小兒神經學理學檢查 Fellow 黃意評 2010-11-25. 檢查大綱 Mental status Cranial nerve,...
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Transcript of 小兒神經學理學檢查 Fellow 黃意評 2010-11-25. 檢查大綱 Mental status Cranial nerve,...
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小兒神經學理學檢查
Fellow 黃意評2010-11-25
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檢查大綱• Mental status • Cranial nerve, • Motor, • Cerebellar, • Sensory examinations
• Newborn:• Primitive reflex• Jitterness and clonus
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GCS:E4M6V5 Vital sign: 36.9 /94bpm/24/min, BP:113/81 mmHg℃1. Judgement : 紅綠燈過馬路、火災時會打 1192. Orientation: Person~ Time~ Place~3. Memory: a. immediate recall 3 objects: 醫院 ( 具體 ) 、紅色 ( 顏色 ) 、勇敢 ( 抽
象 ) b. recent : 為何住院 ? c. remote : 住址、電話、姓名4. Abstract thinking: 蓮霧與西瓜異同、誠實與謙虛5. Calculation: a. Series of 7 b. Series of 36.Language: Fluency: OK Comprehension: OK Naming: OK Repetition: OK7.Hallucination: Visual: denied Auditory: denied Sensory: denied
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• 純感覺 : CN1,2,8 ; 純運動 : 3,4,6,11,12• CN 1 : anosmia (Frontal lobe tumor)• CN 2 : 20/15020/20(6m/o); visual field • CN 2,3 : Pupillary light reflex(+)• CN 3.4.6: EOM full• CN 5 : face: sensory:OK, Mastication: ok• CN 7: No facial palsy, corneal reflex(+) symmetric nasolabial fold• CN 9, 10 : Swallowing(+) ; gag reflex(+)• CN 11 : Head rotation/shoulder elevation(+)• CN 12 : tongue: deviation(-) ; slur speech(-)
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Cranial Nerves ( I )
• Olfactory nerve (I)• Optic nerve (II):– Visual acuity– Visual field: confrontation test
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Cranial Nerves ( II )
• Extra-Ocular Muscles:– Oculomotor nerve (III)– Trochlear nerve (IV)– Abducens nerve (VI)
• Trigeminal Nerve (V):– Three divisions– Motor: masseter, temporalis
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Cranial Nerves ( III )
• Facial Nerve (VII):– Motor –• Facial expression• Naso-labial fold• Eye blinking• Wrinkles
– Sound damping, taste– Central vs peripheral facial palsy
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Cranial Nerves ( IV )
–Vestibulo-Cochlear Nerve (VIII)–Glossopharyngeal (IX) & Vagus (X)
Nerves• Taste• Voice• Gag reflex
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Cranial Nerves ( V )
• Spinoaccessory Nerve (XI):– Trapezius muscles– Sternocleidomastoid muscles
• Hypoglossal Nerve (XII):– Tongue atrophy– Fasciculation– Deviation– Strength
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Cranial Reflex
– Light reflex (II-III)–Corneal reflex (V-VII)–Gag reflex (IX, X)
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MotorMuscle power/muscle toneDTR/ pathologic reflex
Babinskin’s signHoffmann's sign
Involuntary movementTremorClonus/MyoclonusChorea
Cerebellar sign:Finger-nose-fingerRomberg testGait
Pyramidal: no rigidity, no cross DTR, no ankle clonusExtra-pyramidal: no hypotonia, no spasticity, no dystonia, no chorea, no athetoid
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MRC System
• 5 normal power• 4 against resistance : 4+, 4, 4-• 3 against gravity• 2 horizontal movement (no anti-gravity)• 1 muscle contraction• 0 no movement
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Upper motor neuron sign
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DTR (Knee jerk, strech reflex)
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Supraspinal control• Inhibitory signals on gamma neurons through
lateral reticulospinal tract from• Motor Area 6 • Paleocerebellum • Red nucleus • Facilitatory signals on gamma neurons through
ventral reticulospinal tract from• Motor Area 4 • Neocerebellum • Vestibular nucleus
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Babinski sign (Plantar reflex)-- Pyramidal / Lateral corticospinal tract
• In infants• This happens because the corticospinal pathways
that are not fully myelinated at this age, so the reflex is not inhibited by the cerebral cortex.
• The extensor response disappears and gives way to the flexor response around 12-24 m/o.
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MotorMuscle power/muscle toneDTR/ pathologic reflex
Babinskin’s signHoffmann's sign
Involuntary movementTremorClonus/MyoclonusChorea
Cerebellar sign:Finger-nose-fingerRomberg testGait
Pyramidal: no rigidity, no cross DTR, no ankle clonusExtra-pyramidal: no hypotonia, no spasticity, no dystonia, no chorea, no athetoid
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• Pyramidal tract
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Movement disorder= Extrapyramidal disorders
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Coordination• Romberg test : • Cerebellar dysmetria:– Finger-nose-finger test– Heel-to-shin test
• Rapid alternating movement (RAM) ex. • Gait: ataxia1.Limb ataxia = cerebellar lobes2.Gait ataxia = anterior vermis3.Truncal ataxia = posterior vermis
Heel-to-shin.htm
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Proprioceptive and tactile stimuli are projected as shown in the upper (inverted) homunculus and the lower (split) homunculus. The striped area : the region from which evoked responses to auditory and visual stimuli are observed.( 聽、視覺刺激後的反應 ( 動作 ) 區 )
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Sensory Examinationa. Light touch : OK b.Pinprick : OK c. Joint position sense : OK (fingers and toes) d.Vibration e.Temprature :
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•
NewbornNeurology examination
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http://library.med.utah.edu/pedineurologicexam/html/home_exam.html