临床诊断学神经系统检查英文

,*,*,*,*,*,*,*,*,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,*,*,临床诊断学神经系统检查英文,SIX PARTS OF THE NEURO EXAM,Mental State & Cognitive Function,Cranial Nerves,Motor System,Sensory System,Reflexes,Autonomic function,Mental State,-Level of consciousness,NORMAL:,patient awake and alert, attentive to surrounding and to the examiner,DEPRESSED,:,Sleepy,Lethargic,Stuporous-arousing only briefly in response to pain stimulation,Comatose-not arousable by verbal and pain stimulation,Cognitive Function,A.,Memory:instant;Short term-name three common objects, then recall them again after 5 minutes; Long term-verifiable events from the past,B.,Calculations: Serial sevens: count backward from 100, taking away 7 each time. Real-life problem,C.,Orientation to person, place, and time.,Cognitive Function,D.,Aphasia:expression,reception,repeat,name,read,write,Other: Insight and judgment, concentration, patients mood, content of though, appropriateness of behavior, and so on.,MMSE,CRANIAL NERVES,CRANIAL NERVES-Olfactory (I),Ask the patient to identify common scents such as coffee,vanilla,etc, with eyes closed.,Do not use irritants. In testing olfactory nerve function, it is less important to determine whether the patient can correctly identify a particular odor than whether the presence or absence of the stimulus is perceived,CRANIAL NERVES-Optic (II),Visual Acuity-pocket card or wall chart or any reading matter such as news paper,Visual Field,Confrontation Testing-Patient and examiner stand at eye level at about arms length. Have the patient cover his own eye,Threat Testing- applied when the patient is less than fully alert or is uncooperative,Fundus ( Ophthalmoscopic ) Examination,CRANIAL NERVES-Pupillary Reflexes (II, III),A normal pupil will constrict in response to direct light, as a consensual response to light in the opposite eye, and to accommodation ( convergence to focus on a close object),CRANIAL NERVES,-Control of Extraocular Muscle Movements (III, IV, VI),Extraocular muscle movements are controlled by the oculomotor (III), trochlear ( IV), and abducens (V) nerves,Volitional Eye Movement-Follow my finger, just with your eyes. Tracing the Letter H,Ask about Diplopia,Nystagmus is rthythmic oscillation of the eyes,CRANIAL NERVES,-Trigeminal Nerve (V),Facial Sensation,Corneal Reflex-Sweep a wisp of cotton lightly across the lateral surface of the eye ( out of the direct visual field) from sclera to cornea- V, VII,Motor V Testing- Observe the symmetry of opening and closing of the mouth. Ask the patient to clench the teeth and then attempt to force jaw opening,CRANIAL NERVE,-Facial Strength (VII),Facial Symmetry-observe the patients face for symmetry of the palpebral fissures and nasolabial folds at rest. Ask the patient to wrinkle the forehead, then to squeeze the eyes tightly shut, then to smile or snarl, saying show your teeth,Supernuclear lesion,Nucleus or peripheral lesion,Bilateral Facial Weakness,CRANIAL NERVE,-Auditory (VIII),Auditory acuity can be tested crudely by rubbing thumb and forefinger together about 5cm from each ear. If the patient cannot hear the rub, proceed to the follow tests,Rinne Test-hold the base of tuning folk on the mastoid process until the sound is no longer perceived, then bring the still vibrating fork up close to the ear.,Sensorineural loss,Conductive loss,Weber Test,CRANIAL NERVE,-Auditory (VIII),Weber Test-lightly strike a tuning fork and place the handle on the midline of the forehead,Conductive loss,Sensorineural loss,Vestibular Function- need to be tested only if there are complaints dizziness or vertigo or evidence of nystagmus,Nylen-Barany( Dix-Hallpike) maneuver test for positional nystagmus,CRANIAL NERVE,-Glossopharyngeal(IX) & Vagus(X),Test the function of the palate, pharynx, and larynx,1.Palatal elevation- say “ah”,2.Gag reflex ( afferent IX, efferent X)- gently touch each side of the posterior pharyngeal wall with a cotton swab,3.Sensory function-lightly touch each side of the soft palate with the tip of a cotton swab,4. Voice quality-listen for hoarseness or “breathiness”, suggesting laryngeal weakness,CRANIAL NERVE,-Accessory (XI),Sternocleidomastoid- press a hand against the patients jaw and have the patient rotate the head against resistance. Pressing against the right jaw tests the left sternocleidomastoid and vice versa,Trapezius-have the patient shrug shoulders against resistance and assess weakness,CRANIAL NERVE,-Hypoglossal (XII),Tests for hypoglossal nerve function include the following,1.Atrophy or Fasciculations-with the patients tongue resting in the floor of the mouth, first inspect for atrophy or fasciculations. Then ask the patient to protrude the tongue, and observe for deviation to the weak side,2. Subtle Weakness-have the patient push the tongue into each cheek against external resistance(opposite hypoglossal m.),3. Subtle Dysarthria- Ask the patient to repeat difficult phrases,Sensory Function,Motor Function,运动系统,A.Muscle Strength,The classic grading system scores as follows: 5, full strength; 4, movement against gravity and 0, no contraction,运动系统,B.Muscle Tone,Decreased( floppy, flaccid, hypotonic),Normal,Increased( Spastic vs. Rigid),Cerebellar hemisphere are responsible for coordinating and fine-tuning movements (ipsilateral ),2.Rapid Alternating Movements,4. Heel-Knee-Shin,Rombergs test,is a quick and excellent screen for loss of proprioceptive feedback neuropathy or spinal cord disease,D.Involuntary movement,spasm,myoclonus,dystonia,tremor,choreic movement,athetosis,E.Others:fasciculation,myokymia,cramp,Reflexes,Light Tendon Reflexes,abdominal reflex,cremasteric reflex,plantar reflex,anal reflex,Deep Tendon Reflexes,Bicep Reflex(C5-6),Tricep Reflex ( C6-7),Patellar Reflex ( L2-4),Radial Reflex ( C5-8),Achilles ( Ankle Jerk) Reflex (S1-2),Clonus:ankle,patella,Pathologic Reflexes,Babinski Sign,Oppenheim sign,Gordon sign,Hoffmann sign,Meningeal irritation,Neck stiffness,Kernig sign,Brudzinski sign,Autonomic function,skin,sweat,Thank you!,人有了知识，就会具备各种分析能力，,明辨是非的能力。,所以我们要勤恳读书，广泛阅读，,古人说“书中自有黄金屋。,”通过阅读科技书籍，我们能丰富知识，,培养逻辑思维能力；,通过阅读文学作品，我们能提高文学鉴赏水平，,培养文学情趣；,通过阅读报刊，我们能增长见识，扩大自己的知识面。,有许多书籍还能培养我们的道德情操，,给我们巨大的精神力量，,鼓舞我们前进,。,