診斷學(xué)診斷神經(jīng)檢查課件

神經(jīng)系統(tǒng)檢查神經(jīng)系統(tǒng)檢查1神經(jīng)系統(tǒng)檢查概述神經(jīng)系統(tǒng)檢查的重要性神經(jīng)系統(tǒng)檢查包括*通過檢查可獲取對(duì)意識(shí)狀態(tài)、精神狀神經(jīng)系統(tǒng)疾病的定態(tài)位診斷信息*顱神經(jīng)檢查*定位:主要看體運(yùn)動(dòng)功能檢查征定狀*感覺功能檢查性:主要看癥神經(jīng)反射檢查*自主神經(jīng)功能檢查神經(jīng)系統(tǒng)檢查概述2腦神經(jīng)檢查需要掌握的解剖生理腦神經(jīng)共有12對(duì)(由滑車神經(jīng)核叉神經(jīng)中腦核上至下,嗅視動(dòng)滑三展面聽,舌迷副三又神經(jīng)舌)三叉神經(jīng)中腦宋叉神經(jīng)運(yùn)動(dòng)核前庭神經(jīng)核展神經(jīng)核其中:蝸神經(jīng)核面神經(jīng)核面神經(jīng)端腦1(I)面神經(jīng)前庭蝸神經(jīng)必涎核舌咽神經(jīng)*間腦1(Ⅱ)下泌涏核迷走神經(jīng)舌咽神經(jīng)孤束核*中腦2(Ⅲ、IV)迷走神經(jīng)叉神經(jīng)脊束核*腦橋4(VⅧ)劇神經(jīng)核疑棱*延髓4(DX~Ⅻ)迷走神經(jīng)背核神綸腦神經(jīng)檢查3腦神經(jīng)檢查需要掌握的解剖生理(二腦神經(jīng)共有12對(duì),其中:*感覺神經(jīng)有3對(duì):I、、Ⅷ*混合神經(jīng)有4對(duì):V、Ⅶ、Ⅸ、X*運(yùn)動(dòng)神經(jīng)有5對(duì):Ⅲ、Ⅳ、Ⅵ、Ⅺ、Ⅻ對(duì)于含有運(yùn)動(dòng)纖維的腦神經(jīng),要注意:僅接受對(duì)側(cè)中樞支配的腦運(yùn)動(dòng)神經(jīng)核有1對(duì)半:Ⅶ核的下部、Ⅻ核腦神經(jīng)檢查4腦神經(jīng)檢查嗅神經(jīng)(I)解剖生理:嗅粘膜,溴神經(jīng),嗅覺中樞(顳葉)*檢查:用有特殊氣味的物品,兩側(cè)分別測(cè)試*嗅覺障礙:減弱、消失、幻嗅*臨床意義:*一側(cè)嗅覺減弱或消失:多為同側(cè)嗅神經(jīng)病變*雙側(cè)嗅覺減弱或消失:多為鼻粘膜病變*幻嗅:中樞病變(顳葉)腦神經(jīng)檢查5腦神經(jīng)檢查視神經(jīng)(工)解剖生理:視網(wǎng)膜,視神經(jīng),視交叉,視放射,視皮層檢查枧力:臨床上常用粗測(cè)法。如要求精確則使用視力表。視野:臨床上常用粗測(cè)法。如要求精確則使用視野計(jì)眼底:眼底鏡。神經(jīng)科主要看視乳頭及A/V臨床意義視力障礙的程度常代表視神經(jīng)損害的程度。如:視力減退→辨指距離→>僅有光感→無光感。*視野缺損的類型常表明視覺通路受損的部位。如:側(cè)全盲、兩顳側(cè)偏盲、雙側(cè)同向偏盲、象限盲*眼底異常:視乳頭水腫(顱內(nèi)壓增高),視乳頭蒼白(視神經(jīng)萎縮),A八V縮小(多表示視網(wǎng)膜動(dòng)脈硬化)腦神經(jīng)檢查6視覺傳導(dǎo)路民視固鼻網(wǎng)視覺傳導(dǎo)路7第l、I對(duì)顱神經(jīng)的檢查第l、I對(duì)顱神經(jīng)的檢查8腦神經(jīng)檢查動(dòng)眼(Ⅲ)、滑車(Ⅳ)、展神經(jīng)(Ⅵ)解剖生理:眼球運(yùn)動(dòng)神經(jīng),光反射通路檢查方法*靜止時(shí)外觀:有無上瞼下垂,有無斜視眼球運(yùn)動(dòng)時(shí):有無運(yùn)動(dòng)受限(方向及程度),有無復(fù)視瞳孔的檢查及瞳孔對(duì)光反射:直接對(duì)光反射,間接對(duì)光反射臨床意義:*動(dòng)眼神經(jīng)麻痹:眼球向內(nèi)、向上及向下活動(dòng)受限,上瞼下垂,瞳孔擴(kuò)大*滑車神經(jīng)損害:眼球向下及向外運(yùn)動(dòng)減弱*展神經(jīng)損害:眼球向外運(yùn)動(dòng)受限*瞳孔對(duì)光反射異常:光反射的通路受損腦神經(jīng)檢查9第Ⅲ、Ⅳ、Ⅵ對(duì)顱神經(jīng)的檢