神經(jīng)系統(tǒng)規(guī)范化查體課件

神經(jīng)系統(tǒng)宣體NeurologicExamination北家國隱錦經(jīng)閱{數(shù)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL神經(jīng)系統(tǒng)宣體1History-taking-病史采集o臨床醫(yī)生應(yīng)首先初步評價意者的智力狀況和發(fā)病時所處的謀境,以明確者自己陳述的病史是晉可靠,如果息者有明顯的記憶力、意力及思痕牌礙,或發(fā)病時伴隨意識障礙,則病史的荻得必須佩靠家屬、親戚或友o避免管導(dǎo)性的提問o在惠者滔滔不絕或離題太時,可憧慎造時的插悶一些與現(xiàn)有癥狀實切相吳的同題,將話題轉(zhuǎn)回了解蕻病的發(fā)、發(fā)展和般過的方式至吳重要。盡可能搞清楚每個癥狀是如何起始和進展的Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLHistory-taking-病史采集2EquipmentNeededo叩診o音義(256Hz)O享電o棉簽、棉宗曲刪針o眼底鏡Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLEquipmentNeeded3GeneralConsiderationsoOrganizeyourthinkingintoseveralcategories一般檢查(GeneralExamination)智能狀態(tài)(MentalStatus)顱種(CranialNeerves●(MotorSystem)●協(xié)僩性和步態(tài)(CoordinationandGait)反射(Reflexes)●贏覺(SensorySystem)i種功能(AutonomicNerveFunction)腦展剩激征(MeningealIrritationSigns)特檢查(SpecialTests)O莊右對稱o中旭性vs.周圍性損害Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLGeneralConsiderations4GeneralExamination-一檢查o表看、外訛o步態(tài)異常、不自主動作身營養(yǎng)狀況頭部:頭、面、頸o脊框四肢Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLGeneralExamination-一檢查5Menta|Status-智能狀戀O意識水平O炙向力(時間、地點、人物)o淮意力O記憶力o思維過程O語言功能Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLMenta|Status-智能狀戀6Menta|Status-智能狀戀oMiniMentalStatusExamination(MMSE最常用的認如功能障瓣篩查工具共30小項1-5頑一時間定向6-10項一地點定向11-13項一即刺語言記憶14-18項一灌意力和計算力19-21項一短時記憶2-23項一物體命名24項一僖言復(fù)述25項一闃讀理解26-28項一語言理斛29項一語言達30一圖形描畫Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLMenta|Status-智能狀戀7Menta|Status-智能狀態(tài)oMiniMentalStatusExaminationMMSE評含指-每項1,臺值范圍0-30文盲(未受散育)-17分小嚳組(受散肓年限≤6年-20分中學及以上組(受教育年限>6年-24分得分僑亍對威受教盲組喲界值,提示感在認知功能缺損Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLMenta|Status-智能狀態(tài)8Crania|Nerves-顱神經(jīng)觀寨陶容o上瞼下垂〔工工面部下垂或不對貅(V工吐字發(fā)音的清晰度(V,V工工,X,X工異常的眼球笸置(工工,工v,V工o瞳孔的異常或不對稱(工,工工工Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLCrania|Nerves-顱神經(jīng)觀寨陶容9I-Olfactoryo開常親檢查O使用有揮發(fā)性鉭元刺激性的液體或物體,如看水、看皂等,避免使用酒精、氨水等o堵慪一側(cè)鼻孔,檢查另一側(cè)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLI-Olfactory10神經(jīng)系統(tǒng)規(guī)范化查體課件11神經(jīng)系統(tǒng)規(guī)范化查體課件12神經(jīng)系統(tǒng)規(guī)范化查體課件13神經(jīng)系統(tǒng)規(guī)范化查體課件14神經(jīng)系統(tǒng)規(guī)范化查體課件15神經(jīng)系統(tǒng)規(guī)范化查體課件16神經(jīng)系統(tǒng)規(guī)范化查體課件17神經(jīng)系統(tǒng)規(guī)范化查體課件18神經(jīng)系統(tǒng)規(guī)范化查體課件19神經(jīng)系統(tǒng)規(guī)范化查體課件20神經(jīng)系統(tǒng)規(guī)范化查體課件21神經(jīng)系統(tǒng)規(guī)范化查體課件22神經(jīng)系統(tǒng)規(guī)范化查體課件23神經(jīng)系統(tǒng)規(guī)范化查體課件24神經(jīng)系統(tǒng)規(guī)范化查體課件25神經(jīng)系統(tǒng)規(guī)范化查體課件26神經(jīng)系統(tǒng)規(guī)范化查體課件27神經(jīng)系統(tǒng)規(guī)范化查體課件28神經(jīng)系統(tǒng)規(guī)范化查體課件29神經(jīng)系統(tǒng)規(guī)范化查體課件30神經(jīng)系統(tǒng)規(guī)范化查體課件31神經(jīng)系統(tǒng)規(guī)范化查體課件32神經(jīng)系統(tǒng)規(guī)范化查體課件33神經(jīng)系統(tǒng)規(guī)范化查體課件34神經(jīng)系統(tǒng)規(guī)范化查體課件35神經(jīng)系統(tǒng)規(guī)范化查體課件36神經(jīng)系統(tǒng)規(guī)范化查體課件37神經(jīng)系統(tǒng)規(guī)范化查體課件38神經(jīng)系統(tǒng)規(guī)范化查體課件39神經(jīng)系統(tǒng)規(guī)范化查體課件40神經(jīng)系統(tǒng)規(guī)范化查體課件41神經(jīng)系統(tǒng)規(guī)范化查體課件42神經(jīng)系統(tǒng)規(guī)范化查體課件43神經(jīng)系統(tǒng)規(guī)范化查體課件44神經(jīng)系統(tǒng)規(guī)范化查體課件45神經(jīng)系統(tǒng)規(guī)范化查體課件46神經(jīng)系統(tǒng)規(guī)范化查體課件47神經(jīng)系統(tǒng)規(guī)范化查體課件48神經(jīng)系統(tǒng)規(guī)范化查體課件49神經(jīng)系統(tǒng)規(guī)范化查體課件50神經(jīng)系統(tǒng)宣體NeurologicExamination北家國隱錦經(jīng)閱{數(shù)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL神經(jīng)系統(tǒng)宣體51History-taking-病史采集o臨床醫(yī)生應(yīng)首先初步評價意者的智力狀況和發(fā)病時所處的謀境,以明確者自己陳述的病史是晉可靠,如果息者有明顯的記憶力、意力及思痕牌礙,或發(fā)病時伴隨意識障礙,則病史的荻得必須佩靠家屬、親戚或友o避免管導(dǎo)性的提問o在惠者滔滔不絕或離題太時,可憧慎造時的插悶一些與現(xiàn)有癥狀實切相吳的同題,將話題轉(zhuǎn)回了解蕻病的發(fā)、發(fā)展和般過的方式至吳重要。盡可能搞清楚每個癥狀是如何起始和進展的Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLHistory-taking-病史采集52EquipmentNeededo叩診o音義(256Hz)O享電o棉簽、棉宗曲刪針o眼底鏡Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLEquipmentNeeded53GeneralConsiderationsoOrganizeyourthinkingintoseveralcategories一般檢查(GeneralExamination)智能狀態(tài)(MentalStatus)顱種(CranialNeerves●(MotorSystem)●協(xié)僩性和步態(tài)(CoordinationandGait)反射(Reflexes)●贏覺(SensorySystem)i種功能(AutonomicNerveFunction)腦展剩激征(MeningealIrritationSigns)特檢查(SpecialTests)O莊右對稱o中旭性vs.周圍性損害Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLGeneralConsiderations54GeneralExamination-一檢查o表看、外訛o步態(tài)異常、不自主動作身營養(yǎng)狀況頭部:頭、面、頸o脊框四肢Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLGeneralExamination-一檢查55Menta|Status-智能狀戀O意識水平O炙向力(時間、地點、人物)o淮意力O記憶力o思維過程O語言功能Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLMenta|Status-智能狀戀56Menta|Status-智能狀戀oMiniMentalStatusExamination(MMSE最常用的認如功能障瓣篩查工具共30小項1-5頑一時間定向6-10項一地點定向11-13項一即刺語言記憶14-18項一灌意力和計算力19-21項一短時記憶2-23項一物體命名24項一僖言復(fù)述25項一闃讀理解26-28項一語言理斛29項一語言達30一圖形描畫Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLMenta|Status-智能狀戀57Menta|Status-智能狀態(tài)oMiniMentalStatusExaminationMMSE評含指-每項1,臺值范圍0-30文盲(未受散育)-17分小嚳組(受散肓年限≤6年-20分中學及以上組(受教育年限>6年-24分得分僑亍對威受教盲組喲界值,提示感在認知功能缺損Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLMenta|Status-智能狀態(tài)58Crania|Nerves-顱神經(jīng)觀寨陶容o上瞼下垂〔工工面部下垂或不對貅(V工吐字發(fā)音的清晰度(V,V工工,X,X工異常的眼球笸置(工工,工v,V工o瞳孔的異常或不對稱(工,工工工Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLCrania|Nerves-顱神經(jīng)觀寨陶容59I-Olfactoryo開常親檢查O使用有揮發(fā)性鉭元刺激性的液體或物體,如看水、看皂等,避免使用酒精、氨水等o堵慪一側(cè)鼻孔,檢查另一側(cè)Valadononry.chAsposeslidesforNET4odien