究范圍神經(jīng)系統(tǒng)疾病及骨骼肌疾病神經(jīng)系統(tǒng)疾病診斷的特點定位診斷加定性診斷定位診斷體征是重點+結(jié)合神經(jīng)解剖知識定性診斷病史+輔助檢查等神經(jīng)系統(tǒng)體格檢查概述神經(jīng)病學研究范圍神經(jīng)系統(tǒng)疾病及骨骼肌疾5神經(jīng)系統(tǒng)體格檢查一般檢查

生命體征體味或呼吸氣味發(fā)育和體形營養(yǎng)狀態(tài)面容表情體位語言、語調(diào)、語態(tài)和構(gòu)音姿勢和步態(tài)皮膚黏膜頭頸部胸腹部軀干和四肢

神經(jīng)系統(tǒng)體格檢查一般檢查生命體征6神經(jīng)系統(tǒng)體格檢查體溫

正常體溫體溫過高體溫過低

神經(jīng)系統(tǒng)體格檢查體溫正常體溫7神經(jīng)系統(tǒng)體格檢查脈搏脈搏增快細數(shù)或不規(guī)則急性顱內(nèi)壓增高心源性因素

神經(jīng)系統(tǒng)體格檢查脈搏脈搏增快8Anotherfunctionthatisimpairedinall4oftheaphasiasmentionedaboveisrepetition.Arcuatefasciculusanormallyfunctioningcerebellum.體格檢查時檢查者一般在病人的右邊Transcorticalmixedaphasiaandglobalaphasiaaresimilarexceptforthepreservationofrepetition,andresultsfromcombinedlesionsanteriortotheBrocaandWernickeareas,respectivelyAnotherfunctionthatisimpairedinall4oftheaphasiasmentionedaboveisrepetition.大腦功能的綜合表現(xiàn)，人對自身和外界環(huán)境進行認識和做出適宜反應的基礎，包括覺醒狀態(tài)和意識內(nèi)容。anormallyfunctioningcerebellum.疑蛛網(wǎng)膜下腔出血但CT不能證實時WernickeareaTheSensorySystemExaminationJackson征、下肢輕癱試驗NeurologicalExaminationconductivehearinglossthevibrationwillbelouderontheaffected其它疑顱壓異常（顱高壓、低顱壓）等Tellthepatienttosay"now"whentheycannolongerhearthevibration.Disconjugatelesionsinternuclearophthalmoplegia(INO).神經(jīng)系統(tǒng)體格檢查呼吸Kussmual呼吸淺快呼吸呼吸緩慢呼吸節(jié)律改變潮式呼吸間腦中樞神經(jīng)源性過度呼吸中腦被蓋部長吸式呼吸中腦下部和橋腦上部叢集式呼吸腦橋下部共濟失調(diào)式呼吸延髓上部Anotherfunctionthatisimpai9神經(jīng)系統(tǒng)體格檢查神經(jīng)系統(tǒng)體格檢查10神經(jīng)系統(tǒng)體格檢查血壓血壓顯著升高血壓過低神經(jīng)系統(tǒng)體格檢查血壓血壓顯著升高11神經(jīng)系統(tǒng)體格檢查體味或呼吸氣味酒味爛蘋果味肝臭味氨味或尿味大蒜味神經(jīng)系統(tǒng)體格檢查體味或呼吸氣味酒味12神經(jīng)系統(tǒng)體格檢查發(fā)育和體形發(fā)育正常胸圍、上肢展開、坐高身材矮小神經(jīng)系統(tǒng)體格檢查發(fā)育和體形發(fā)育正常胸圍、上肢展開、坐高13神經(jīng)系統(tǒng)體格檢查營養(yǎng)狀態(tài)評估檢查方法神經(jīng)系統(tǒng)體格檢查營養(yǎng)狀態(tài)評估14神經(jīng)系統(tǒng)體格檢查面容表情正常人特殊表情帕金森病神經(jīng)系統(tǒng)體格檢查面容表情正常人15腦脊液鼻漏或耳漏Anotherfunctionthatisimpairedinall4oftheaphasiasmentionedaboveisrepetition