马偕纪念医院临床技能训练学习单讲解.doc

馬偕紀念醫院臨床技能訓練學習單訓練技能神經學檢查 (Neurological Examination )I.History taking: most important part of neurological evaluation II.Neurological examinationA. Mental status assessment1. Level of consciousness a.Alert, awake, and oriented. b.Confusion: responsive to stimuli, but disoriented to time, person and place.c. Drowsiness: inclination to sleep; easily aroused and able to response to most stimuli.d. Stupor: little spontaneous physical or mental activity.e. Coma: lack of response to most painful stimuli.Glasgow coma scale (E4M6V5 滿分15分)GCS分數最佳運動反應Motor Response發聲反應Verbal Response眼睛張開Eye Opening6聽從命令5對疼痛刺激處會用手去除談話有條理4對疼痛有無意識反應語無倫次自動張開眼睛3對疼痛有屈關節緊張只會說一些不正確的字聽從命令眼睛張開2對疼痛有伸展僵直只能發聲對疼痛刺激眼睛才會張開1對疼痛全無反應全無反應全無反應2. Memory 3. Language ： aphasia, fluency , comprehension , repetition4. Mini mental testB. Cranial nerve function1. Olfactory nerve: smell (CN I)2. Optic nerve (CN II) visual acuity , visual field , pupil size , light reflex , funduscopy (papilledema)optic atrophy 3.Oculomotor nerve (CN III)&4.Trochlear nerve (CN IV)&6. Abducent nerve (CNVI)control of eye movement 5. Trigeminal nerve (CN V) facial sensation corneal reflex muscles of mastication 7. Facial nerve (CN VII)Lower motor neuron facial palsy: weakness of all facial muscles including forehead on same sideUpper motor neuron facial palsy: preserved ability to wrinkle forehead 8. Vestibuloacoustic nerve (CN VIII)i. Hearingii. Webers testiii. Rinne testiv. Nylen-Barany maneuverv. Coloric test (COWS)vi. Nystagmus9.Glossopharynegeai and vagus nerves (CN IX and X)&10.gag reflexuvula deviates toward normal side phonation swallowing 11. Spinal accessory nerve (CN XI) sternocleidomastoid muscletrapezius muscle12. Hypoglossal nerve (CN XII) tongue deviates toward weak side tongue atrophy, fasciculationC. Motor function 1.Muscle strengthScoreNormal 5Apparent weakness 4Movement against gravity 3Joint movement 2Flicker of muscle contraction 1No joint movement No muscle contraction 02.Muscle tone 3.Atrophy, fasciculation 4.Movement and postures: Spasticity RigidityD. Reflexes l.Deep tendon reflexesScoreclonus +hyperactive + normal +hypoactive + absent -Biceps reflex C5Brachioradialis C6Triceps reflex C7Knee reflex L4Ankle reflex S12.Plantar reflexBabinski sign3.Releasing signsRooting reflexGrasp reflex snouting reflexE. Sensation1.Pinprick (pain ), temperature, proprioception2.Cortical sensation : stereognosis graphesthesiaF. Cerebellar functionG. Gait and balanceH. Autonomic functionMini-Mental Test1. 今天是幾月幾號？ (2)2. 今天是星期幾？ (1)3. 今天是民國幾年或什麼年(十二天干)？ (1)4. 現在是那一季節？春夏秋冬？ (1)5. 這個醫院叫什麼名字？6. 現在在幾樓？ (1)7. 這個醫院在那裡(什麼地方)？ (1)台北-台北宜蘭-羅東鎮基隆-基隆高雄-高雄8. 這個醫院在那一個縣(市)？ (1)台北-台北宜蘭-羅東鎮基隆-基隆高雄-高雄9. 我們的國家叫什麼名字？ (1)中國中華民國台灣10. 說出三件東西的名字，請病人馬上覆誦。 (3)例:汽車、皮帶、碗(等一下要再問一次)11. 減七測驗，從100到65。(5)100-7=9393-7=8686-7=7979-7=7272-7=6512. 回想剛才三件東西的名字。 (3)13. 出示手錶和筆，要病人說出東西的名字。 (2