神经系统查体概述ppt课件.ppt

* * * Screen Hearing [9] Face the patient and hold out your arms with your fingers near each ear. Rub your fingers together on one side while moving the fingers noiselessly on the other. Ask the patient to tell you when and on which side they hear the rubbing. Increase intensity as needed and note any assymetry. If abnormal, proceed with the Weber and Rinne tests Test for Lateralization (Weber) ++ Use a 512 Hz or 1024 Hz tuning fork. Start the fork vibrating by tapping it on your opposite hand. Place the base of the tuning fork firmly on top of the patients head. Ask the patient where the sound appears to be coming from (normally in the midline). Compare Air and Bone Conduction (Rinne) ++ Use a 512 Hz or 1024 Hz tuning fork. Start the fork vibrating by tapping it on your opposite hand. Place the base of the tuning fork against the mastoid bone behind the ear. When the patient no longer hears the sound, hold the end of the fork near the patients ear (air conduction is normally greater than bone conduction) * * Watch and palpate the sternomastoid muscle on the opposite side * * 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. * * * * * * * * * Pain Use a suitable sharp object to test sharp or dull sensation. [7] Test the following areas: Shoulders (C4) Inner and outer aspects of the forearms (C6 and T1) Thumbs and little fingers (C6 and C8) Front of both thighs (L2) Medial and lateral aspect of both calves (L4 and L5) Little toes (S1) Temperature Often omitted if pain sensation is normal. ++ Use a tuning fork heated or cooled by water and ask the patient to identify hot or cold. Test the following areas: Shoulders (C4) Inner and outer aspects of the forearms (C6 and T1) Thumbs and little fingers (C6 and C8) Front of both thighs (L2) Medial and lateral aspect of both calves (L4 and L5) Little toes (S1)