Neurological ExaminationVIP免费

NeurologicalExaminationConsciousness&HighCorticalfunctionConsciousness•Consciouslevel:wakefulness-alertness(GCS,drowsiness,stupor,coma)•Consciouscontent:awareness(confusion)AscendingReticularactivatingsystem(ARAS):upperbrainstemtegmentumandmidlineandintralaminarnucleiofthethalamusCorticalandsubcorticalstructureGlasgowComaScaleEyeopeningVerbalMotorresponse1NoneNoneNone2TopainSoundsDecerebrate3TospeechWordsDecorticate4SpontaneousConfusedWithdrawtopain5OrientedLocalizingtopain6ObeycommandsOrientation•Person•Place•TimeJudgement•Whattodowhensmelledsmokeintheater?Orientation&Judgement•Immediatememory&attention~Digitspan:Normalsevenforward,fivebackward•Recentmomory~Recallthreeitemsorabriefstoryafteradelayof3to5minutes•Remotemomory~historicalorverifiablepersonaleventsMemory•Calculation~(100–7)x7times~(20-3)x5times~Adjusttopremorbid•Abstractthinking•"姚明比馬英九高,且馬英九比陳水扁高,誰最高?"•"甚麼叫『覆水難收』"?•"車子跟飛機有甚麼共通點嗎?"•"你覺得空位該填甚麼:AZBYCXD_"?Calculation&AbstractthinkingCranialnerve選擇有特定氣味,例如:肥皂,薄荷,香煙及一有刺激性的物品，如ammonia.將這些物品置於相似瓶中,請病人指明這些氣味.一鼻孔受試時另一鼻孔應用手遮擋.Normal:allidentifiedOnlyrecognisedAmmonia:CNIimpaired,CNVpartlyintactAllnotrecognised:NotorganicCranialnerveI:Olfactorynerve•exophthalmosorenophthalmos,ptosisorlidretraction•Size,outline•Lightreflex請病人眼直視前方,以手掌或紙張至於兩眼之間隔檔光線,並以光照一眼.光點由眼外側斜斜照入.觀察時須同時注意受光照之眼與另一眼的瞳孔反應,正常應會出現協同反射(Consensualreflex)•Accommodationreflex將手指或筆置於病人鼻前10cm,要求病人先注視遠方,再注視眼前物體,觀察病人瞳孔調焦的反應•PERRLA(D+C):PupilsEqualandRegular;ReactivetoLightandAccommodation(DirectandConsensual)CranialnerveII:Opticnerve•Wallorhandchart(Snellen’sChart)countfingersmovementlight•Refractiveerror:Ifacuityimprovedbylookingthrupinholecard•Confrontationtest:約相距一隻手臂長以30cm為半徑請病人試著回答你哪一邊的手指在動•TestIndividualEye左眼注視你的右眼,以病人的眼睛為中心劃一半徑30cm的假想球面使用白色大頭針,要求病人告訴你何時最先看到大頭針改用紅色大頭針再測試一次CranialnerveII:Opticnerve•Saccade(Frontal)FrontalgazecentertoPPRF(paramedianpontinereticularformation)forrapideyemovementstoviewnewobjectsontothefovea.•Pursuit(Occipitallobe)Parietal-occipitalgazecenterviacerebellarandvestibularpathways;foreyemovementstokeepamovingimagecenteredonthefovea.•Convergence(Midbrain)opticpathwaystooculomotornuclei;keepimageonfoveawhenviewedobjectmovednear•Vestibulo-ocularreflex(Cerebellarvestibularnuclei)vestibularinput;keepsimagesteadyonfoveaduringheadmovements.CranialnerveIII:OculomotornerveCranialnerveIV：TrochlearNerveCranialnerveVI：AbducensNerve•Position•Saccade•Pursuit握一筆於病人前50cm在空氣中劃一個大大的H請病人注視•Convergence•握一隻筆於病人前50cm將筆移向病人鼻樑前5~8cm觀察眼睛是否成會聚狀態•Vestibulo-ocularreflex(Cerebellarvestibularnuclei)CranialnerveIII&IV&VIExtraocularmovementMuscleNervePrimarySecondaryTertiaryMRIIIadduction----SRIIIElevationIntorsionadductionIRIIIDepressionIntorsionadductionSOIVIntorsionDepressionAbductionIOIIIExtorsionElevationAbductionLRVIAbduction----•Inspection:~看有無肌肉消瘦(temporal&massetermuscle)—maxillarybranch~請病人把下巴張開,觀察下巴有無偏向某邊—mandibular...