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NeurologicalExamination

NeurologicalExamination

IMPORTANTCE!Despiterecentadvancesinneuroscienceandthecontinuingdevelopmentofsensitivediagnosticprocedures,theessentialskillrequiredforthediagnosisremainstheclinicalneurologicexaminationMostneurologicdiagnosiscanbemadeonthebasisofthehistoryaloneIMPORTANTCE!DespiterecentadvSIXPARTSOFTHENEUROEXAMMentalState&CognitiveFunctionCranialNervesMotorSystemSensorySystemReflexesGaitSIXPARTSOFTHENEUROEXAMMenMENTALSTATUS&COGNITIVEFUNCTIONMENTALSTATUS&COGNITIVEFUMentalStatus&CognitiveFunction

-Levelofconsciousness(MentalStatus)NORMAL:patientawakeandalert,attentivetosurroundingandtotheexaminerDEPRESSED:SomnolenceStuporous-arousingonlybrieflyinresponsetopainstimulationComatose-notarousablebyverbalandpainstimulationMentalStatus&CognitiveFunc神经病学英文课件：01NeuroexamGlasgowComaScaleDate,TimeScore6/10/20097am1pmEyeopening**Spontureness4**Tosound3*Topain2***None1MotorResponseObeyscommand6Localizespains5**Normalflexion(withdrawal)4***Abnormalflexion(decortication)3***Abnormalextension(decerebration)2None1VerbalresponseOriented5Confusedconversation4**Inapprepriatewords3***Incomprehensivesounds2**None1TotalGlasgowComaScaleDate,神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamMentalStatus&CognitiveFunction

-CognitivefunctionchecklistA.Orientationtoperson,place,andtime.B.Commonknowledgesuchas“whoisthepresident”C.Memory:Shortterm-namethreecommonobjects,thenrecallthemagainafter5minutes;Longterm-verifiableeventsfromthepastMentalStatus&CognitiveFuncMentalStatus&CognitiveFunction

-CognitivefunctionchecklistD.Calculations:Serialsevens:countbackwardfrom100,takingaway7eachtime.Real-lifeproblemE.Abstractthough:“Howisanappledifferentfrom–orthesameas–anorangeF.Other:Insightandjudgment,concentration,verbalfluency,patientsmood,contentofthough,appropriatenessofbehavior,andsoon.MentalStatus&CognitiveFuncMMSEMMSEMentalStatus&CognitiveFunction

-Languagefunctioningcheck-upBroca’sAphasiasexpressiveaphasiasWernicke’sAphasiasreceptiveaphasiasConductionalAphasiasMentalStatus&CognitiveFunc神经病学英文课件：01NeuroexamCRANIALNERVESCRANIALNERVESCRANIALNERVES

-Olfactory(I)Askthepatienttoidentifycommonscentssuchascoffee,vanilla,etc,witheyesclosed.Donotuseirritants.Intestingolfactorynervefunction,itislessimportanttodeterminewhetherthepatientcancorrectlyidentifyaparticularodorthanwhetherthepresenceorabsenceofthestimulusisperceivedCRANIALNERVES

-Olfactory(I)A神经病学英文课件：01NeuroexamCRANIALNERVES

-Optic(II)VisualAcuity-pocketcardorwallchartoranyreadingmattersuchasnewspaperVisualFieldConfrontationTesting-Patientandexaminerstandateyelevelataboutarm’slength.HavethepatientcoverhisowneyeThreatTesting-appliedwhenthepatientislessthanfullyalertorisuncooperativeFundus(Ophthalmoscopic)ExaminationCRANIALNERVES

-Optic(II)Vis神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVES

-PupillaryReflexes(II,III)Anormalpupilwillconstrict(1)inresponsetodirectlight,(2)asaconsensualresponsetolightintheoppositeeye,and(3)toaccommodation(convergencetofocusonacloseobject)CRANIALNERVES

