神经系统查体

DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity神经系统体格检查neurophysicalexamination张爱武中山大学附属第一医院神经病学教研室[e-mail]heFirstAffiliatedHospitalSunYat-SenUniversity学习要求1235脑神经检查运动功能检查感觉功能检查自主神经功能检查4神经反射检查DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity神经系统检查工具DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity高级神经活动颅神经运动系统感觉系统反射系统脑膜刺激征植物神经神经系统检查内容内容顺序手法DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity高级神经活动意识精神智能语言DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity脑神经cranialnerves一嗅二视三动眼四滑五叉六外展七面八听九舌咽十迷一副舌下完DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅠ嗅神经olfactorynerve非刺激性物体主观测试方法(心理物理测试法)1.五味试嗅液检测法2.标准微胶囊嗅觉功能检查（UPSIT）客观测试法—嗅性相关电位DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅡ视神经opticnerve视力眼底视野DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅡopticnerve视力数指(CF)、手动(HM)光感(LP)无光感(NLP)神经科注意最佳校正视力近视力卡DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity检查方法：对向法Ⅱopticnerve视野DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity观察：①视乳头②血管③视网膜Ⅱopticnerve眼底DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅢ、Ⅳ、Ⅵ上斜滑，外直展，其余都由动眼管。八个方向检查Oculomotor,Trochlear,AbducentDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity动眼神经麻痹：上睑下垂，上视、内收不能，瞳孔散大，对光反应消失，复视。Ⅲ动眼神经DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅢ眼裂C.重症肌无力的双侧非对称性上睑下垂：波动性、Cogan眼睑抽动征（Cogan‘slidtwitchsign）、门帘征（curtainsign)。A.右侧动眼神经麻痹所引起的上睑下垂；B.左侧Homer综合征伴随上睑下垂和下睑轻度抬高；DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅢ大小对光反射直接间接阿罗瞳孔调节反射瞳孔D直径:3~4mmDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅣ、Ⅵ滑车神经麻痹：外下方活动障碍。外展神经麻痹：外展不能，内斜视，复视。DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅤ三叉神经运动感觉反射trigeminalnerveDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅤ感觉DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅤ角膜反射(cornealreflex)眼神经面神经DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅦ面神经facialnerve◆运动——表情肌◆味觉——舌前2/3DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅧ位听神经vestibulocochlear听力眼震前庭DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅧ前庭功能检查1.眩晕2.冷热水试验3.旋转试验4.Dix-HallpikeDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅧ眼球震颤(nystagmus)DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅨglossopharyngealnerve，Ⅹvagusnerve运动反射感觉DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅪ副神经spinalaccessorynerve运动：转颈、耸肩支配胸锁乳突肌和斜方肌DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversityⅫ舌下神经hypoglossalnerve•舌的位置、形态。•运动：伸舌DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity高级神经活动颅神经运动系统感觉系统反射系统脑膜刺激征植物神经神经系统检查内容肌张力肌容积肌力步态共济运动运动障碍DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity运动检查肌营养DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity肌张力降低肌张力增高运动检查肌张力(muscletone)DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity0级完全瘫痪1级肌肉可收缩，但不能产生动作2级肢体能在床面上移动但不能抬起3级肢体能抬离床面但不能抵抗阻力4级能做抗阻力动作，但较正常差5级正常肌力运动检查肌力(musclepower)对于小关节，如指间关节、掌指关节如何评价？2级、3级适用吗？DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity指鼻试验跟膝胫试验快复轮替试验Rombergtest运动检查共济运动(coordinationg)DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity运动检查不自主运动震颤舞蹈样手足徐动DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity高级神经活动颅神经运动系统感觉系统反射系统脑膜刺激征植物神经神经系统检查内容深感觉复合感觉浅感觉DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity运动觉位置觉音叉振动觉痛觉触觉温度觉感觉检查浅感觉与深感觉DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity感觉检查复合感觉定位觉两点辨别觉图形觉实体觉DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity高级神经活动颅神经运动系统感觉系统反射系统脑膜刺激征植物神经神经系统检查内容深反射病理反射浅反射DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity四、神经反射系统Sherrington交互神经支配定律相应的节段和该节段以上的结构均参与反射DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity浅反射：角膜反射、腹壁反射、提睾反射、跖反射深反射：肱二头肌反射、肱三头肌反射、桡骨骨膜反射、膝反射、跟腱反射。阵挛：踝阵挛及髌阵挛病理反射：Hoffmann征、Babinski征及其临床意义相同的Oppenheim征、Gordon征脑膜刺激征：颈强直、Kernig征、Brudzinski征DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity神经反射深反射•肱二头肌反射•肱三头肌反射•桡骨骨膜反射•膝腱反射•跟腱反射•阵挛DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity(-)消失(+)减弱(++)存在(+++)增强(活跃)(++++)亢进(伴非持续阵挛)(+++++)明显亢进(伴持续阵挛)DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity肱二头肌反射bicepsreflexDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity肱三头肌反射tricepsreflexDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity桡骨骨膜反射branchioradialisDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity膝腱反射patellarreflexJendrassik手法DepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity跟腱反射achillestendonreflexDepartmentofNeurologytheFirstAffiliatedHospitalSunYat-SenUniversity阵挛clonus髌阵挛踝阵挛DepartmentofNeurologytheFirstA