外科学课件：神经系统查体.ppt

* * The neurologic examination is always performed and recorded in a sequential and uniform manner in order to avoid omissions and to facilitate the subsequent analysis of case records. * * . * Test Extraocular Movements Stand or sit 3 to 6 feet in front of the patient. Ask the patient to follow your finger with their eyes without moving their head. Check gaze in the six cardinal directions using a cross or H pattern. Pause during upward and lateral gaze to check for nystagmus. [6] Check convergence by moving your finger toward the bridge of the patients nose. Test Pupillary Reactions to Light Dim the room lights as necessary. Ask the patient to look into the distance. Shine a bright light obliquely into each pupil in turn. Look for both the direct (same eye) and consensual (other eye) reactions. Record pupil size in mm and any asymmetry or irregularity * Test Temporal and Masseter Muscle Strength Ask patient to both open their mouth and clench their teeth. Palpate the temporal and massetter muscles as they do this Test the Three Divisions for Pain Sensation Explain what you intend to do. Use a suitable sharp object to test the forehead, cheeks, and jaw on both sides. [7] Substitute a blunt object occasionally and ask the patient to report sharp or dull Test the Corneal Reflex ++ Ask the patient to look up and away. From the other side, touch the cornea lightly with a fine wisp of cotton. Look for the normal blink reaction of both eyes. Repeat on the other side. * Screen Hearing [9] Face the patient and hold out your arms with your fingers near each ear. Rub your fingers together on one side while moving the fingers noiselessly on the other. Ask the patient to tell you when and on which side they hear the rubbing. Increase intensity as needed and note any assymetry. If abnormal, proceed with the Weber and Rinne tests Test for Lateralization (Weber) ++ Use a 512 Hz or 1024 Hz tuning fork. Start the fork vibrating by tapping it on y