-PupillaryRefl神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVES

-ControlofExtraocularMuscleMovements

(III,IV,VI)Extraocularmusclemovementsarecontrolledbytheoculomotor(III),trochlear(IV),andabducens(VI)nervesVolitionaleyemovement-followmyfinger,justwithyoureyes.TracingtheLetterHAskaboutdiplopiaNystagmusisrthythmicoscillationoftheeyesCRANIALNERVES

-ControlofExt神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamUnilateralptosisoccursinHorner’ssyndrome,withasmallpupil;orinaIIIcranialnervelesion,withalargepupilandlossofadductiveandverticaleyemovementUnilateralptosisoccursinHoCRANIALNERVES

-TrigeminalNerve(V)FacialSensationCornealReflex-Sweepawispofcottonlightlyacrossthelateralsurfaceoftheeye(outofthedirectvisualfield)fromscleratocornea-V,VIIMotorVTesting-Observethesymmetryofopeningandclosingofthemouth.AskthepatienttoclenchtheteethandthenattempttoforcejawopeningJawjerk-briskindicatesUNLCRANIALNERVES

-TrigeminalNer神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-FacialStrength(VII)FacialSymmetry-observethepatient’sfaceforsymmetryofthepalpebralfissuresandnasolabialfoldsatrest.Askthepatienttowrinkletheforehead,thentosqueezetheeyestightlyshut,thentosmileorsnarl,sayingshowyourteethSupernuclearlesionNucleusorperipherallesionBilateralFacialWeaknessCRANIALNERVE

-FacialStrengt神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-Auditory(VIII)Auditoryacuitycanbetestedcrudelybyrubbingthumbandforefingertogetherabout5cmfromeachear.Ifthepatientcannotheartherub,proceedtothefollowtestsRinneTest-holdthebaseoftuningfolkonthemastoidprocessuntilthesoundisnolongerperceived,thenbringthestillvibratingforkupclosetotheear.SensorineurallossConductivelossWeberTestCRANIALNERVE

-Auditory(VIIICRANIALNERVE

-Auditory(VIII)WeberTest-lightlystrikeatuningforkandplacethehandleonthemidlineoftheforeheadConductivelossSensorineurallossVestibularFunction-needtobetestedonlyiftherearecomplaintsdizzinessorvertigoorevidenceofnystagmusNylen-Barany(Dix-Hallpike)maneuvertestforpositionalnystagmusCRANIALNERVE

-Auditory(VIII神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-Glossopharyngeal(IX)&Vagus(X)Testthefunctionofthepalate,pharynx,andlarynx1.Palatalelevation-say“ah”2.Gagreflex(afferentIX,efferentX)-gentlytoucheachsideoftheposteriorpharyngealwallwithacottonswab3.Sensoryfunction-lightlytoucheachsideofthesoftpalatewiththetipofacottonswab4.Voicequality-listenforhoarsenessor“breathiness”,suggestinglaryngealweaknessCRANIALNERVE

-Glossopharynge神经病学英文课件：01NeuroexamCRANIALNERVE

-Accessory(XI)Sternocleidomastoid-pressahandagainstthepatient’sjawandhavethepatientrotatetheheadagainstresistance.PressingagainsttherightjawteststheleftsternocleidomastoidandviceversaTrapezius-havethepatientshrugshouldersagainstresistanceandassessweaknessCRANIALNERVE

-Accessory(XI)神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-Hypoglossal(XII)Testsforhypoglossalnervefunctionincludethefollowing1.AtrophyorFasciculations-withthepatient’stonguerestinginthefloorofthemouth,firstinspectforatrophyorfasciculations.Thenaskthepatienttoprotrudethetongue,andobservefordeviationtotheweakside2.SubtleWeakness-havethepatientpushthetongueintoeachcheekagainstexternalresistance(oppositehypoglossalm.)3.SubtleDysarthria-AskthepatienttorepeatdifficultphrasesCRANIALNERVE

