史上最详尽的神经系统查体（双语版）.ppt

* * * * * Neurocutaneous system Several neurologic conditions have telltale cutaneous stigmata. Evaluation for the following can provide valuable diagnostic clues: loss of skin pigmentation as in vitiligo, white hair-lock in Vogt-Harada-Koyanagi disease, cutaneous tumors or ash-leaf spots in tuberous sclerosis (see), and cutaneous eruptions over a dermatome which may signify herpes zoster (see). Coffee-brown pigmented (ie, café; au lait) spots of varying sizes, usually greater than 1.5 cm in diameter, and axillary freckling (see) are seen in neurofibromatosis. These are observed in addition to or in the absence of the characteristic blubbery subcutaneous tumors that give the condition its name. Tufts of hair (satyrs tail), dimples, and large moles along the spine may indicate spina bifida occulta or diastematomyelia of the spinal column. * Axillary freckling as seen in neurofibromatosis. ??????????????????? * Skeletal system - Cranium, spine, bones, joints Palpation of the skull can reveal congenital anomalies that may indicate underlying abnormalities of the brain. In cephaloplegia, one half of the skull may be smaller than the other, possibly signifying asymmetric brain development. Microcephaly or macrocephaly may be detected by measuring the circumference of the head. Observation of the spine may reveal the presence of myelomeningocele, scoliosis, and/or kyphosis. In cases of prenatal brain injuries, the length of the long bones may be reduced on the side opposite the cephaloplegia. Trophic changes in the joints can be associated with denervation in tabes dorsalis or Charcot-Marie-Tooth (CMT) disease. The distal muscular atrophy seen in CMT disease gives the legs the appearance of inverted champagne bottles (see Media file 6). Muscular atrophy seen in the region of the temporalis muscles and facial musculature associated with frontal balding is typical of myotonic dystrophy (see?Media file 7). Pes cavus deformity (see Media file 8) can be associated with spina