《神经反射的检查》PPT课件.ppt

1、神经反射检查,西南医院神就内科 罗春霞,检查方法 检查内容 异常体征的临床意义,重点：,神 经 反 射 检 查,Examination of the Relexs,反射（Reflex）： 反射是由于刺激诱发出的自发的一种运动反应.是通过反射弧（包括外周感受器、传入神经、神经中枢、传出神经及外周效应器组成）的完成的。,Reflex： Reflex action is an automatic motor response through reflex arc ,that is elicted by a stimulus. Confomation of reflex arc: Sensor, Af

2、ferent nerve, Nerve centre, Efferent nerve Effector,神经反射: 浅反射 深反射 病理反射,Reflex: Superficial reflex Myotasis reflex Pathologic reflex,浅反射：,角膜反射 腹壁反射 提睾反射 跖 反 射 肛门反射,Superficial reflex: Corneal reflex Abdominal reflex Cremasteric reflex Plantar reflex Anal reflex,角膜反射Corneal reflex,Corneal reflex: Sens

3、or:corneal Afferent nerve：Trigeminal nerve Nerve centre：pons Efferent nerve ：Facial nerve Effector：Orbicularis oculi muscle,角膜反射： 感受器：角膜 传入神经：三叉神经 中枢：桥脑 传出神经：面神经 效应器：眼轮匝肌,临床意义: 一侧直接、对侧间接反射均消失同侧三叉N病变； 一侧直接消失，对侧间接存在同侧面N病变。 一侧直接消失间接反射消失 面神经或三叉神经病变。,Clinical significance: one lateral direct and contrala

4、teral indirect reflex extinctation: ipsilateral trigeminal nerve damage; one lateral direct reflex and contralateral indirect reflex extinctation: ipsilateral facial nerve damage; one lateral direct and indirect reflex extinctation: ipsilateral trigeminal and facial nerve damage,腹壁反射(Abdominal refle

5、x,AR) ： 上腹壁反射：胸7-8； 中腹壁反射：胸9-10； 下腹壁反射：胸11-12。临床意义： 上、中、下均消失：昏迷，急腹症或神经系统病变。 一侧消失：同侧锥体束病变或脊神经损伤。,Clinical significance: All abdominal reflex extinction:Coma,Acute abdomen and nerve system disease; Unilateral extinction:isolateral pyramidal tract injuried or spinal nerves injuried.,提睾反射： 腰1-2。临床意义： 双侧

6、消失：腰1-2病损； 一侧消失：锥体束受损。,Cremasteric reflex(CR): Nerves centre:Lumbal spinal cord 1-2. Clinical significance: Bislateral CR extinction:L1-2 injuried; Unilateral CR edtinction:Pyramidal tract injurid.,CR,跖反射(Plantar reflex)：骶1-2,肛门反射,骶4、5节段 骶4、5病变或肛尾神经损伤,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,Myotasis refl

7、ex: Biceps reflex Triceps jerk reflex Radioperiosteal reflex Knee jerk reflex Achilles tendon reflex,肱二头肌反射 (Biceps reflex ) （C5、6）,肱三头肌反射Triceps jerk reflex （C7、8）,桡骨骨膜反射(Radioperiosteal reflex)（C5、6）,膝腱反射(Knee jerk reflex)（L2-4）,跟腱反射(Achilles tendon reflex)（S1、2）,临床意义：,深反射减弱或消失：周围神经病变、肌肉病变及中枢神经病变的

8、休克期； 深反射亢进：中枢神经系统病变（伴有病理征）或引起神经系统兴奋性增高的病变(如甲亢)（不伴有病理征）。,Clinical Significance Hyporeflexia or absent deep reflex: Peripheral neuropathy,Myopathy and shock stage of central nerve disease; Hyperreflexia: central nerve disease(with pathologic sign often) or Diseases inducing hyperexcitation of nerve sy

9、stem (e.g Hyperthyreosis) (Without pathologic sign ).,病理反射: 锥体束病损时，失去了对脑干和脊髓的抑制功能，而出现的异常反射。 主要的病理征有：,Pathologic reflex: It is abnormal reflex due to deinhibition of mortor neuron in brain stem or spinal cord by pyramidal tract injuried.,Babinski sign，Chaddock sign， Gordon sign， Gonda sign， Oppenheim

10、 sign，Hoffmann sign。,Babinski sign,拇趾缓缓背伸，其它四趾呈扇形展开。见于锥体束损害。,Manifestation: Great toe dorsum extension and other four toes sectorly outspreading. Significance: Pyramidal tract injuried,Oppenheim sign,Gordon sign,Hoffmann sign,阵挛（Clonus）： 腱反射增强的极度表现，是拉长某一肌腱后该肌肉所发生的节律性收缩，见于锥体束损害。,That is a manifestati

11、on of incresed tendon reflex。When one muscle tendon is dragged sharply ，the muscle could contact rhythmly。,髌阵挛（Patella clonus）股四头肌节律性收缩,踝阵挛（ankle clonus）：腓肠肌与比目鱼肌节律性收缩。,Irritation of the menings and spinal root caused by inflammation , hemorroge etc can cause head retraction,neck stiffness , and spi

12、nal rigidity, which is named as mening stimulation sign , which elicits protective reflexes intended to shorted the spinal axis and immobilize the irritated tissue .,脑膜刺激征： 脑膜和脊神经根由于炎症、出血等的刺激从而引起的头缩、颈强直及脊柱僵硬的反应。它是一种保护性的反射，可以使脊柱缩短稳定受刺激的组织。,颈项强直 Neck Rigidity,Brudzinski &Kernig sign,Flexion at the hip and knee in response to forward flexion of the neck(Brudzinski sign) and inability