.non-visualconfirmationofposition(including頭眼反射（oculocephalicreflex）語言、語調(diào)、語態(tài)和構(gòu)音characteristicofdamagetothepons.Ocularbobbingistherhythmicalconjugatedeviationoftheeyesdownward.Transcorticalmixedaphasiaandglobalaphasiaaresimilarexceptforthepreservationofrepetition,andresultsfromcombinedlesionsanteriortotheBrocaandWernickeareas,respectively其它疑顱壓異常（顱高壓、低顱壓）等語言、語調(diào)、語態(tài)和構(gòu)音MotorSystem腦脊液鼻漏或耳漏其它疑顱壓異常（顱高壓、低顱壓）等性功能障礙的電生理檢查Wernickearea長吸式呼吸中腦下部和橋腦上部Normally,onewillhavegreaterairconductionthanboneconductionandthereforehearthevibrationlongerwiththeforkintheair.Theclinicalterm:DysmetriaMotorandsensoryfunctionsTheanklejerkreflexismediatedbytheS1nerveroot.神經(jīng)系統(tǒng)體格檢查體位自主體位被動體位強迫體位腦脊液鼻漏或耳漏神經(jīng)系統(tǒng)體格檢查體位自主體位16神經(jīng)系統(tǒng)體格檢查語言、語調(diào)、語態(tài)和構(gòu)音語言語調(diào)語音和聲調(diào)語態(tài)節(jié)奏構(gòu)音神經(jīng)系統(tǒng)體格檢查語言、語調(diào)、語態(tài)和構(gòu)音語言17神經(jīng)系統(tǒng)體格檢查姿勢與步態(tài)姿勢舉止步態(tài)行走神經(jīng)系統(tǒng)體格檢查姿勢與步態(tài)姿勢舉止18神經(jīng)系統(tǒng)體格檢查皮膚黏膜黃染、蒼白、發(fā)紺櫻紅色、潮紅多汗有機磷中毒、甲亢危象或低血糖面部黃色瘤神經(jīng)系統(tǒng)體格檢查皮膚黏膜黃染、蒼白、發(fā)紺19神經(jīng)系統(tǒng)體格檢查頭頸部頭顱部面部及五官頸部頭顱外傷眶周瘀斑鼓膜血腫腦脊液鼻漏或耳漏神經(jīng)系統(tǒng)體格檢查頭頸部頭顱部20神經(jīng)系統(tǒng)體查與腰椎穿刺課件21神經(jīng)系統(tǒng)體格檢查胸腹部胸部異常心律異常肝、脾大合并腹水腹部膨隆并壓痛神經(jīng)系統(tǒng)體格檢查胸腹部胸部異常22神經(jīng)系統(tǒng)體格檢查軀干和四肢脊柱異常翼狀肩胛、四肢、指趾畸形皮下瘤結(jié)節(jié)和牛奶咖啡斑肌束震顫撲翼樣震顫神經(jīng)系統(tǒng)體格檢查軀干和四肢脊柱異常23意識障礙檢查LevelofConsciousness意識障礙檢查LevelofConsciousness24意識障礙檢查概述大腦功能的綜合表現(xiàn)，人對自身和外界環(huán)境進行認識和做出適宜反應的基礎，包括覺醒狀態(tài)和意識內(nèi)容。覺醒狀態(tài)意識內(nèi)容意識障礙意識障礙檢查概述大腦功能的綜合表現(xiàn)，人對自身和外界環(huán)境進行25意識障礙檢查概述采集病史全身和神經(jīng)系統(tǒng)檢查意識障礙的覺醒水平意識內(nèi)容的改變意識障礙檢查概述采集病史26意識障礙檢查概述眼征疼痛刺激的反應癱瘓體征腦干反射錐體束征腦膜刺激征意識障礙檢查概述眼征27意識障礙檢查意識障礙檢查28andisindicativeofacentrallesion顱高壓有明顯視乳頭水腫和后顱窩占位病變ipsilateralmedianlongitudinalfasciculus(MLF)lesion.Coordination,GaitandRhombergTest意識內(nèi)容的改變Anotherfunctionthatisimpairedinall4oftheaphasiasmentionedaboveisrepetition.Notethechalkywhitediscwithdiscretemargins.