（优质课件）神经系统查体.ppt

8. 脑膜刺激征 屈颈试验 克匿格(Kernig)征 布鲁津斯基(Brudzinski)征 ■常见于中枢神经系统感染 ■蛛网膜下腔出血 ■颅内高压症 但深昏迷时消失 * 自主神经检查 ■一般检查：皮肤黏膜、毛发、指甲、出汗、瞳孔 ■内脏及括约肌功能：胃肠功能、排尿障碍及性质、下腹部膀胱区碰撞程度等 ■自主神经反射 眼心反射 皮肤划痕试验 竖毛试验 * THE END * 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 Test Temporal and Masseter Muscle Strength Ask patient to both open their mouth and clench their teeth. Palpate the temporal and massetter muscles as they do this Test the Three Divisions for Pain Sensation Explain what you intend to do. Use a suitable sharp object to test the forehead, cheeks, and jaw on both sides. [7] Substitute a blunt object occasionally and ask the patient to report sharp or dull Test the Corneal Reflex ++ Ask the patient to look up and away. From the other side, touch the cornea lightly with a fine wisp of cotton. Look for the normal blink reaction of both eyes. Repeat on the other side. 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