NEUROLOGICAL EXAMINATION课件.pptVIP

NEUROLOGICAL EXAMINATION Headache 5th most common reason for OP visit Symptom! (not a disease) Most important diagnostic clue is a steady, bilateral, nonthrobbing pain that is worse in the a.m. May awaken patient Worse with VALSALVA Types of Headaches Tension Sinus Migraine Classic Common Complicated Cluster Post-traumatic Post-LP Types of Headaches Temporal Arteritis ICP Subarachnoid hemorrhage Infection Ocular Trigeminal neuralgia (Tic doloureaux) TMJ syndrome Toxic Headache History Location Unilateral ~ migraine Periorbital ~ glaucoma/uveitis Parietal/Occipital ~ tension Neck ~ meningitis or Subarachnoid hemorrhage Quality “Throbbing” ~ vascular “Intermittent jabbing” ~ Trigeminal neuralgia “Pressure” ~ sinus Radiation? Severity Timing Constant vs. intermittent Worse in a.m. or p.m. Worst headache ever????? Headache History Associated Sx’s Visual disturbance Vertigo N/V Dysesthesias Aura Past medical history Family history Current medication/drug use Suspect an extracranial etiology if pain is the only symptom The Neuro Exam Should Evaluate the Entire Neuraxis Higher Cortical Function: cortex Cranial Nerves: subcortex, brainstem Cerebellar Function: cerebellum Motor: motor homonculous, subcortical pyramidal tracts, BS, cord, radicle, PN, muscle Sensory: ascending tracts, thalamus, subcortical tracts, sensory hononculous Deep Tendon Reflexes: afferent PN, radicle, cord, efferent PN, muscle Pathologic Reflexes: SIX PARTS OF THE NEURO EXAM Mental State Cognitive Function Cranial Nerves Motor System Sensory System Reflexes cerebellar Function Meninges system survey Reticular Activating System Receives multiple sensory inputs Mediates wakefulness Mental State Cognitive Function -Level of consciousness( Mental State) NORMAL: patient awake and alert, attentive to surrounding and to the examiner DEPRESSED: Sleepy: An obtunded patient opens their eyes, responds slowly to questions, is somewhat confused, and has a decreased interest in their environ