大腦功能的綜合表現(xiàn)，人對自身和外界環(huán)境進行認識和做出適宜反應的基礎，包括覺醒狀態(tài)和意識內(nèi)容。性功能障礙的電生理檢查Anotherfunctionthatisimpairedinall4oftheaphasiasmentionedaboveisrepetition.TheanklejerkreflexismediatedbytheS1nerveroot.SensorySystem定位診斷體征是重點+結(jié)合神經(jīng)解剖知識PositionSense睫脊反射（ciliospinalreflex）Iftheboneconductionisthesameorgreaterthantheairconduction,thereisaconductivehearingimpairmentonthatside.MotorSystemDisconjugatelesionsTypeofDysphasiaRhombergTest定性診斷病史+輔助檢查等意識障礙檢查眼征瞳孔眼底眼球位置眼球運動andisindicativeofacentral29意識障礙檢查疼痛刺激反應肢體反應面部表情去皮質(zhì)強直去腦強直腦橋和延髓病變意識障礙檢查疼痛刺激反應肢體反應30意識障礙檢查癱瘓體征面癱自發(fā)活動疼痛刺激肌張力墜落試驗意識障礙檢查癱瘓體征面癱31意識障礙檢查腦干反射睫脊反射（ciliospinalreflex）角膜反射（cornealreflex）頭眼反射（oculocephalicreflex）眼前庭反射（oculovestibularreflex）意識障礙檢查腦干反射睫脊反射（ciliospinalref32意識障礙檢查呼吸形式腦膜刺激征意識障礙的其他體征意識障礙檢查呼吸形式腦膜刺激征意識障礙的其他體征33精神狀態(tài)和高級皮質(zhì)功能檢查MentalStateandCognitiveFunction精神狀態(tài)和高級皮質(zhì)功能檢查MentalStateand34精神狀態(tài)和皮質(zhì)功能概述神經(jīng)性/精神性疾病局灶性/彌漫性腦損害精神狀態(tài)高級皮質(zhì)功能檢查認知功能非認知功能精神狀態(tài)和皮質(zhì)功能概述神經(jīng)性/精神性疾病35精神狀態(tài)和皮質(zhì)功能記憶瞬時記憶短時記憶長時記憶精神狀態(tài)和皮質(zhì)功能記憶瞬時記憶36精神狀態(tài)和皮質(zhì)功能計算力時間定向力地點定向力人物定向力定向力精神狀態(tài)和皮質(zhì)功能計算力時間定向力定向力37精神狀態(tài)和皮質(zhì)功能失語口語表達流暢，語音障礙，找詞，錯語、新語等，語法障礙聽理解復述命名閱讀書寫精神狀態(tài)和皮質(zhì)功能失語口語表達流暢，語音障礙，找詞，錯語、38精神狀態(tài)和皮質(zhì)功能DamagetoBroca’sareaproducesdifficultyinspeakingDamagetoWernicke’sarearesultsindifficultyinlanguagecomprehension精神狀態(tài)和皮質(zhì)功能DamagetoBroca’sare39ArcuatefasciculusNormally,onewillhavegreaterairconductionthanboneconductionandthereforehearthevibrationlongerwiththeforkintheair.CoordinationTheclinicalterm:Dysmetria長吸式呼吸中腦下部和橋腦上部其它疑顱壓異常（顱高壓、低顱壓）等角膜反射（cornealreflex）PositionSenseRhombergTestThisfindingisimportantinthediagnosisoftranscorticalaphasias.Jackson征、下肢輕癱試驗神經(jīng)病學研究范圍神經(jīng)系統(tǒng)疾病及骨骼肌疾病Thenormalreflexistoeflexion.ThekneejerkreflexismediatedbytheL3andL4nerveroots,mainlyL4.