神经系统体查与腰椎穿刺完整版课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Page,#,中南大学,湘雅医院,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,outline,神经系统体格检查,一般检查,意识障碍检查,精神状态和高级皮质功能检查,脑神经检查,运动系统检查,感觉系统检查,反射检查,自主神经检查,腰椎穿刺,腰椎穿刺,脑脊液检查,outline神经系统体格检查,1,神经系统体格检查,Neurological Examination,神经系统体格检查Neurological Examinati,2,神经系统体格检查,检查顺序,病房：卧位,-,坐位,-,立位,门诊：坐位,-,立位,-,卧位,体格检查时检查者一般在病人的右边,神经系统体格检查检查顺序病房：卧位-坐位-立位,3,神经系统体格检查,概述,神经病学研究范围：神经系统疾病及骨骼肌疾病,神经系统疾病诊断的特点：,定位诊断,加,定性诊断,定位诊断：,体征是重点,+,结合神经解剖知识,定性诊断：病史,+,辅助检查等,神经系统体格检查概述 神经病学研究范围：神经系统疾病及骨骼肌,4,神经系统体格检查,一般检查,生命体征,体味或呼吸气味,发育和体形,营养状态,面容表情,体位,语言、语调、语态和构音,姿势和步态,皮肤黏膜,头颈部,胸腹部,躯干和四肢,神经系统体格检查一般检查 生命体征,5,神经系统体格检查,体温,正常体温,体温过高,体温过低,神经系统体格检查体温 正常体温,6,神经系统体格检查,脉搏,脉搏增快,细数或不规则,急性颅内压增高,心源性因素,神经系统体格检查脉搏脉搏增快,7,神经病学研究范围：神经系统疾病及骨骼肌疾病,Ethanol and barbiturates (recreational or therapuetic) are the most common cause of nystagmus,Mental State and Cognitive Function,Motor and sensory functions,The knee jerk reflex is mediated by the L3 and L4 nerve roots, mainly L4.,conductive hearing loss the vibration will be louder on the affected,常规：性状、细胞数、潘迪试验,Broca and Wernicke areas,Jackson征、下肢轻瘫试验,定位诊断：体征是重点+结合神经解剖知识,Comprehension,It is an indicative of an UMN lesion,Downbeat nystagmus indicate a lesion compressing on the cervicomedullary junction,When repetition is preserved in a patient with Broca aphasia, it signifies transcortical motor aphasia, and the lesion is anterior to the Broca area.,Rapidly Alternating Movement Evaluation,The biceps and brachioradialis reflexes are mediated by the C5 and C6 nerve roots,翼状肩胛、四肢、指趾畸形,共济失调式呼吸：延髓上部,颅内感染：脑膜炎、脑炎,神经系统体格检查,呼吸,Kussmual,呼吸,浅快呼吸,呼吸缓慢,呼吸节律改变,潮式呼吸：间脑,中枢神经源性过度呼吸：中脑被盖部,长吸式呼吸：中脑下部和桥脑上部,丛集式呼吸：脑桥下部,共济失调式呼吸：延髓上部,神经病学研究范围：神经系统疾病及骨骼肌疾病神经系统体格检查呼,8,神经系统体格检查,神经系统体格检查,9,神经系统体格检查,血压,血压显著升高,血压过低,神经系统体格检查血压血压显著升高,10,Dysdiadochokinesis is the clinical term for an inability to perform rapidly alternating movements.,The Weber test(256Hz).,Jackson征、下肢轻瘫试验,internuclear ophthalmoplegia (INO).,If the bone conduction is the same or greater than the air conduction, there is a conductive hearing impairment on that side.,If the bone conduction is the same or greater than the air conduction, there is a conductive hearing impairment on that side.,The Weber test(256Hz).,皮肤皮下黄韧带硬膜外腔硬脊膜硬膜下腔蛛网膜蛛网膜下腔,Arise from brain stem,颅内感染：脑膜炎、脑炎,Lumbar Puncture,Rhomberg Test,穿刺部位：L3-4，L4-5,Jackson征、下肢轻瘫试验,Normally, the