尹恝_神经系统检查2016_06_16.pptVIP

* * * * * * 感音性耳聋即为神经性耳聋症状是由于内耳耳蜗螺旋器发生病变而引起的听力障碍。临床上将内、外淋巴及基底膜病变引起的内耳导音性聋概括在感音性耳聋中。 传导性耳聋又称传音性聋。外界声波传入内耳的途径因耳部传音系统的病理因素而发生障碍。耳部传音系统有外耳道、鼓膜、听骨、蜗窗等。 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Biceps (C5, C6) The patients arm should be partially flexed at the elbow with the palm down. Place your thumb or finger firmly on the biceps tendon. Strike your finger with the reflex hammer. You should feel the response even if you cant see it. Triceps (C6, C7) Support the upper arm and let the patients forearm hang free. Strike the triceps tendon above the elbow with the broad side of the hammer. If the patient is sitting or lying down, flex the patients arm at the elbow and hold it close to the chest. Brachioradialis (C5, C6) Have the patient rest the forearm on the abdomen or lap. Strike the radius about 1-2 inches above the wrist. Watch for flexion and supination of the forearm. Abdominal (T8, T9, T10, T11, T12) Use a blunt object such as a key or tongue blade. Stroke the abdomen lightly on each side in an inward and downward direction above (T8, T9, T10) and below the umbilicus (T10, T11, T12). Note the contraction of the abdominal muscles and deviation of the umbilicus towards the stimulus. Knee (L2, L3, L4) Have the patient sit or lie down with the knee flexed. Strike the patellar tendon just below the patella. Note contraction of the quadraceps and extension of the knee. Ankle (S1, S2) Dorsiflex the foot at the ankle. Strike the Achilles tendon. Watch and feel for plantar flexion at the ankle * 跟腱反射 腱 反 射 腱反射分级标准 分级 描述 0 消失 1+ or + 反射减弱 2+ or ++ 正常 3+ or +++ 反射增强（活跃），无阵挛 4+ or ++++ 反射增强（亢进），有阵挛 腱反射的定位 反射 涉及的神经根 肱二头肌 颈5,颈6 桡骨膜 颈6 肱三头肌 颈7 膝反射 腰4 踝反射 骶1 跖 反 射 用棉签从后向前轻划足底外侧缘 注意大脚趾的运动，正常向足底屈曲 异常时大脚趾背屈，伴其他四指的散开（巴彬斯基征 Babinski’s sign) 霍夫曼征 (Hoffmann’s sign) 握住中指，向下弹击中指指甲，如果出现其余四指屈曲，大拇指内收，即为阳性 病 理 反 射 Babinski Oppenheim Gordon 下肢各种病理反射 病理反射的意义 提示上运动神经元损害 脑膜刺激征 颈项强直 Kernig’s Sign Brudzinski’s Sign 神经系统查体的内容 一般检查 颅神经 运动系统 感觉系统 反射 自主神经系统