定位診斷體征是重點+結(jié)合神經(jīng)解剖知識皮下瘤結(jié)節(jié)和牛奶咖啡斑MotorSystemThekneejerkreflexismediatedbytheL3andL4nerveroots,mainlyL4.精神狀態(tài)和皮質(zhì)功能Arcuatefasciculus精神狀態(tài)和皮質(zhì)功能40TypeofDysphasiaFluencyComprehensionNamingLocalizationBrocaNonfluentIntactImpairedBrocaareaWernickeFluentImpairedImpairedWernickeareaConductionFluentIntactImpairedArcuatefasciculusGlobalNonfluentImpairedImpairedBrocaandWernickeareasTranscorticalaphasiasAnotherfunctionthatisimpairedinall4oftheaphasiasmentionedaboveisrepetition.Thisfindingisimportantinthediagnosisoftranscorticalaphasias.WhenrepetitionispreservedinapatientwithBrocaaphasia,itsignifiestranscorticalmotoraphasia,andthelesionisanteriortotheBrocaarea.WhenrepetitionispreservedinWernickeaphasia,itiscalledtranscorticalsensoryaphasia,andthelesionisposteriortotheWernickearea.Transcorticalmixedaphasiaandglobalaphasiaaresimilarexceptforthepreservationofrepetition,andresultsfromcombinedlesionsanteriortotheBrocaandWernickeareas,respectivelyTypeofDysphasiaFluencyCompr41精神狀態(tài)和皮質(zhì)功能精神狀態(tài)和皮質(zhì)功能42精神狀態(tài)和皮質(zhì)功能精神狀態(tài)和皮質(zhì)功能43精神狀態(tài)和皮質(zhì)功能失用口頭和書面命令觀察患者執(zhí)行命令模仿動作實物演示能力精神狀態(tài)和皮質(zhì)功能失用口頭和書面命令44精神狀態(tài)和皮質(zhì)功能失認視覺失認聽覺失認觸覺失認精神狀態(tài)和皮質(zhì)功能失認視覺失認45精神狀態(tài)和皮質(zhì)功能視空間技能和執(zhí)行功能畫鐘面填數(shù)字指定時間畫出表針精神狀態(tài)和皮質(zhì)功能視空間技能和執(zhí)行功能畫鐘面46顱神經(jīng)檢查CranialNerves顱神經(jīng)檢查CranialNerves47顱神經(jīng)檢查12PairsArisefrombrainstemMotorandsensoryfunctions顱神經(jīng)檢查12Pairs48顱神經(jīng)檢查顱神經(jīng)檢查49顱神經(jīng)檢查嗅神經(jīng)特殊感覺神經(jīng)檢查方法異常表現(xiàn)和定位嗅覺喪失和減退嗅覺過敏幻嗅顱神經(jīng)檢查嗅神經(jīng)特殊感覺神經(jīng)50顱神經(jīng)檢查視神經(jīng)視力視野眼底異常表現(xiàn)和定位視力障礙和視野缺損視乳頭異常顱神經(jīng)檢查視神經(jīng)視力51顱神經(jīng)檢查顱神經(jīng)檢查52顱神經(jīng)檢查顱神經(jīng)檢查53顱神經(jīng)檢查顱神經(jīng)檢查54Papilledema.Noteswellingofthedisc,hemorrhages,andexudates,withpreservationofthephysiologiccupPapilledema.55OpticAtrophy.