sound is heard in the center of the head or equally in both ears.,常规：性状、细胞数、潘迪试验,isolated impairment of adduction of one eye, nystagmus is often present,Broca and Wernicke areas,Level of Consciousness,Rapidly Alternating Movement Evaluation,语言、语调、语态和构音,area results in,神经系统体格检查,体味或呼吸气味,酒味,烂苹果味,肝臭味,氨味或尿味,大蒜味,Dysdiadochokinesis is the clin,11,神经系统体格检查,发育和体形,发育正常：胸围、上肢展开、坐高,身材矮小,神经系统体格检查发育和体形发育正常：胸围、上肢展开、坐高,12,神经系统体格检查,营养状态,评估,检查方法,神经系统体格检查营养状态评估,13,神经系统体格检查,面容表情,正常人,特殊表情：帕金森病,神经系统体格检查面容表情正常人,14,神经系统体格检查,体位,自主体位,被动体位,强迫体位,神经系统体格检查体位自主体位,15,神经系统体格检查,语言、语调、语态和构音,语言,语调：语音和声调,语态：节奏,构音,神经系统体格检查语言、语调、语态和构音语言,16,神经系统体格检查,姿势与步态,姿势：举止,步态：行走,神经系统体格检查姿势与步态姿势：举止,17,神经系统体格检查,皮肤黏膜,黄染、苍白、发绀,樱红色、潮红,多汗：有机磷中毒、甲亢危象或低血糖,面部黄色瘤,神经系统体格检查皮肤黏膜黄染、苍白、发绀,18,神经系统体格检查,头颈部,头颅部,面部及五官,颈部,头颅外伤：,眶周瘀斑,鼓膜血肿,脑脊液鼻漏或耳漏,神经系统体格检查头颈部头颅部,19,神经系统体查与腰椎穿刺完整版课件,20,神经系统体格检查,胸腹部,胸部异常,心律异常,肝、脾大合并腹水,腹部膨隆并压痛,神经系统体格检查胸腹部胸部异常,21,Mental State and Cognitive Function,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,Jackson征、下肢轻瘫试验,颅内感染：脑膜炎、脑炎,意识内容的改变,proprioceptive and vestibular input), and,眼前庭反射（oculovestibular reflex）,Broca and Wernicke areas,意识内容的改变,Jackson征、下肢轻瘫试验,口语表达：流畅，语音障碍，找词，错语、新语等，语法障碍,If the toes extend and separate, this is an abnormal finding called a positive Babinskis sign.,共济失调式呼吸：延髓上部,定位诊断：体征是重点+结合神经解剖知识,The Weber test(256Hz).,Downbeat nystagmus indicate a lesion compressing on the cervicomedullary junction,Rapidly Alternating Movement Evaluation,a normally functioning cerebellum.,性功能障碍的电生理检查,视空间技能和执行功能,Level of Consciousness,精神状态和高级皮质功能检查,神经系统体格检查,躯干和四肢,脊柱异常,翼状肩胛、四肢、指趾畸形,皮下瘤结节和牛奶咖啡斑,肌束震颤,扑翼样震颤,Mental State and Cognitive Fun,22,意识障碍检查,Level of Consciousness,意识障碍检查Level of Consciousness,23,意识障碍检查,概述,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,觉醒状态,意识内容,意识障碍,意识障碍检查概述 大脑功能的综合表现，人对自身和外界环境进行,24,意识障碍检查,概述,采集病史,全身和神经系统检查,意识障碍的觉醒水平,意识内容的改变,意识障碍检查概述 采集病史,25,意识障碍检查,概述,眼征,疼痛刺激的反应,瘫痪体征,脑干反射,锥体束征,脑膜刺激征,意识障碍检查概述 眼征,26,意识障碍检查,意识障碍检查,27,意识障碍检查,眼征,瞳孔,眼底,眼球位置,眼球运动,意识障碍检查眼征 瞳孔,28,意识障碍检查,疼痛刺激反应,肢体反应,面部表情,去皮质强直,去脑强直,脑桥和延髓病变,意识障碍检查疼痛刺激反应 肢体反应,29,意识障碍检查,瘫痪体征,面瘫,自发活动,疼痛刺激,肌张力,坠落试验,意识障碍检查瘫痪体征面瘫,30,意识障碍检查,脑干反射,睫脊反射（,ciliospinal reflex,）,角膜反射（,corneal reflex,）,头眼反射（,oculocephalic reflex,）,眼前庭反射（,oculovestibular reflex,）,意识障碍检查脑干反射睫脊反射（ciliospinal ref,31,意识障碍检查,呼吸形式,脑膜刺激征,意识障碍的其他体征,意识障碍检查呼吸形式脑膜刺激征意识障碍的其他体征,32,精神状态和高级皮质功能检查,Mental State and