课件：神经系统检查2013.ppt

THANK YOU SUCCESS * * 可编辑 * * 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. * * * Biceps (C5, C6) The patients arm should be partially flexed at the elbow with the palm down. Place your thumb or finger firmly on the biceps tendon. Strike your finger with the reflex hammer. You should feel the response even if you cant see it. Triceps (C6, C7) Support the upper arm and let the patients forearm hang free. Strike the triceps tendon above the elbow with the broad side of the hammer. If the patient is sitting or lying down, flex the patients arm at the elbow and hold it close to the chest. Brachioradialis (C5, C6) Have the patient rest the forearm on the abdomen or lap. Strike the radius about 1-2 inches above the wrist. Watch for flexion and supination of the forearm. Abdominal (T8, T9, T10, T11, T12) Use a blunt object such as a key or tongue blade. Stroke the abdomen lightly on each side in an inward and downward direction above (T8, T9, T10) and below the umbilicus (T10, T11, T12). Note the contraction of the abdominal muscles and deviation of the umbilicus towards the stimulus. Knee (L2, L3, L4) Have the patient sit or lie down with the knee flexed. Strike the patellar tendon just below the patella. Note contraction of the quadraceps and extension of the knee. Ankle (S1, S2) Dorsiflex the foot at the ankle. Strike the Achilles tendon. Watch and feel for plantar flexion at the ankle * * * * * * 刺激皮肤\粘膜\角膜等引起肌肉快速收缩反应 角膜\咽\软腭反射(见脑神经检查) 2. 浅反射 反射(reflex)检查 角膜反射 （脑桥） 腹壁反射 （上：胸 7-8） （中：胸 9-10） （下：胸 11-12） 提睾反射 （腰 1-2） 肛门反射 （骶 4-5） 2.浅反射(皮肤、粘膜反射） 反射中心T7~12, 经肋间神经传导 患者仰卧, 双下肢略屈曲, 沿肋弓下 缘(T7~8)\脐孔水平(T9~10)\腹股沟 上(T11~12)由外向内轻划腹壁皮肤, 引起该侧腹肌收缩\脐孔向刺激部 偏移分别为上\中\下腹壁反射 肥胖者经产妇可引不出 (1) 腹壁反射(abdominal reflexes) 反射(r