查第Ⅲ、Ⅳ、Ⅵ對(duì)顱神經(jīng)的檢查10診斷學(xué)診斷神經(jīng)檢查課件11診斷學(xué)診斷神經(jīng)檢查課件12診斷學(xué)診斷神經(jīng)檢查課件13診斷學(xué)診斷神經(jīng)檢查課件14診斷學(xué)診斷神經(jīng)檢查課件15診斷學(xué)診斷神經(jīng)檢查課件16診斷學(xué)診斷神經(jīng)檢查課件17診斷學(xué)診斷神經(jīng)檢查課件18診斷學(xué)診斷神經(jīng)檢查課件19診斷學(xué)診斷神經(jīng)檢查課件20診斷學(xué)診斷神經(jīng)檢查課件21診斷學(xué)診斷神經(jīng)檢查課件22診斷學(xué)診斷神經(jīng)檢查課件23診斷學(xué)診斷神經(jīng)檢查課件24診斷學(xué)診斷神經(jīng)檢查課件25診斷學(xué)診斷神經(jīng)檢查課件26診斷學(xué)診斷神經(jīng)檢查課件27診斷學(xué)診斷神經(jīng)檢查課件28診斷學(xué)診斷神經(jīng)檢查課件29診斷學(xué)診斷神經(jīng)檢查課件30診斷學(xué)診斷神經(jīng)檢查課件31診斷學(xué)診斷神經(jīng)檢查課件32診斷學(xué)診斷神經(jīng)檢查課件33診斷學(xué)診斷神經(jīng)檢查課件34診斷學(xué)診斷神經(jīng)檢查課件35診斷學(xué)診斷神經(jīng)檢查課件36診斷學(xué)診斷神經(jīng)檢查課件37診斷學(xué)診斷神經(jīng)檢查課件38診斷學(xué)診斷神經(jīng)檢查課件39診斷學(xué)診斷神經(jīng)檢查課件40診斷學(xué)診斷神經(jīng)檢查課件41診斷學(xué)診斷神經(jīng)檢查課件42診斷學(xué)診斷神經(jīng)檢查課件43診斷學(xué)診斷神經(jīng)檢查課件44診斷學(xué)診斷神經(jīng)檢查課件45診斷學(xué)診斷神經(jīng)檢查課件46診斷學(xué)診斷神經(jīng)檢查課件47診斷學(xué)診斷神經(jīng)檢查課件48診斷學(xué)診斷神經(jīng)檢查課件49診斷學(xué)診斷神經(jīng)檢查課件50診斷學(xué)診斷神經(jīng)檢查課件51診斷學(xué)診斷神經(jīng)檢查課件52診斷學(xué)診斷神經(jīng)檢查課件53診斷學(xué)診斷神經(jīng)檢查課件54神經(jīng)系統(tǒng)檢查神經(jīng)系統(tǒng)檢查55神經(jīng)系統(tǒng)檢查概述神經(jīng)系統(tǒng)檢查的重要性神經(jīng)系統(tǒng)檢查包括*通過檢查可獲取對(duì)意識(shí)狀態(tài)、精神狀神經(jīng)系統(tǒng)疾病的定態(tài)位診斷信息*顱神經(jīng)檢查*定位:主要看體運(yùn)動(dòng)功能檢查征定狀*感覺功能檢查性:主要看癥神經(jīng)反射檢查*自主神經(jīng)功能檢查神經(jīng)系統(tǒng)檢查概述56腦神經(jīng)檢查需要掌握的解剖生理腦神經(jīng)共有12對(duì)(由滑車神經(jīng)核叉神經(jīng)中腦核上至下,嗅視動(dòng)滑三展面聽,舌迷副三又神經(jīng)舌)三叉神經(jīng)中腦宋叉神經(jīng)運(yùn)動(dòng)核前庭神經(jīng)核展神經(jīng)核其中:蝸神經(jīng)核面神經(jīng)核面神經(jīng)端腦1(I)面神經(jīng)前庭蝸神經(jīng)必涎核舌咽神經(jīng)*間腦1(Ⅱ)下泌涏核迷走神經(jīng)舌咽神經(jīng)孤束核*中腦2(Ⅲ、IV)迷走神經(jīng)叉神經(jīng)脊束核*腦橋4(VⅧ)劇神經(jīng)核疑棱*延髓4(DX~Ⅻ)迷走神經(jīng)背核神綸腦神經(jīng)檢查57腦神經(jīng)檢查需要掌握的解剖生理(二腦神經(jīng)共有12對(duì),其中:*感覺神經(jīng)有3對(duì):I、、Ⅷ*混合神經(jīng)有4對(duì):V、Ⅶ、Ⅸ、X*運(yùn)動(dòng)神經(jīng)有5對(duì):Ⅲ、Ⅳ、Ⅵ、Ⅺ、Ⅻ對(duì)于含有運(yùn)動(dòng)纖維的腦神經(jīng),要注意:僅接受對(duì)側(cè)中樞支配的腦運(yùn)動(dòng)神經(jīng)核有1對(duì)半:Ⅶ核的下部、Ⅻ核腦神經(jīng)檢查58腦神經(jīng)檢查嗅神經(jīng)(I)解剖生理:嗅粘膜,溴神經(jīng),嗅覺中樞(顳葉)*檢查:用有特殊氣味的物品,兩側(cè)分別測(cè)試*嗅覺障礙:減弱、消失、幻嗅*臨床意義:*一側(cè)嗅覺減弱或消失:多為同側(cè)嗅神經(jīng)病變*雙側(cè)嗅覺減弱或消失:多為鼻粘膜病變*幻嗅:中樞病變(顳葉)腦神經(jīng)檢查59腦神經(jīng)檢查視神經(jīng)(工)解剖生理:視網(wǎng)膜,視神經(jīng),視交叉,視放射,視皮層檢查枧力:臨床上常用粗測(cè)法。如要求精確則使用視力表。視野:臨床上常用粗測(cè)法。如要求精確則使用視野計(jì)眼底:眼底鏡。神經(jīng)科主要看視乳頭及A/V臨床意義視力障礙的程度常代表視神經(jīng)損害的程度。如:視力減退→辨指距離→>僅有光感→無光感。*視野缺損的類型常表明視覺通路受損的部位。如:側(cè)全盲、兩顳側(cè)偏盲、雙側(cè)同向偏盲、象限盲*眼底異常:視乳頭水腫(顱內(nèi)壓增高),視乳頭蒼白(視神經(jīng)萎縮),A八V縮小(多表示視網(wǎng)膜動(dòng)脈硬化)腦神經(jīng)檢查60視覺傳導(dǎo)路民視固鼻網(wǎng)視覺傳導(dǎo)路61第l、I對(duì)顱神經(jīng)的檢查第l、I對(duì)顱神經(jīng)的檢查62腦神經(jīng)檢查動(dòng)眼(Ⅲ)、滑車(Ⅳ)、展神經(jīng)(Ⅵ)解剖生理:眼球運(yùn)動(dòng)神經(jīng),光反射通路檢查方法*靜止時(shí)外觀:有無上瞼下垂,有無斜視眼球運(yùn)動(dòng)時(shí):有無運(yùn)動(dòng)受限(方向及程度),有無復(fù)視瞳孔的檢查及瞳孔對(duì)光反射:直接對(duì)光反射,間接對(duì)光反射臨床意義:*動(dòng)眼神經(jīng)麻痹:眼球向內(nèi)、向上及向下活動(dòng)受限,上瞼下垂,瞳孔擴(kuò)大*滑車神經(jīng)損害:眼球向下及向外運(yùn)動(dòng)減弱*展神經(jīng)損害:眼球向外運(yùn)動(dòng)受限*瞳孔對(duì)光反射異常:光反射的通路受損腦神經(jīng)檢查63第Ⅲ、Ⅳ、Ⅵ對(duì)顱神經(jīng)的檢查第Ⅲ、Ⅳ、Ⅵ對(duì)顱神經(jīng)的檢查64診斷學(xué)診斷神經(jīng)檢查課件65診斷學(xué)診斷神經(jīng)檢查課件66診斷學(xué)診斷神經(jīng)檢查課件67診斷學(xué)診斷神經(jīng)檢查課件68診斷學(xué)診斷神經(jīng)檢查課件69診斷學(xué)診斷神經(jīng)檢查課件70診斷學(xué)診斷神經(jīng)檢查課件71診斷學(xué)診斷神經(jīng)檢查課件72診斷學(xué)診斷神經(jīng)檢查課件73診斷學(xué)診斷神經(jīng)檢查課件74診斷學(xué)診斷神經(jīng)檢查課件75診斷學(xué)診斷神經(jīng)檢查課件76診斷學(xué)診斷神經(jīng)檢查課件77診斷學(xué)診斷神經(jīng)檢查課件78診斷學(xué)診斷神經(jīng)檢查課件79診斷學(xué)診斷神經(jīng)檢查課件80診斷學(xué)診斷神經(jīng)檢查課件81診斷學(xué)診斷神經(jīng)檢查課件82診斷學(xué)診斷神經(jīng)檢查課件83診斷學(xué)診斷神經(jīng)檢查課件84診斷學(xué)診斷神經(jīng)檢查課件85診斷學(xué)診斷神經(jīng)檢查課件86診斷學(xué)診斷神經(jīng)檢查課件87診斷學(xué)診斷神經(jīng)檢查課件88診斷學(xué)診斷神經(jīng)檢查課件89診斷學(xué)診斷神經(jīng)檢查課件90診斷學(xué)診斷神經(jīng)檢查課件91診斷學(xué)診斷神經(jīng)檢查課件92診斷學(xué)診斷神經(jīng)檢查課件93診斷學(xué)診斷神經(jīng)檢查課件94診斷學(xué)診斷神經(jīng)檢查課件95診斷學(xué)診斷神經(jīng)檢查課件96