臨床診斷學(xué)-神經(jīng)系統(tǒng)檢查英文

NeurologicalexaminationSunranSIXPARTSOFTHENEUROEXAMMentalState&CognitiveFunctionCranialNervesMotorSystemSensorySystemReflexesAutonomicfunctionMentalState

-LevelofconsciousnessNORMAL:patientawakeandalert,attentivetosurroundingandtotheexaminerDEPRESSED:SleepyLethargicStuporous-arousingonlybrieflyinresponsetopainstimulationComatose-notarousablebyverbalandpainstimulationCognitiveFunctionA.Memory:instant;Shortterm-namethreecommonobjects,thenrecallthemagainafter5minutes;Longterm-verifiableeventsfromthepastB.Calculations:Serialsevens:countbackwardfrom100,takingaway7eachtime.Real-lifeproblemC.Orientationtoperson,place,andtime.CognitiveFunctionD.Aphasia:expression,reception,repeat,name,read,writeE.ApraxiaF.AgnosiaG.exetutionOther:Insightandjudgment,concentration,patientsmood,contentofthough,appropriatenessofbehavior,andsoon.MMSECRANIALNERVES

CRANIALNERVES

-Olfactory(I)Askthepatienttoidentifycommonscentssuchascoffee,vanilla,etc,witheyesclosed.Donotuseirritants.Intestingolfactorynervefunction,itislessimportanttodeterminewhetherthepatientcancorrectlyidentifyaparticularodorthanwhetherthepresenceorabsenceofthestimulusisperceivedCRANIALNERVES

-Optic(II)VisualAcuity-pocketcardorwallchartoranyreadingmattersuchasnewspaperVisualFieldConfrontationTesting-Patientandexaminerstandateyelevelataboutarm’slength.HavethepatientcoverhisowneyeThreatTesting-appliedwhenthepatientislessthanfullyalertorisuncooperativeFundus(Ophthalmoscopic)ExaminationCRANIALNERVES

-PupillaryReflexes(II,III)Anormalpupilwillconstrictinresponsetodirectlight,asaconsensualresponsetolightintheoppositeeye,andtoaccommodation(convergencetofocusonacloseobject)CRANIALNERVES

-ControlofExtraocularMuscleMovements

(III,IV,VI)Extraocularmusclemovementsarecontrolledbytheoculomotor(III),trochlear(IV),andabducens(V)nervesVolitionalEyeMovement-Followmyfinger,justwithyoureyes.TracingtheLetterHAskaboutDiplopiaNystagmusisrthythmicoscillationoftheeyesCRANIALNERVES

-TrigeminalNerve(V)FacialSensationCornealReflex-Sweepawispofcottonlightlyacrossthelateralsurfaceoftheeye(outofthedirectvisualfield)fromscleratocornea-V,VIIMotorVTesting-Observethesymmetryofopeningandclosingofthemouth.AskthepatienttoclenchtheteethandthenattempttoforcejawopeningCRANIALNERVE

-FacialStrength(VII)FacialSymmetry-observethepatient’sfaceforsymmetryofthepalpebralfissuresandnasolabialfoldsatrest.Askthepatienttowrinkletheforehead,thentosqueezetheeyestightlyshut,thentosmileorsnarl,sayingshowyourteethSupernuclearlesionNucleusorperipherallesionBilateralFacialWeaknessCRANIALNERVE

-Auditory(VIII)Auditoryacuitycanbetestedcrudelybyrubbingthumbandforefingertogetherabout5cmfromeachear.Ifthepatientcannotheartherub,proceedtothefollowtestsRinneTest-holdthebaseoftuningfolkonthemastoidprocessuntilthesoundisnolongerperceived,thenbringthestillvibratingforkupclosetotheear.SensorineurallossConductivelossWeberTestCRANIALNERVE

-Auditory(VIII)WeberTest-lightlystrikeatuningforkandplacethehandleonthemidlineoftheforeheadConductivelossSensorineurallossVestibularFunction-needtobetestedonlyiftherearecomplaintsdizzinessorvertigoorevidenceofnystagmusNylen-Barany(Dix-Hallpike)maneuvertestforpositionalnystagmusCRANIALNERVE

-Glossopharyngeal(IX)&Vagus(X)Testthefunctionofthepalate,pharynx,andlarynx1.Palatalelevation-say“ah”2.Gagreflex(afferentIX,efferentX)-gentlytoucheachsideoftheposteriorpharyngealwallwithacottonswab3.Sensoryfunction-lightlytoucheachsideofthesoftpalatewiththetipofacottonswab4.Voicequality-listenforhoarsenessor“breathiness”,suggestinglaryngealweaknessCRANIALNERVE

-Accessory(XI)Sternocleidomastoid-pressahandagainstthepatient’sjawandhavethepatientrotatetheheadagainstresistance.PressingagainsttherightjawteststheleftsternocleidomastoidandviceversaTrapezius-havethepatientshrugshouldersagainstresistanceandassessweaknessCRANIALNERVE

-Hypoglossal(XII)Testsforhypoglossalnervefunctionincludethefollowing1.AtrophyorFasciculations-withthepatient’stonguerestinginthefloorofthemouth,firstinspectforatrophyorfasciculations.Thenaskthepatienttoprotrudethetongue,andobservefordeviationtotheweakside2.SubtleWeakness-havethepatientpushthetongueintoeachcheekagainstexternalresistance(oppositehypoglossalm.)3.SubtleDysarthria-AskthepatienttorepeatdifficultphrasesSensoryFunctionMotorFunction運動系統(tǒng)A.MuscleStrengthTheclassicgradingsystemscoresasfollows:5,fullstrength;4,movementagainstgravityand&resistance;3,movementagainstgravityonly;2,movementhorizontallyalongthesurfaceofthebed;1,palpablecontractionbutlittlevisiblemovement;0,nocontraction運動系統(tǒng)B.MuscleToneDecreased(floppy,flaccid,hypotonic)NormalIncreased(Spasticvs.Rigid)C.AtaxiaCerebellarhemisphereareresponsibleforcoordinatingandfine-tuningmovements(ipsilateral)1.Finger-to-Nose2.RapidAlternatingMovements3.Rebound4.Heel-Knee-ShinRomberg’stestisaquickandexcellen