Neurological Exami的nation.ppt

Neurological Examination;Consciousness High Cortical function;Consciousness;Glasgow Coma Scale;Orientation Person Place Time Judgement What to do when smelled smoke in theater? ;Immediate memory attention ~ Digit span: Normal seven forward, five backward Recent momory ~ Recall three items or a brief story after a delay of 3 to 5 minutes Remote momory ~ historical or verifiable personal events ;Calculation ~ ( 100 – 7) x 7 times ~ (20 - 3) x 5 times ~ Adjust to premorbid Abstract thinking 姚明比馬英九高, 且馬英九比陳水扁高, 誰最高? 甚麼叫『覆水難收』? 車子跟飛機有甚麼共通點嗎? 你覺得空位該填甚麼: AZ BY CX D_? ;Cranial nerve;選擇有特定氣味,例如: 肥皂, 薄荷,香煙及一有刺激性的物 品，如 ammonia. 將這些物品置於相似瓶中, 請病人指明 這些氣味. 一鼻孔受試時另一鼻孔應用手遮擋. Normal : all identified Only recognised Ammonia: CNI impaired, CN V partly intact All not recognised: Not organic ;General exophthalmos or enophthalmos, ptosis or lid retraction Pupils Size, outline Light reflex 請病人眼直視前方, 以手掌或紙張至於兩眼之間隔檔光線, 並以光照一眼. 光點由眼外側斜斜照入. 觀察時須同時注意受光照之眼與另一眼的瞳孔反應, 正常應會出現協同反射 (Consensual reflex) Accommodation reflex 將手指或筆置於病人鼻前10 cm, 要求病人先注視遠方, 再注視眼前物體, 觀察病人瞳孔調焦的反應 PERRLA (D+C): Pupils Equal and Regular; Reactive to Light and Accommodation (Direct and Consensual) ;Visual Acuity Wall or hand chart(Snellen’s Chart) ? count fingers ? movement ? light Refractive error: If acuity improved by looking thru pinhole card Visual Field Confrontation test: 約相距一隻手臂長 ?以30cm為半徑?請病人試著回答你哪一邊的手指在動 Test Individual Eye 左眼注視你的右眼, ?以病人的眼睛為中心劃一半徑30cm 的假想球面 ?使用白色大頭針, 要求病人告訴你何時最先看到大頭針? 改用紅色大頭針再測試一次;Saccade (Frontal) Frontal gaze center to PPRF (paramedian pontine reticular formation) for rapid eye movements to view new objects on to the fovea. Pursuit (Occipital lobe) Parietal-occipital gaze center via cerebellar and vestibular pathways; for eye movements to keep a moving image centered on the fovea. Convergence (Midbrain) optic pathways to oculomotor nuclei; keep image on fovea when viewed object moved near Vestibulo-ocular reflex (Cerebellar vestibular nucl