Cognitive Function,精神状态和高级皮质功能检查Mental State and,33,常规：性状、细胞数、潘迪试验,意识障碍的觉醒水平,Rapidly Alternating Movement Evaluation,共济失调式呼吸：延髓上部,穿刺部位：L3-4，L4-5,Coordination,Wernicke area,Rhomberg Test,Autonomic Nerve,Tandem walking,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,ipsilateral median longitudinal fasciculus (MLF) lesion.,定位诊断：体征是重点+结合神经解剖知识,Graphesthesia,The Weber test(256Hz).,精神状态和高级皮质功能检查,Downbeat nystagmus indicate a lesion compressing on the cervicomedullary junction,Dysdiadochokinesis is the clinical term for an inability to perform rapidly alternating movements.,The Rinne test,The knee jerk reflex is mediated by the L3 and L4 nerve roots, mainly L4.,精神状态和高级皮质功能检查,Localization,精神状态和皮质功能,概述,神经性,/,精神性疾病,局灶性,/,弥漫性脑损害,精神状态,高级皮质功能检查,认知功能,非认知功能,常规：性状、细胞数、潘迪试验精神状态和皮质功能概述 神经性/,34,精神状态和皮质功能,记忆,瞬时记忆,短时记忆,长时记忆,精神状态和皮质功能记忆 瞬时记忆,35,精神状态和皮质功能,计算力,时间定向力,地点定向力,人物定向力,定向力,精神状态和皮质功能计算力 时间定向力定向力,36,精神状态和皮质功能,失语,口语表达：流畅，语音障碍，找词，错语、新语等，语法障碍,听理解,复述,命名,阅读,书写,精神状态和皮质功能失语 口语表达：流畅，语音障碍，找词，错语,37,精神状态和皮质功能,Damage to Brocas area produces,difficulty in speaking,Damage to Wernickes,area results in,difficulty in language,comprehension,精神状态和皮质功能Damage to Brocas are,38,精神状态和皮质功能,精神状态和皮质功能,39,Localization,Naming,Comprehension,Fluency,Type of Dysphasia,Broca area,Impaired,Intact,Nonfluent,Broca,Wernicke area,Impaired,Impaired,Fluent,Wernicke,Arcuate fasciculus,Impaired,Intact,Fluent,Conduction,Broca and Wernicke areas,Impaired,Impaired,Nonfluent,Global,Transcortical aphasias,Another function that is impaired in all 4 of the aphasias mentioned above is repetition,.,This finding is important in the diagnosis of transcortical aphasias,.,When repetition is preserved in a patient with Broca aphasia, it signifies transcortical motor aphasia, and the lesion is anterior to the Broca area,.,When repetition is preserved in Wernicke aphasia, it is called transcortical sensory aphasia, and the lesion is posterior to the Wernicke area,.,Transcortical mixed aphasia and global aphasia are similar except for the preservation of repetition, and results from combined lesions anterior to the Broca and Wernicke areas, respectively,LocalizationNamingComprehensio,40,The Sensory System Examination,When repetition is preserved in a patient with Broca aphasia, it signifies transcortical motor aphasia, and the lesion is anterior to the Broca area.,精神状态和高级皮质功能检查,Rhomberg