神经系统查体

运动检查
0级 Βιβλιοθήκη Baidu级 完全瘫痪
肌力(muscle power)
肌肉可收缩，但不能产生动作
2级
3级 4级
肢体能在床面上移动但不能抬起
肢体能抬离床面但不能抵抗阻力 能做抗阻力动作，但较正常差
5级
正常肌力
对于小关节，如指间关节、掌指关节如何评价？ 2级、3级适用吗？
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
神经系统检查内容
高级神经活动
颅神经 运动系统 感觉系统 反射系统 脑膜刺激征 植物神经
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
内容
顺序 手法
高级神经活动
语言
Ⅰ嗅神经olfactory nerve
非刺激 性物体
主观测试方法(心理物 理测试法) 1. 五味试嗅液检测法 2. 标准微胶囊嗅觉功 能检查（UPSIT） 客观测试法—嗅性相 关电位
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
浅感觉与深感觉
触觉
温度觉
运动觉
位置觉
音叉振动觉
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
感觉检查
复合感觉
定位觉
两点辨别觉
图形觉
实体觉
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅷ
前庭功能检查 1. 眩晕
2. 3. 冷热水试验 旋转试验
4. Dix-Hallpike
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅷ
眼球震颤(nystagmus)
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
神经反射
• 肱二头肌反射 • 肱三头肌反射 • 桡骨骨膜反射 • 膝腱反射 • 跟腱反射 • 阵挛
深反射
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
(-) 消失 (+) 减弱
(++) 存在
Ⅶ面神经facial nerve
◆运动——表情肌 ◆味觉——舌前2/3
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅷ位听神经vestibulocochlear
听力
前庭
眼震
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅴ
感觉
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅴ
角膜反射 (corneal reflex)
眼神经 面神经
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
运动检查
共济运动(coordinationg)
指鼻试验
跟膝胫试验
快复轮替试验
Romberg test
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
运动检查
震颤 舞蹈样 手足徐动
不自主运动
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅸglossopharyngeal nerve，Ⅹvagus nerve
运动
感觉
反射
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅺ副神经spinal accessory nerve
运动：转 颈、耸肩 支配胸锁 乳突肌和 斜方肌
神经系统检查内容
高级神经活动
颅神经 运动系统 感觉系统 反射系统 脑膜刺激征 植物神经
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
浅感觉
深感觉
复合感觉
感觉检查
痛觉
Ⅱ optic nerve 眼底
观察：①视乳头②血管③视网膜
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅲ、Ⅳ、Ⅵ
Oculomotor,Trochlear,Abducent
上斜滑，外直展， 其余都由动眼管。 八个方向检查
神经系统检查内容
高级神经活动
颅神经 运动系统 感觉系统 反射系统 脑膜刺激征 植物神经
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
肌容 积
肌张 力
肌力
步态
运动 障碍
Ⅲ
眼裂
A. 右侧动眼神经麻痹 所引起的上睑下垂； B. 左侧Homer 综合征伴随 上睑下垂和下睑轻度抬高； C. 重症肌无力的双侧非对称性上 睑下垂：波动性、Cogan眼睑抽 动征（Cogan ‘s lid twitch sign）、 门帘征（ curtain sign)。
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅴ三叉神经
trigeminal nerve
运动 感觉 反射
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅻ舌下神经hypoglossal nerve
• 舌的 位置、 形态。 • 运动： 伸舌
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅱ optic nerve 视野
检查方法：对向法
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
射、膝反射、跟腱反射。阵挛：踝阵挛及髌阵挛
病理反射： Hoffmann 征、Babinski 征及其临床意义相
同的Oppenheim征、Gordon征
脑膜刺激征：颈强直、Kernig征、Brudzinski征
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅱ 视神经optic nerve
视力
视野
眼底
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅱ optic nerve 视力
神经科 注意最佳校正视力 近视力卡
"数指"(CF) 、 "手动"(HM) "光感"(LP) "无光感"(NLP)
共济 运动
运动检查
肌营养
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
运动检查
肌张力降低 肌张力增高
肌张力(muscle tone)
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅲ动眼神经
动眼神经麻痹：上睑下垂，上视、内收不能，瞳孔散大，对光反 应消失，复视。
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅲ
大小 对光反射
直接 间接
瞳孔
阿罗瞳孔 调节反射
直径:3~4mm
D
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Ⅳ、Ⅵ
滑车神经麻痹： 外下方活动障 碍。
外展神经麻痹： 外展不能，内 斜视，复视。
学习要求
1
2
3
4
5
脑神经检查 运动功能检查 感觉功能检查 神经反射检查 自主神经功能检查
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
神经系统检查工具
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
(+++) 增强(活跃) (++++) 亢进(伴非持续阵挛) (+++++) 明显亢进(伴持续阵挛)
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
神经系统体格检查
neurophysical examination
张爱武
中山大学附属第一医院神经病学教研室 zhangaw@mail.sysu.edu.cn
Sherrington交互神经支配定律 相应的节段和该节段以上的结构均参与反射
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
浅反射：角膜反射、腹壁反射、提睾反射、跖反射
深反射： 肱二头肌反射、肱三头肌反射、桡骨骨膜反
神经系统检查内容
高级神经活动
颅神经 运动系统 感觉系统 反射系统 脑膜刺激征 植物神经
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
浅反射
深反射
病理反射
四、神经反射系统
精神
智能 意识
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University
脑神经cranial nerves
一嗅二视三动眼 四滑五叉六外展 七面八听九舌咽 十迷一副舌下完
Department of Neurology the First Affiliated Hospital Sun Yat-Sen University