-Hypoglossal(X神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamMOTORSYSTEMMOTORSYSTEMMotorFunctionMuscleToneDecreased(floppy,flaccid,hypotonic)NormalIncreased(Spasticvs.Rigid)MuscleBulkAtrophy(orwithfasciculation)MuscleStrength-Theclassicgradingsystemscoresasfollows:5,fullstrength;4,movementagainstgravityand&resistance;3,movementagainstgravityonly;2,movementhorizontallyalongthesurfaceofthebed;1,palpablecontractionbutlittlevisiblemovement;0,nocontractionMotorCoordination&GaitMotorFunctionMuscleTone神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamTibialisanteriorwillbeweakinuppermotorneuronlesions,inpolyneuropathy,incommonperionealnervelesions,andinL5/S1rootlesionsduetoprolapsedintervertebraldiscTibialisanteriorwillbeweak神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamMotorCoordination&GaitCerebellarhemisphereareresponsibleforcoordinatingandfine-tuningmovements(ipsilateral)1.Finger-to-Nose2.RapidAlternatingMovements3.Rebound4.Heel-Knee-ShinMotorCoordination&GaitCereb神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamRomberg’stestisaquickandexcellentscreenforlossofproprioceptivefeedbackneuropathyorspinalcorddiseaseRomberg’stestisaquickand神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamSENSORYSYSTEMSENSORYSYSTEMSensoryFunctionLarge-fiber&DorsalColumnFunctionVibrationSenseJointPositionSenseRomberg’sTestSmall-fiber&SpinothalamicFunctionTemperatureSensationSuperficialPainSensationLightTouchSensationSensoryFunctionLarge-fiber&神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamInthelesionofthesomatosensorycortexjointpositionperceptionislossbutvibrationsensationisnotInthelesionofthesomatosen神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamREFLEXSREFLEXSReflexesDeepTendonReflexesBicepReflex(C5-6)TricepReflex(C7-8)Quadiceps(Patellar,KneeJerk)Reflex(L3-4)Achilles(AnkleJerk)Reflex(S1-2)PathologicReflexesBabinskiSignFrontalReleaseSignGraspSignSuckSignSnoutSignGlabellarSignReflexesDeepTendonReflexes神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamBrisktendonreflexessignifyuppermotorlesions,absencereflexesoccurinperipheralnerveornerverootlesionsBrisktendonreflexessignifyAnextensorplantarorBabinskiresponseisadefiniteimmediatesignofanuppermotorneuronlesion,presentswellbeforeclonusorhyperreflexiaAnextensorplantarorBabinsk神经病学英文课件：01NeuroexamAnkleclonus,whensustainedorunsustainedbutofmorethansixbeatsduration,providesdefiniteevidenceforanuppermotorneuronlesionAnkleclonus,whensustainedo

Thankyou!Thankyouforyourattention!Thankyou!Thankyoufo

NeurologicalExamination

NeurologicalExamination

IMPORTANTCE!Despiterecentadvancesinneuroscienceandthecontinuingdevelopmentofsensitivediagnosticprocedures,theessentialskillrequiredforthediagnosisremainstheclinicalneurologicexaminationMostneurologicdiagnosiscanbemadeonthebasisofthehistoryaloneIMPORTANTCE!DespiterecentadvSIXPARTSOFTHENEUROEXAMMentalState&CognitiveFunctionCranialNervesMotorSystemSensorySystemReflexesGaitSIXPARTSOFTHENEUROEXAMMenMENTALSTATUS&COGNITIVEFUNCTIONMENTALSTATUS&COGNITIVEFUMentalStatus&CognitiveFunction