Test,Arise from brain stem,Transcortical mixed aphasia and global aphasia are similar except for the preservation of repetition, and results from combined lesions anterior to the Broca and Wernicke areas, respectively,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,Rhomberg Test,Graphesthesia,Wernicke area,脑脊液鼻漏或耳漏,语言、语调、语态和构音,Motor and sensory functions,Papilledema.,Ocular bobbing is the rhythmical conjugate deviation of the eyes downward.,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,proprioceptive and vestibular input), and,神经病学研究范围：神经系统疾病及骨骼肌疾病,The limitation of movement of both eyes in one direction is called a conjugate lesion or gaze palsy,area results in,Mental State and Cognitive Function,Jackson征、下肢轻瘫试验,精神状态和皮质功能,The Sensory System Examination,41,精神状态和皮质功能,精神状态和皮质功能,42,精神状态和皮质功能,失用,口头和书面命令,观察患者,执行命令,模仿动作,实物演示能力,精神状态和皮质功能失用 口头和书面命令,43,精神状态和皮质功能,失认,视觉失认,听觉失认,触觉失认,精神状态和皮质功能失认 视觉失认,44,精神状态和皮质功能,视空间技能和执行功能,画钟面,填数字,指定时间画出表针,精神状态和皮质功能视空间技能和执行功能 画钟面,45,颅神经检查,Cranial Nerves,颅神经检查Cranial Nerves,46,颅神经检查,12 Pairs,Arise from brain stem,Motor and sensory functions,颅神经检查12 Pairs,47,颅神经检查,颅神经检查,48,颅神经检查,嗅神经,特殊感觉神经,检查方法,异常表现和定位,嗅觉丧失和减退,嗅觉过敏,幻嗅,颅神经检查嗅神经 特殊感觉神经,49,颅神经检查,视神经,视力,视野,眼底,异常表现和定位,视力障碍和视野缺损,视乳头异常,颅神经检查视神经 视力,50,颅神经检查,颅神经检查,51,颅神经检查,颅神经检查,52,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,共济失调式呼吸：延髓上部,Note the chalky white disc with discrete margins.,ipsilateral median longitudinal fasciculus (MLF) lesion.,If the bone conduction is the same or greater than the air conduction, there is a conductive hearing impairment on that side.,Jackson征、下肢轻瘫试验,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,侧脑室脉络丛产生经室间孔进入三脑室中脑导水管四脑室经四脑室正中孔、两个侧孔进入蛛网膜下腔和脑池脑穹窿表面的蛛网膜颗粒吸收上矢状窦窦汇横窦乙状窦颈内静脉,non-visual confirmation of position (including,ipsilateral median longitudinal fasciculus (MLF) lesion.,This finding is important in the diagnosis of transcortical aphasias.,conductive hearing loss the vibration will be louder on the affected,Extinction,侧脑室脉络丛产生经室间孔进入三脑室中脑导水管四脑室经四脑室正中孔、两个侧孔进入蛛网膜下腔和脑池脑穹窿表面的蛛网膜颗粒吸收上矢状窦窦汇横窦乙状窦颈内静脉,Normally, the sound is heard in the center of the head or equally in both ears.,长吸式呼吸：中脑下部和桥脑上部,Broca and Wernicke areas,Normally, the sound is heard in the center of the head or equally in both ears.,Ocular bobbing is the rhythmical conjugate deviation of the eyes downward.,Pain