1、The Precise Neurological Exam,原创：哈佛医学院 制作：杜万良 2011.2.25,1,Preparing the patient and the physician,2,Six basic tools,The reflex hammer The 256 hertz tuning fork The ophthalmoscope Visual acuity card A large Q-tip Soap,3,The reflex hammer,4,The 256 hertz tuning fork,the 512 is better for auditory eval
2、uation the 126 is optimal for vibratory examination the 256 hertz fork is adequate for an initial examination of both modalities,5,Visual acuity card,Hand held card,6,Snellen chart,Q-tips,7,General Appearance Mental Status Examination Testing Cranial Nerves Sensation Examination Motor Examination De
3、ep Tendon Reflexes Examination Coordination Examination,8,General Appearance,Level of consciousness Personal Hygiene and Dress Posture and Motor Activity Height, Build and Weight Vital Signs,9,vital sign acquisition,10,Mental Status Examination,11,Examination of the Cranial Nerves,I - Smell II - Vis
4、ual acuity, visual fields and ocular fundi II,III - Pupillary reactions III,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 t
5、he palate, gag reflex and gustation V,VII,X,XII - Voice and speech XI - Shrugging the shoulders and turning the head XII - Movement and protrusion of tongue,12,Cranial Nerve I,13,Cranial Nerve II,14,Normal findings,15,Pathology found on opthalmologic examination 1,Papilledema,Optic Atrophy,16,Pathol
6、ogy found on opthalmologic examination 2,Central Retinal Artery Occlusion,Central Retinal Vein Occlusion,17,Pathology found on opthalmologic examination 3,Proliferative Diabetic Retinopathy,Cytomegalovirus Retinitis,18,Cranial Nerves II and III,19,Cranial Nerves III, IV and VI,20,Right CN3 Lesion,le
7、ft CN6 lesion,21,CN3 palsy,Right CN3 Lesion,22,CN6 palsy,23,left CN6 lesion,Horners sign,24,Adies pupil,25,Recovered ability to focus up close,Cranial Nerve V,26,Cranial Nerve V,27,Cranial Nerve VII,28,Cranial Nerve VII,29,Cranial Nerve VII,Central paralysis Right central CN7 dysfunction,30,Cranial
8、Nerve VII,Peripheral paralysis Left peripheral CN7 dysfunction,31,Jaw Jerk,32,Cranial Nerve VIII,33,Cranial Nerves IX and X,34,normal,Left CN9 Dysfunction,35,Cranial Nerve XI,36,Cranial Nerve XII,37,Cranial Nerve XII,tongue deviation Left CN 12 Dysfunction,38,Lower Motor Neuron Syndrome,Dysarthria,“
9、Pa“： CN7 “Ka“：CN10 “La“：CN12,39,The Motor System Examination,body positioning involuntary movements the appearance or muscularity of the muscle (wasted, highly developed, normal). muscle tone muscle strength .,40,Appearance,41,Winging of scapula,muscle strength,Paresis：weakness, partial loss of move
10、ment, or impaired movement . Paralysis (- Plegia) ：complete loss of muscle function for one or more muscle groups,42,The major muscle groups,The deltoid muscle C5 the axillary nerve,43,The major muscle groups,44,Shoulder Abduction,The major muscle groups,Shoulder Adduction C 5 thru T1 the Pectoralis
11、 Major the Latissiumus,45,Pronator,46,The biceps muscle C5 and C6 the musculocutaneous nerve,Elbow Flexion,47,The triceps muscle C6 and C7 the radial nerve,Elbow Extension,48,The wrist extensors C6 and C7 the radial nerve,Wrist flexion C 7, 8, T 1 the Median and Ulnar Nerves,49,Finger flexion C8 the
12、 median nerve,50,Finger abduction T1 the ulnar nerve,51,52,Finger adduction,Thumb opposition C8 and T1 the median nerve,53,Hip flexion L2 and L3 the femoral nerve,54,Adduction of the hip L2, L3 and L4,55,Hip Abduction L4, L5 and S1,56,Hip extension L4 and L5 the gluteal nerve,57,Knee extension L3 an
13、d L4 the femoral nerve,58,Knee flexion L5 and S1 the sciatic nerve,59,Ankle dorsiflexion L4 and L5 the peroneal nerve,60,Ankle plantar flexion S1 and S2 the tibial nerve,61,move the large toe up towards the patients face L5,62,The Sensory System Examination,Pain sensation (pin prick) Light touch sen
14、sation (brush) Position sense Stereognosia Graphesthesia Extinction.,63,Pain and Light Touch Sensation,64,The corresponding nerve root for each area,1. posterior 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.
15、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. lower-medial part of the upper leg (L3) 11. medial lower leg (L4) 12. lateral lower leg (L5) 13. sole of foot (S1),65,Position Sense,66,
16、vibratory sensation,67,Stereognosia,68,Graphesthesia,69,Extinction,70,Deep Tendon Reflexes,71,Deep Tendon Reflexes,The biceps and brachioradialis reflexes C5 and C6,72,The triceps reflex C6 and C7 , predominantly by C7,73,The Brachioradialis Reflex,74,The knee jerk reflex L3 and L4 , mainly L4,75,Th
17、e ankle jerk reflex S1,76,Ankle clonus,77,Patella clonus,78,Hoffman response,79,Abdorminal reflex,80,Cremasteric reflex,L1 and L2,81,Babinskis sign,82,Chaddocks reflex,The plantar reflex (Chaddock),83,Oppenheim sign,84,Gorden sign,85,Primitive reflex,Glabellar reflex Palmomental reflex Suckling refl
18、ex Snouting reflex Grasp reflex,86,Coordination,Rapidly Alternating Movement Evaluation,87,Coordination,finger-to-nose test,heel-knee-tibia test,88,tandem gait,89,tandem gait,90,Coordination,91,Romberg Test,Meningeal irritation,neck stiffness,92,Meningeal irritation,Kernigs test,93,Lasegues Test,Meningeal irritation,Brudzinskis test,94,Gait,Parkinsons,95,rising from the sitting position,96,The Examination of a Comatose or Stuporous Patient,97,Thank you!,98,