Notethechalkywhitediscwithdiscretemargins.Opticatrophyisalatefindingwithincreasedintracranialpressure.OpticAtrophy.56顱神經(jīng)檢查動眼、滑車、展神經(jīng)

外觀眼球運動瞳孔及其反射異常表現(xiàn)和定位眼瞼下垂眼外肌麻痹眼球震顫瞳孔顱神經(jīng)檢查動眼、滑車、展神經(jīng)外觀57神經(jīng)系統(tǒng)體查與腰椎穿刺課件58神經(jīng)系統(tǒng)體查與腰椎穿刺課件59神經(jīng)系統(tǒng)體查與腰椎穿刺課件60神經(jīng)系統(tǒng)體查與腰椎穿刺課件61神經(jīng)系統(tǒng)體查與腰椎穿刺課件62神經(jīng)系統(tǒng)體查與腰椎穿刺課件63神經(jīng)系統(tǒng)體查與腰椎穿刺課件64Noteextra-ocularmusclepalsiesandhorizontalorverticalnystagmus.

Noteextra-ocularmusclepalsi65神經(jīng)系統(tǒng)體查與腰椎穿刺課件66神經(jīng)系統(tǒng)體查與腰椎穿刺課件67Thelimitationofmovementofbotheyesinonedirectioniscalledaconjugatelesionorgazepalsy,andisindicativeofacentrallesionitcanbeeithersupranuclear(incorticalgazecenters)ornuclear(inbrainstemgazecenters).Disconjugatelesionsinternuclearophthalmoplegia(INO).isolatedimpairmentofadductionofoneeye,nystagmusisoftenpresentipsilateralmedianlongitudinalfasciculus(MLF)lesion.Gaze-evokednystagmus(nystagmusthatisapparentonlywhenthepatientlookstothesideordown)maybecausedbymanydrugs,includingethanol,barbiturates,andphenytoin(Dilantin).Ethanolandbarbiturates(recreationalortherapuetic)arethemostcommoncauseofnystagmusThelimitationofmovementof68Ocularbobbingistherhythmicalconjugatedeviationoftheeyesdownward.characteristicofdamagetothepons.DownbeatnystagmusindicatealesioncompressingonthecervicomedullaryjunctionOcularbobbingistherhythmic69顱神經(jīng)檢查三叉神經(jīng)

混合神經(jīng)面部感覺咀嚼肌運動反射異常表現(xiàn)和定位

顱神經(jīng)檢查三叉神經(jīng)混合神經(jīng)70神經(jīng)系統(tǒng)體查與腰椎穿刺課件71神經(jīng)系統(tǒng)體查與腰椎穿刺課件72神經(jīng)系統(tǒng)體查與腰椎穿刺課件73顱神經(jīng)檢查面神經(jīng)

混合神經(jīng)面肌運動感覺反射副交感異常表現(xiàn)和定位

顱神經(jīng)檢查面神經(jīng)混合神經(jīng)74神經(jīng)系統(tǒng)體查與腰椎穿刺課件75顱神經(jīng)檢查位聽神經(jīng)

蝸神經(jīng)Rinne試驗Weber試驗前庭神經(jīng)異常表現(xiàn)和定位

顱神經(jīng)檢查位聽神經(jīng)蝸神經(jīng)76TheWebertest(256Hz).

Normally,thesoundisheardinthecenteroftheheadorequallyinbothears.

conductivehearinglossthevibrationwillbelouderontheaffectedTheWebertest(256Hz).77神經(jīng)系統(tǒng)體查與腰椎穿刺課件78TheRinnetestplacethebuttonthemastoideminencefirmly.Tellthepatienttosay"now"whentheycannolongerhearthevibration.TheRinnetest79Normally,onewillhavegreaterairconductionthanboneconductionandthereforehearthevibrationlongerwiththeforkintheair.Iftheboneconductionisthesameorgreaterthantheairconduction,thereisaconductivehearingimpairmentonthatside.Ifthereisasensineuronalhearingloss,thenthevibrationisheardsubstantiallylongerthanusualintheair.Normally,onewillhavegreate80神經(jīng)系統(tǒng)體查與腰椎穿刺課件81顱神經(jīng)檢查舌咽、迷走神經(jīng)

運動感覺味覺反射異常表現(xiàn)和定位真性球麻痹假性球麻痹迷走神經(jīng)刺激癥狀

顱神經(jīng)檢查舌咽、迷走神經(jīng)運動82神經(jīng)系統(tǒng)體查與腰椎穿刺課件83顱神經(jīng)檢查副神經(jīng)

運動神經(jīng)胸鎖乳突肌斜方肌上部

顱神經(jīng)檢查副神經(jīng)運動神經(jīng)84顱神經(jīng)檢查舌下神經(jīng)