and Light Touch Sensation,Coordination,精神状态和高级皮质功能检查,颅神经检查,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应,53,Papilledema.,Note swelling of the disc, hemorrhages, and exudates, with preservation of the physiologic cup,Papilledema.,54,Optic Atrophy.,Note the chalky white disc with discrete margins. Optic atrophy is a late finding with increased intracranial pressure.,Optic Atrophy.,55,颅神经检查,动眼、滑车、展神经,外观,眼球运动,瞳孔及其反射,异常表现和定位,眼睑下垂,眼外肌麻痹,眼球震颤,瞳孔,颅神经检查动眼、滑车、展神经 外观,56,神经系统体查与腰椎穿刺完整版课件,57,神经系统体查与腰椎穿刺完整版课件,58,神经系统体查与腰椎穿刺完整版课件,59,神经系统体查与腰椎穿刺完整版课件,60,神经系统体查与腰椎穿刺完整版课件,61,性功能障碍的电生理检查,The Sensory System Examination,神经病学研究范围：神经系统疾病及骨骼肌疾病,发育正常：胸围、上肢展开、坐高,侧脑室脉络丛产生经室间孔进入三脑室中脑导水管四脑室经四脑室正中孔、两个侧孔进入蛛网膜下腔和脑池脑穹窿表面的蛛网膜颗粒吸收上矢状窦窦汇横窦乙状窦颈内静脉,Normally, the sound is heard in the center of the head or equally in both ears.,area results in,internuclear ophthalmoplegia (INO).,共济失调式呼吸：延髓上部,The Weber test(256Hz).,精神状态和高级皮质功能检查,Tell the patient to say now when they can no longer hear the vibration.,共济失调式呼吸：延髓上部,Extinction,Autonomic Nerve,Pain and Light Touch Sensation,The Weber test(256Hz).,The Rinne test,丛集式呼吸：脑桥下部,中枢神经源性过度呼吸：中脑被盖部,皮肤皮下黄韧带硬膜外腔硬脊膜硬膜下腔蛛网膜蛛网膜下腔,ipsilateral median longitudinal fasciculus (MLF) lesion.,性功能障碍的电生理检查,62,神经系统体查与腰椎穿刺完整版课件,63,Note extra-ocular muscle palsies and horizontal or vertical nystagmus.,Note extra-ocular muscle palsi,64,神经系统体查与腰椎穿刺完整版课件,65,神经系统体查与腰椎穿刺完整版课件,66,The limitation of movement of both eyes in one direction is called a conjugate lesion or gaze palsy,and is indicative of a central lesion,it can be either supranuclear (in cortical gaze centers) or nuclear (in brain stem gaze centers).,Disconjugate lesions,internuclear ophthalmoplegia (INO).,isolated impairment of adduction of one eye, nystagmus is often present,ipsilateral median longitudinal fasciculus (MLF) lesion.,Gaze-evoked nystagmus (nystagmus that is apparent only when the patient looks to the side or down) may be caused by many drugs, including ethanol, barbiturates, and phenytoin (Dilantin). Ethanol and barbiturates (recreational or therapuetic) are the most common cause of nystagmus,The limitation of movement of,67,Ocular bobbing is the rhythmical conjugate deviation of the eyes downward.,characteristic of damage to the pons.,Downbeat nystagmus,indicate a lesion compressing on the cervicomedullary junction,Ocular bobbing is the rhythmic,68,颅神经检查,三叉神经,混合神经,面部感觉,咀嚼肌运动,反射,异常表现和定位,颅神经检查三叉神经 混合神经,69,神经系统体查与腰椎穿刺完整版课件,70,神经系统体查与腰椎穿刺完整版课件,71,其它：疑颅压异常（颅高压、低颅压）等,Disconjugate lesions,Jackson征、下肢轻瘫试验,This finding is important in the diagnosis of transcortical aphasias.,and is indicative of a central lesion,Mental State and Cognitive Function,Note extra-ocular muscle palsies and horizontal or vertical nystagmus.,Tell the patient to say now when they can no longer hear the vibration.,定位诊断：体征是重点+结合神经解剖知识,characteristic of damage to the pons.,脑脊液鼻漏或耳漏,共济失调式呼吸：延髓上部,Ocular bobbing is the rhythmical conjugate deviation of the eyes downward.,脑脊液鼻漏或耳漏,Downbeat nystagmus indicate a lesion compressing on the cervicomedullary junction,定性诊断：病史+辅助检查等,排尿障碍的尿道动力学检查,语言、语调、语态和构音,Papilledema.,Rhomberg Test,神经病学研究范围：神经系统疾病及骨骼肌疾病,病房：卧位-坐位-立位,其它：疑颅压异常（颅高压、低颅压）等,72,颅神经检查,面神经,混合神经,面肌运动,感觉,反射,副交感,异常表现和定位,颅神经检查面神经 混合神经,73,神经系统体查与腰椎穿刺完整版课件,74,颅神经检查,位听神经,蜗神经,Rinne,试验,Weber,试验,前庭神经,异常表现和定位,颅神经检查位听神经 蜗神经,75,The Weber test(256Hz).,Normally, the sound is heard in the center of the head or equally in both ears.,conductive hearing loss the vibration will be louder on the affected,The Weber test(256Hz).,76,神经系统体查与腰椎穿刺完整版课件,77,The Rinne test,place the butt on the mastoid eminence firmly. Tell the patient to say now when they can no longer hear the vibration.,The Rinne test,78,Normally, one will have greater air conduction than bone conduction and therefore hear the vibration longer with the fork in the air.,If the bone conduction is the same or greater than the air conduction, there is a conductive hearing impairment on that side,.,If there is a sensineuronal hearing loss, then the vibration is heard substantially longer than usual in the air.,Normally, one will have greate,79,神经系统体查与腰椎穿刺完整版课件,80,颅神经检查,舌咽、迷走神经,运动,感觉,味觉,反射,异常表现和定位,真性球麻痹,假性球麻痹,迷走神经刺激症状,颅神经检查舌咽、迷走神经 运动,81,神经系统体查与腰椎穿刺完整版课件,82,颅神经检查,副神经,运动神经,胸锁乳突肌,斜方肌上部,颅神经检查副神经 运动神经,83,定位诊断：体征是重点+结合神经解剖知识,Coordination,Jackson征、下肢轻瘫试验,视空间技能和执行功能,Lumbar Puncture,The Sensory System Examination,Localization,Tell the patient to say now when they can no longer hear the vibration.,Localization,侧脑室脉络丛产生经室间孔进入三脑室中脑导水管四脑室经四脑室正中孔、两个侧孔进入蛛网膜下腔和脑池脑穹窿表面的蛛网膜颗粒吸收上矢状窦窦汇横窦乙状窦颈内静脉,internuclear ophthalmoplegia (INO).,Ocular bobbing is the rhythmical conjugate deviation of the eyes downward.,Rapidly Alternating Movement Evaluation,颅内感染：脑膜炎、脑炎,大脑功能的综合表现，人对自身和外界环境进行认识和做出适宜反应的基础，包括觉醒状态和意识内容。