-Levelofconsciousness(MentalStatus)NORMAL:patientawakeandalert,attentivetosurroundingandtotheexaminerDEPRESSED:SomnolenceStuporous-arousingonlybrieflyinresponsetopainstimulationComatose-notarousablebyverbalandpainstimulationMentalStatus&CognitiveFunc神经病学英文课件：01NeuroexamGlasgowComaScaleDate,TimeScore6/10/20097am1pmEyeopening**Spontureness4**Tosound3*Topain2***None1MotorResponseObeyscommand6Localizespains5**Normalflexion(withdrawal)4***Abnormalflexion(decortication)3***Abnormalextension(decerebration)2None1VerbalresponseOriented5Confusedconversation4**Inapprepriatewords3***Incomprehensivesounds2**None1TotalGlasgowComaScaleDate,神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamMentalStatus&CognitiveFunction

-CognitivefunctionchecklistA.Orientationtoperson,place,andtime.B.Commonknowledgesuchas“whoisthepresident”C.Memory:Shortterm-namethreecommonobjects,thenrecallthemagainafter5minutes;Longterm-verifiableeventsfromthepastMentalStatus&CognitiveFuncMentalStatus&CognitiveFunction

-CognitivefunctionchecklistD.Calculations:Serialsevens:countbackwardfrom100,takingaway7eachtime.Real-lifeproblemE.Abstractthough:“Howisanappledifferentfrom–orthesameas–anorangeF.Other:Insightandjudgment,concentration,verbalfluency,patientsmood,contentofthough,appropriatenessofbehavior,andsoon.MentalStatus&CognitiveFuncMMSEMMSEMentalStatus&CognitiveFunction

-Languagefunctioningcheck-upBroca’sAphasiasexpressiveaphasiasWernicke’sAphasiasreceptiveaphasiasConductionalAphasiasMentalStatus&CognitiveFunc神经病学英文课件：01NeuroexamCRANIALNERVESCRANIALNERVESCRANIALNERVES

-Olfactory(I)Askthepatienttoidentifycommonscentssuchascoffee,vanilla,etc,witheyesclosed.Donotuseirritants.Intestingolfactorynervefunction,itislessimportanttodeterminewhetherthepatientcancorrectlyidentifyaparticularodorthanwhetherthepresenceorabsenceofthestimulusisperceivedCRANIALNERVES

-Olfactory(I)A神经病学英文课件：01NeuroexamCRANIALNERVES

-Optic(II)VisualAcuity-pocketcardorwallchartoranyreadingmattersuchasnewspaperVisualFieldConfrontationTesting-Patientandexaminerstandateyelevelataboutarm’slength.HavethepatientcoverhisowneyeThreatTesting-appliedwhenthepatientislessthanfullyalertorisuncooperativeFundus(Ophthalmoscopic)ExaminationCRANIALNERVES

-Optic(II)Vis神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVES

-PupillaryReflexes(II,III)Anormalpupilwillconstrict(1)inresponsetodirectlight,(2)asaconsensualresponsetolightintheoppositeeye,and(3)toaccommodation(convergencetofocusonacloseobject)CRANIALNERVES

-PupillaryRefl神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVES

-ControlofExtraocularMuscleMovements

(III,IV,VI)Extraocularmusclemovementsarecontrolledbytheoculomotor(III),trochlear(IV),andabducens(VI)nervesVolitionaleyemovement-followmyfinger,justwithyoureyes.TracingtheLetterHAskaboutdiplopiaNystagmusisrthythmicoscillationoftheeyesCRANIALNERVES

-ControlofExt神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamUnilateralptosisoccursinHorner’ssyndrome,withasmallpupil;orinaIIIcranialnervelesion,withalargepupilandlossofadductiveandverticaleyemovementUnilateralptosisoccursinHoCRANIALNERVES

-TrigeminalNerve(V)FacialSensationCornealReflex-Sweepawispofcottonlightlyacrossthelateralsurfaceoftheeye(outofthedirectvisualfield)fromscleratocornea-V,VIIMotorVTesting-Observethesymmetryofopeningandclosingofthemouth.AskthepatienttoclenchtheteethandthenattempttoforcejawopeningJawjerk-briskindicatesUNLCRANIALNERVES

