神经系统查体 (2)课件课件.ppt

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2024-11-16 发布于广东
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神经系统查体 (2)课件课件.ppt

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**Differentkindsoflanguageabnormalitiesarecausedbylesionsinthedominant(usuallyleft)frontallobe,includingBrocasarea;thelefttemporalandparietallobes,includingWernickesarea****TestExtraocularMovementsStandorsit3to6feetinfrontofthepatient.Askthepatienttofollowyourfingerwiththeireyeswithoutmovingtheirhead.CheckgazeinthesixcardinaldirectionsusingacrossorHpattern.Pauseduringupwardandlateralgazetocheckfornystagmus.[6]Checkconvergencebymovingyourfingertowardthebridgeofthepatientsnose.TestPupillaryReactionstoLightDimtheroomlightsasnecessary.Askthepatienttolookintothedistance.Shineabrightlightobliquelyintoeachpupilinturn.Lookforboththedirect(sameeye)andconsensual(othereye)reactions.Recordpupilsizeinmmandanyasymmetryorirregularity**TestTemporalandMasseterMuscleStrengthAskpatienttobothopentheirmouthandclenchtheirteeth.PalpatethetemporalandmassettermusclesastheydothisTesttheThreeDivisionsforPainSensationExplainwhatyouintendtodo.Useasuitablesharpobjecttotesttheforehead,cheeks,andjawonbothsides.[7]SubstituteabluntobjectoccasionallyandaskthepatienttoreportsharpordullTesttheCornealReflex++Askthepatienttolookupandaway.Fromtheotherside,touchthecornealightlywithafinewispofcotton.Lookforthenormalblinkreactionofbotheyes.Repeatontheotherside.**ScreenHearing[9]Facethepatientandholdoutyourarmswithyourfingersneareachear.Rubyourfingerstogetherononesidewhilemovingthefingersnoiselesslyontheother.Askthepatienttotellyouwhenandonwhichsidetheyheartherubbing.Increaseintensityasneededandnoteanyassymetry.Ifabnormal,proceedwiththeWeberandRinnetestsTestforLateralization(Weber)++Usea512Hzor1024Hztuningfork.Starttheforkvibratingby