脑中风的神经学检查及评价.PPT

? ? 15.中樞神經系統損害之病史(腫瘤、血管瘤、顱內或脊柱的手術) ? ? 16.懷疑或經證實包括SAH之顱內出血或其病史 ? ? 17.嚴重且未被控制的動脈高血壓 ? ? 18.過去10天內曾動過大手術或有嚴重創傷(包括最近之急性心肌梗塞所伴隨的任何創傷)，最近頭部或顱部曾發生創傷 ? ? 19.過久的或創傷性的心肺甦醒術(超過2分鐘)、分娩、過去10天內曾對無法壓制之部位施行血管穿刺(如鎖骨下靜脈或頸靜脈穿刺) ? ? 20.嚴重肝病，包括肝衰竭、肝硬化、肝門脈高壓(食道靜脈 曲張)及急性肝炎 ? ? 21.出血性視網膜病變，如糖尿病性(視覺障礙可能為出血性視網膜病變的指標)或其他出血性眼疾 ? ? 22.細菌性心內膜炎，心包炎 ? ? 23.急性胰臟炎 ? ? 24最近3個月內曾患胃腸道潰瘍 ? ? 25.動脈瘤動靜脈型畸形 ? ? 26.易出血之腫瘤 ? ? 27.對本藥之主成分Actilyse或賦型劑過敏者 ? ? 28.其他(例如在排除條件未提到但會增加出血危險的狀況，如洗腎患者、嚴重心衰竭或身體太衰弱者 THANK YOU!! The End NEUROLOGY R1 陳安芝 2008/08/05 腦中風的神經學檢查及評估 檢查的原則 原有功能喪失 額外的症狀 運動/感覺 Sudden weakness, paralysis, or numbness of the face, arm and the leg on one or both sides of the body Loss of speech, or difficulty speaking or understanding speech Dimness or loss of vision, particularly in only one eye Unexplained dizziness (especially when associated with other neurologic symptoms) unsteadiness, or sudden falls Sudden severe headache and/or loss of consciousness EVALUATION Vital signs Consciousness Cranial nerve Motor Sensory High cortical function Cranial nerve CN 2: visual field, light reflex CN 3, 4, 6: extra-ophthalmic muscle, nystagmus CN 5: facial sensation, masseter muscle CN 7: facial expression CN 8: audiotory/vestibular CN 9, 10: swallow, gag reflex CN 11: sternocleidomastoideus CN 12: tongue movement Motor Muscle power/muscle tone DTR/ pathologic reflex Barbinskin’s sign Holfmann’s sign Involuntary movement Tremor Clonus/Myoclonus Chorea Cerebellar sign: Finger-nose-finger Romberg test Gait Sensory numbness Paresthesia Pain/temperature Joint position/vibration High cortical function 左腦(優勢半球): 語言 右腦:視覺、立體感覺?半邊忽略 失語症 失用症 人格異常 JOMAC:JudgementOrientationMemoryAbstract thinkingCalculation Loss of Consciousness Vital sign Light reflex/ Treaten test Eye movement/Doll’s eye sign Facial nerve Gag reflex Extremities movement/ stimulation DTR/ pathologic reflex 衛教 微笑測試：叫病人微笑或秀出牙齒，看嘴角有無歪斜。 舉手測試：叫病人雙眼閉合，雙手手心朝上，向前平舉約10秒，看患側有無垂下。 言語測試：叫病人說話或唸報紙，看是否流暢。 腦中風發作的徵兆 1. 臉部或一側肢體突然感