神经系统检查2—培训课件.ppt

4. 脑膜刺激征 颈项强直 Kernig Sign Brudzinski Sign 视力检查 视 力 表 数 指 指 动 光 感 全 盲 无 对比法检查视野 意识障碍分类 意识清醒 嗜睡 昏睡 昏迷 * 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. * Memory: Ask the patient to recall three items after a delay of 3 to 5 minutes Remote memory. Ask the patient about historical personal events. Calculation:subtract 7 from 100 and then subtract 7 from the product, and so on. * Level of consciousness is severely impaired in damage to the brainstem reticular formation, and in bilateral lesions of the thalami or cerebral hemispheres * * Different kinds of language abnormalities are caused by lesions in the dominant (usually left) frontal lobe, including Brocas area; the left temporal and parietal lobes, including Wernickes area * 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 light obliquely into each pupil in turn. Look for both the direct (same eye) and consensual (other eye) reactions. Record pupil size in mm and any asymmetry or irregularity * Tes