,头眼反射（oculocephalic reflex）,Stereognosia,常规：性状、细胞数、潘迪试验,Ocular bobbing is the rhythmical conjugate deviation of the eyes downward.,常规：性状、细胞数、潘迪试验,This finding is important in the diagnosis of transcortical aphasias.,共济失调式呼吸：延髓上部,颅神经检查,舌下神经,运动神经,核下性病变,核性病变,核上性病变,定位诊断：体征是重点+结合神经解剖知识颅神经检查舌下神经 运,84,运动系统检查,Motor System,运动系统检查Motor System,85,运动系统检查,肌容积,肌张力,肌力,不自主运动,共济运动,姿势与步态,运动系统检查肌容积,86,运动系统检查,肌容积,肌萎缩,假性肥大,肌肉束颤,运动系统检查肌容积 肌萎缩,87,运动系统检查,肌张力,肌张力减低,肌张力增高,锥体系损伤,锥体外系损伤,运动系统检查肌张力 肌张力减低,88,运动系统检查,肌力,六级肌力记录法,肌群肌力测定,单块肌肉检查,轻瘫检查法,上肢平伸试验、,Barre,分指试验、小指征,Jackson,征、下肢轻瘫试验,运动系统检查肌力 六级肌力记录法,89,运动系统检查,不自主运动,舞蹈样动作,手足徐动,肌束颤动,肌痉挛,震颤,肌张力障碍,运动系统检查不自主运动 舞蹈样动作,90,运动系统检查,共济运动,指鼻试验,反击征,跟膝胫试验,轮替试验,起坐试验,闭目难立试验,运动系统检查共济运动 指鼻试验,91,Coordination, Gait and Rhomberg Test,Coordination,Rapidly Alternating Movement Evaluation,Dysdiadochokinesis is the clinical term for an inability to perform rapidly alternating movements.,Point-to-Point Movement Evaluation,The clinical term: Dysmetria,heel to shin coordination test,Coordination, Gait and Rhomber,92,Rhomberg Test,To achieve balance, a person requires 2 out of the following 3 inputs to the cortex:,1. visual confirmation of position,2. non-visual confirmation of position (including,proprioceptive and vestibular input), and,3. a normally functioning cerebellum.,Rhomberg Test,93,运动系统检查,姿势与步态,姿势,步态,起步情况,步幅,速度,运动系统检查姿势与步态 姿势,94,Gait,Tandem walking,On Toes,On Heels,Gait Tandem walkingOn ToesOn H,95,感觉系统检查,Sensory System,感觉系统检查Sensory System,96,感觉系统检查,感觉系统,浅感觉,深感觉,复合感觉,感觉系统检查感觉系统 浅感觉,97,感觉系统检查,浅感觉,痛觉,触觉,温度觉,感觉系统检查浅感觉 痛觉,98,The Sensory System Examination,Pain and Light Touch Sensation,The Sensory System Examination,99,感觉系统检查,深感觉,运动觉,位置觉,振动觉,感觉系统检查深感觉 运动觉,100,神经系统体查与腰椎穿刺完整版课件,101,感觉系统检查,复合感觉,定位觉,两点辨别觉,图形觉,实体觉,感觉系统检查复合感觉 定位觉,102,Position Sense,Stereognosia,Graphesthesia,Extinction,Position Sense Stereognosia,103,神经系统体查与腰椎穿刺完整版课件,104,反射检查,Reflex,反射检查Reflex,105,反射检查,反射检查,深反射,浅反射,病理反射,反射检查反射检查 深反射,106,反射检查,深反射,上肢反射,下肢反射,阵挛,Hoffmann,征,Rossolimo,征,反射检查深反射 上肢反射,107,神经系统体查与腰椎穿刺完整版课件,108,The biceps and brachioradialis reflexes are mediated by the C5 and C6 nerve roots,The triceps reflex is mediated by the C6 and C7 nerve roots, predominantly by C7.,The knee jerk reflex is mediated by the L3 and L4 nerve roots, mainly L4.,The ankle jerk reflex is mediated by the S1 nerve root.,The biceps and