神经系统查体333__培训课件.ppt

肱三头肌反射 桡 反 射 膝 反 射 跟腱反射 跖反射 用棉签从后向前轻划足底外侧缘 注意大脚趾的运动，正常向足底屈曲 异常时大脚趾背屈，伴其他四指的散开（ 巴彬斯基征 Babinski sign) 霍夫曼征 (Hoffmann‘s sign) 握住病人的中指，向下弹击中指指甲，如果出现其余四指的屈曲，大拇指的内收，即为阳性。 巴彬斯基征 提示上运动神经元损害，锥体束损害 霍夫曼征 提示上运动神经元损害，累及上肢 2. 浅反射 提睾反射：用棉签轻划大腿内侧缘，引起同侧睾丸上提。（腰1，2） 肛门反射：用棉签轻划肛门周围皮肤，引起肛门外括约肌。（骶4，5） 腹壁反射：用棉签轻划一侧腹壁，引起同侧腹肌收缩。（上腹7，8 中腹9，10 下腹11，12） 跖反射：用棉签轻足底外侧，自足跟向前至小趾根部足掌时转向内侧，引起足趾跖屈。（骶1，2） 3. 病 理 反 射 Babinski Oppenheim Gordon 4. 脑膜刺激征 颈项强直 Kernig Sign Brudzinski Sign 六.自主神经系统检查 眼心反射 卧立位反射 皮肤划痕试验 竖毛反射 发汗试验 谢 谢！ * great clinicians could pinpoint a lesion in the nervous system with often astounding accuracy. Today, with the availability of modern imaging techniques, the neurologic exam remains a critical way in the clinical decision-making process. All these questions can quickly be answered by a carefully performed neurologic exam * In addition, we will briefly discuss which neuroanatomic systems are tested by each part of the neurologic exam, so that its functional and practical relevance will be better appreciated. * The neurologic exam is part of the general physical examination. Thus, the neurologic exam should always be preceded by and interpreted in the context of a more general examination including vital signs, heart, lungs, abdomen, etc. * The neurologic examination is always performed and recorded in a sequential and uniform manner in order to avoid omissions and to facilitate the subsequent analysis of case records. * . * Test Extraocular Movements Stand or sit 3 to 6 feet in front of the patient. Ask the patient to follow your finger with their eyes without moving their head. Check gaze in the six cardinal directions using a cross or H pattern. Pause during upward and lateral gaze to check for nystagmus. [6] Check convergence by moving your finger toward the bridge of the patients nose. Test Pupillary Reactions to Light Dim the room lights as necessary. Ask the patient to look into the distance. Shine a bright