運動神經(jīng)核下性病變核性病變核上性病變

顱神經(jīng)檢查舌下神經(jīng)運動神經(jīng)85運動系統(tǒng)檢查MotorSystem運動系統(tǒng)檢查MotorSystem86運動系統(tǒng)檢查肌容積肌張力肌力不自主運動共濟運動姿勢與步態(tài)

運動系統(tǒng)檢查肌容積87運動系統(tǒng)檢查肌容積

肌萎縮假性肥大肌肉束顫

運動系統(tǒng)檢查肌容積肌萎縮88運動系統(tǒng)檢查肌張力

肌張力減低肌張力增高

錐體系損傷

錐體外系損傷

運動系統(tǒng)檢查肌張力肌張力減低89運動系統(tǒng)檢查肌力

六級肌力記錄法肌群肌力測定單塊肌肉檢查輕癱檢查法

上肢平伸試驗、Barre分指試驗、小指征

Jackson征、下肢輕癱試驗

運動系統(tǒng)檢查肌力六級肌力記錄法90運動系統(tǒng)檢查不自主運動

舞蹈樣動作手足徐動肌束顫動肌痙攣震顫肌張力障礙運動系統(tǒng)檢查不自主運動舞蹈樣動作91運動系統(tǒng)檢查共濟運動

指鼻試驗反擊征跟－膝－脛試驗輪替試驗起坐試驗閉目難立試驗

運動系統(tǒng)檢查共濟運動指鼻試驗92Coordination,GaitandRhombergTestCoordination

RapidlyAlternatingMovementEvaluation

Dysdiadochokinesisistheclinicaltermforaninabilitytoperformrapidlyalternatingmovements.Point-to-PointMovementEvaluationTheclinicalterm:DysmetriaheeltoshincoordinationtestCoordination,GaitandRhomber93RhombergTest

Toachievebalance,apersonrequires2outofthefollowing3inputstothecortex:1.visualconfirmationofposition,2.non-visualconfirmationofposition(includingproprioceptiveandvestibularinput),and3.anormallyfunctioningcerebellum.

RhombergTest94運動系統(tǒng)檢查姿勢與步態(tài)

姿勢步態(tài)起步情況步幅速度運動系統(tǒng)檢查姿勢與步態(tài)姿勢95GaitTandemwalkingOnToesOnHeelsGaitTandemwalkingOnToesOnH96感覺系統(tǒng)檢查SensorySystem感覺系統(tǒng)檢查SensorySystem97感覺系統(tǒng)檢查感覺系統(tǒng)

淺感覺深感覺復合感覺

感覺系統(tǒng)檢查感覺系統(tǒng)淺感覺98感覺系統(tǒng)檢查淺感覺

痛覺觸覺溫度覺

感覺系統(tǒng)檢查淺感覺痛覺99TheSensorySystemExaminationPainandLightTouchSensationTheSensorySystemExamination100感覺系統(tǒng)檢查深感覺

運動覺位置覺振動覺

感覺系統(tǒng)檢查深感覺運動覺101神經(jīng)系統(tǒng)體查與腰椎穿刺課件102感覺系統(tǒng)檢查復合感覺

定位覺兩點辨別覺圖形覺實體覺感覺系統(tǒng)檢查復合感覺定位覺103PositionSense

StereognosiaGraphesthesiaExtinctionPositionSenseStereognosia104神經(jīng)系統(tǒng)體查與腰椎穿刺課件105反射檢查Reflex反射檢查Reflex106反射檢查反射檢查

深反射淺反射病理反射

反射檢查反射檢查深反射107反射檢查深反射

上肢反射下肢反射陣攣Hoffmann征Rossolimo征

反射檢查深反射上肢反射108神經(jīng)系統(tǒng)體查與腰椎穿刺課件109ThebicepsandbrachioradialisreflexesaremediatedbytheC5andC6nerveroots

ThetricepsreflexismediatedbytheC6andC7nerveroots,predominantlybyC7.ThekneejerkreflexismediatedbytheL3andL4nerveroots,mainlyL4.

TheanklejerkreflexismediatedbytheS1nerveroot.Thebicepsandbrachioradialis110Thenormalreflexistoeflexion.Ifthetoesextendandseparate,thisisanabnormalfin