brachioradialis,109,The normal reflex is toe flexion. If the toes extend and separate, this is an abnormal finding called a positive Babinskis sign. It is an indicative of an UMN lesion,A positive Hoffman response is indicative of an upper motor neuron lesion affecting the upper extremity in question,.,Finally, test clonus,The normal reflex is toe flexi,110,反射检查,浅反射,腹壁反射,提睾反射,跖反射,肛门反射,反射检查浅反射 腹壁反射,111,反射检查,病理反射,巴彬斯基征,巴彬斯基等位征,强握反射,脊髓自主反射,反射检查病理反射 巴彬斯基征,112,神经系统体查与腰椎穿刺完整版课件,113,神经系统体查与腰椎穿刺完整版课件,114,神经系统体查与腰椎穿刺完整版课件,115,脑膜刺激征检查,Meninges,脑膜刺激征检查Meninges,116,脑膜刺激征,脑膜刺激征,屈颈试验,克匿格征,布鲁津斯基征,脑膜刺激征脑膜刺激征 屈颈试验,117,神经系统体查与腰椎穿刺完整版课件,118,自主神经检查,Autonomic Nerve,自主神经检查Autonomic Nerve,119,自主神经检查,自主神经,一般检查,内脏及括约肌功能,自主神经反射,自主神经实验检查,自主神经检查自主神经 一般检查,120,自主神经检查,一般检查,皮肤黏膜,毛发和指甲,出汗,瞳孔,自主神经检查一般检查 皮肤黏膜,121,自主神经检查,内脏及括约肌功能,胃肠功能,排尿障碍及性质,膀胱区膨胀程度,自主神经检查内脏及括约肌功能 胃肠功能,122,自主神经检查,自主神经反射,竖毛试验,皮肤划痕试验,眼心反射,自主神经检查自主神经反射 竖毛试验,123,自主神经检查,自主神经实验检查,卧立位试验,汗腺分泌,性功能障碍的电生理检查,排尿障碍的尿道动力学检查,自主神经检查自主神经实验检查 卧立位试验,124,腰椎穿刺,Lumbar Puncture,腰椎穿刺Lumbar Puncture,125,一、脑脊液循环,侧脑室脉络丛产生,经室间孔进入三脑室,中脑导水管,四脑室,经四脑室正中孔、两个侧孔进入蛛网膜下腔和脑池,脑穹窿表面的蛛网膜颗粒吸收,上矢状窦,窦汇,横窦,乙状窦,颈内静脉,一、脑脊液循环侧脑室脉络丛产生经室间孔进入三脑室中脑,126,二、腰椎穿刺,解剖,皮肤,皮下,黄韧带,硬膜外腔,硬脊膜,硬膜下腔,蛛网膜,蛛网膜下腔,二、腰椎穿刺解剖,127,神经系统体查与腰椎穿刺完整版课件,128,神经系统体查与腰椎穿刺完整版课件,129,1,、适应症,颅内感染：脑膜炎、脑炎,疑蛛网膜下腔出血但,CT,不能证实时,脊髓病变,格林,-,巴利综合征,鞘内给药,脊髓造影,其它：疑颅压异常（颅高压、低颅压）等,1、适应症 颅内感染：脑膜炎、脑炎,130,2,、禁忌症,颅高压有明显视乳头水肿和后颅窝占位病变,穿刺部位有化脓性感染或脊椎结核,血液系统疾病有出血倾向，血小板,50000/mm3,2、禁忌症颅高压有明显视乳头水肿和后颅窝占位病变,131,3,、并发症,腰穿后头痛：低颅压,出血：损伤,感染,脑疝,3、并发症腰穿后头痛：低颅压,132,4,、操作方法,体位：侧卧、屈颈抱膝，背部与床垂直,穿刺部位：,L3-4,，,L4-5,步骤：消毒,铺无菌巾,局麻,进针,成功，拔出针芯，测压，必要时压颈试验,取脑脊液,将针芯放回，拔针,消毒，无菌纱布覆盖,术后平卧,4-6,小时,4、操作方法 体位：侧卧、屈颈抱膝，背部与床垂直,133,5,、脑脊液检查,压力：,80-180mmH2O,压颈试验,常规：性状、细胞数、潘迪试验,生化：蛋白质、糖、氯化物,三大染色和病毒学检测,寄生虫检查,细胞学检查,5、脑脊液检查 压力：80-180mmH2O,134,神经系统体查与腰椎穿刺完整版课件,135,谢谢！,谢谢！,136,神经系统体格检查,血压,血压显著升高,血压过低,神经系统体格检查血压血压显著升高,神经系统体格检查,语言、语调、语态和构音,语言,语调：语音和声调,语态：节奏,构音,神经系统体格检查语言、语调、语态和构音语言,意识障碍检查,疼痛刺激反应,肢体反应,面部表情,去皮质强直,去脑强直,脑桥和延髓病变,意识障碍检查疼痛刺激反应 肢体反应,神经系统体查与腰椎穿刺完整版课件,The Weber test(256Hz).,Normally, the sound is heard in the center of the head or equally in both ears.,conductive hearing loss the vibration will be louder on the affected,The Weber test(256Hz).,运动系统检查,肌力,六级肌力记录法,肌群肌力测定,单块肌肉检查,轻瘫检查法,上肢平伸试验、,Barre,分指试验、小指征,Jackson,征、下肢轻瘫试验,运动系统检查肌力 六级肌力记录法,反射检查,浅反射,腹壁反射,提睾反射,跖反射,肛门反射,反射检查浅反射 腹壁反射,自主神经检查,一般检查,皮肤黏膜,毛发和指甲,出汗,瞳孔,自主神经检查一般检查 皮肤黏膜,