-TrigeminalNer神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-FacialStrength(VII)FacialSymmetry-observethepatient’sfaceforsymmetryofthepalpebralfissuresandnasolabialfoldsatrest.Askthepatienttowrinkletheforehead,thentosqueezetheeyestightlyshut,thentosmileorsnarl,sayingshowyourteethSupernuclearlesionNucleusorperipherallesionBilateralFacialWeaknessCRANIALNERVE

-FacialStrengt神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-Auditory(VIII)Auditoryacuitycanbetestedcrudelybyrubbingthumbandforefingertogetherabout5cmfromeachear.Ifthepatientcannotheartherub,proceedtothefollowtestsRinneTest-holdthebaseoftuningfolkonthemastoidprocessuntilthesoundisnolongerperceived,thenbringthestillvibratingforkupclosetotheear.SensorineurallossConductivelossWeberTestCRANIALNERVE

-Auditory(VIIICRANIALNERVE

-Auditory(VIII)WeberTest-lightlystrikeatuningforkandplacethehandleonthemidlineoftheforeheadConductivelossSensorineurallossVestibularFunction-needtobetestedonlyiftherearecomplaintsdizzinessorvertigoorevidenceofnystagmusNylen-Barany(Dix-Hallpike)maneuvertestforpositionalnystagmusCRANIALNERVE

-Auditory(VIII神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-Glossopharyngeal(IX)&Vagus(X)Testthefunctionofthepalate,pharynx,andlarynx1.Palatalelevation-say“ah”2.Gagreflex(afferentIX,efferentX)-gentlytoucheachsideoftheposteriorpharyngealwallwithacottonswab3.Sensoryfunction-lightlytoucheachsideofthesoftpalatewiththetipofacottonswab4.Voicequality-listenforhoarsenessor“breathiness”,suggestinglaryngealweaknessCRANIALNERVE

-Glossopharynge神经病学英文课件：01NeuroexamCRANIALNERVE

-Accessory(XI)Sternocleidomastoid-pressahandagainstthepatient’sjawandhavethepatientrotatetheheadagainstresistance.PressingagainsttherightjawteststheleftsternocleidomastoidandviceversaTrapezius-havethepatientshrugshouldersagainstresistanceandassessweaknessCRANIALNERVE

-Accessory(XI)神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamCRANIALNERVE

-Hypoglossal(XII)Testsforhypoglossalnervefunctionincludethefollowing1.AtrophyorFasciculations-withthepatient’stonguerestinginthefloorofthemouth,firstinspectforatrophyorfasciculations.Thenaskthepatienttoprotrudethetongue,andobservefordeviationtotheweakside2.SubtleWeakness-havethepatientpushthetongueintoeachcheekagainstexternalresistance(oppositehypoglossalm.)3.SubtleDysarthria-AskthepatienttorepeatdifficultphrasesCRANIALNERVE

-Hypoglossal(X神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamMOTORSYSTEMMOTORSYSTEMMotorFunctionMuscleToneDecreased(floppy,flaccid,hypotonic)NormalIncreased(Spasticvs.Rigid)MuscleBulkAtrophy(orwithfasciculation)MuscleStrength-Theclassicgradingsystemscoresasfollows:5,fullstrength;4,movementagainstgravityand&resistance;3,movementagainstgravityonly;2,movementhorizontallyalongthesurfaceofthebed;1,palpablecontractionbutlittlevisiblemovement;0,nocontractionMotorCoordination&GaitMotorFunctionMuscleTone神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamTibialisanteriorwillbeweakinuppermotorneuronlesions,inpolyneuropathy,incommonperionealnervelesions,andinL5/S1rootlesionsduetoprolapsedintervertebraldiscTibialisanteriorwillbeweak神经病学英文课件：01Neuroexam神经病学英文课件：01NeuroexamMotorCoordination&GaitCerebellarhemisphereareresponsibleforcoordinatingandfine-tu

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