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【医学PPT课件】 神经系统检查

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医学PPT课件 PPT医学课件 神经系统检查 检查ppt课件 神经系统检查ppt课件 神经系统检查神经系统检查 神经系统PPT课件 神经检查ppt课件 神经检查ppt课件神经系统检查
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单击此处编辑母 版标题样式 单击此处编辑母版副标 题样式 *1 第九章第九章 神经系统检查神经系统检查 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 第一节第一节 颅神经检查颅神经检查 颅神经共12对,按功能分三种: v一、特殊感觉神经 嗅、视神经及听神 经。 v二、运动神经 动眼神经、滑车神经、 外展神经、副神经、舌下神经。 v三、混合神经 兼有运动和感觉两种神 经纤维。三叉神经、面神经、舌神经、 迷走神经。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 面瘫-面神经麻痹 可分为可分为:: v中枢性(上运动神经元)面瘫 对侧面下部瘫痪,即面部的1/4瘫。 v周围性(下运动神经元)面瘫 同侧面部瘫痪,即面部的1/2瘫。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 第二节第二节 感觉功能检查感觉功能检查 一、浅感觉检查一、浅感觉检查 v1.痛觉 v2.温度觉 v3.触觉 二、深感觉检查 v1.关节觉 v2.震动觉 三、复合感觉 v1.皮肤定位觉 v2.两点辨别感觉 v3.实体辨别觉 v4.体表图形觉 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 第二节第二节 运动功能检查运动功能检查 随意运动随意运动是指意识支配下的主动运动。是指意识支配下的主动运动。 随意运动是在大脑皮质运动区的直接管随意运动是在大脑皮质运动区的直接管 理下,由锥体束传导最终有骨骼肌来完理下,由锥体束传导最终有骨骼肌来完 成。用肌力来衡量。成。用肌力来衡量。 一、随意运动一、随意运动 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 肌力肌力 v肌力是指随意运动时肌肉收缩的力量。 v检查肌力的方法 嘱被检查者作肢体关节的伸屈动作, 检查者从相反方向施以阻力,测试被检 查者克服阻力的力量大小。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 一般将肌力分为一般将肌力分为6 6级(度)级(度) v0级 无肢体活动,无肌肉收缩,完全瘫。 v1级 肌肉可收缩,但不产生动作。 v2级 肢体在床面上能移动,但不能抬 离床面。 v3级 肢体能抬离床面,不能抗阻力。 v4级 能作抗阻力动作,但较正常差。 v5级 正常肌力。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 1.1.瘫痪瘫痪 肌力减退,随意运动功能丧失或减肌力减退,随意运动功能丧失或减 弱称为瘫痪。弱称为瘫痪。 瘫痪按肌力减退的程度分为:瘫痪按肌力减退的程度分为: ⑴完全性瘫痪 v完全不能作随意运动为完全性瘫痪。 ⑵轻瘫 v肌力减弱而肢体仍能运动者称为不完全性瘫痪或轻瘫。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 瘫痪按损伤解剖部位分为: 特点: v瘫痪肌的肌张力增 高 v腱反射亢进 v病理反射阳性 v瘫痪肌无萎缩 v电检查无变性反应 v又称上运动神 经元瘫痪; 痉挛性瘫痪; 硬瘫。 ⑴中枢性瘫痪 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑵周围性瘫痪 特点: v瘫痪肌的肌张力下降 v腱反射减弱或消失 v瘫痪肌出现肌肉萎缩 v电兴奋性检查有变性 反应 v又称下运动神 经元瘫痪痪; 弛缓性瘫痪; 软瘫。 v如格林巴利综 合征、小儿麻 痹。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 表1 上运动神经元瘫痪与下运动神经元瘫的鉴别 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 瘫痪按损害分布范围分为:瘫痪按损害分布范围分为: ⑴偏瘫 v一侧肢体随意运动丧失,伴有同侧中 枢性面瘫及舌瘫(舌下神经瘫痪)。 v属于中枢性瘫痪。 v见于对侧脑出血、脑动脉血栓形成、 脑栓塞和脑脓肿等(即大脑皮层运动 区或锥体束的病变)。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑶截瘫 v躯干下半部及双侧下肢随意运动丧失 。多为脊髓横断性损伤的结果。 v颈髓以下的双侧皮质脊髓束损害,为 周围性瘫痪。 v见于脊髓外伤、急性脊髓炎、脊髓结 核等。 vv少数患者为大脑皮质运动区或双侧内少数患者为大脑皮质运动区或双侧内 囊、脑干中的皮质脊髓束损害(矢状囊、脑干中的皮质脊髓束损害(矢状 窦旁中窦旁中1/31/3损害),属损害),属中枢性瘫痪。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑷交叉瘫 v偏瘫伴有对侧下肢中枢性瘫痪。 v可见于矢状窦旁中1/3损害。 ⑸三肢瘫 v由于病灶同侧颅神经损害所致的周围 性颅神经麻痹及病灶对侧肢体的中枢 性偏瘫。 v见于一侧脑干病变。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 被动运动被动运动- -肌张力肌张力 v触诊时受累肌肉有坚实感,作被动 运动检查时阻力增加。 1 1. .肌张力增加肌张力增加 v肌张力是指静息状态时的肌肉紧张 度。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. v在被动检查时阻力较大,终末时阻 力突然减弱,称为折刀现象折刀现象。 v见于锥体束损害。 v一般为上肢屈肌、下肢伸肌肌张力 增加。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑵⑵强直性肌张力增加强直性肌张力增加 v一组拮抗肌的肌张力增加,肢体作 被动运动检查时,伸肌与屈肌的肌 张力同等增强,如同弯曲铅管,称 铅管样强直铅管样强直。见于锥体外束系损害 。 v肢体在强直性肌力增加的基础上伴 有震颤,作被动运动时可出现齿轮 顿挫样感觉,称齿轮样强直齿轮样强直。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 2 2. .肌张力降低肌张力降低 v触诊时受累肌肉松软,被动运动 检查时其肢体阻力降低,关节运动 范围扩大。 v见于周围神经炎、脊髓前角灰质 和小脑病变。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 三、不随意运动 v不随意运动(又称不自主运动) 是随意肌不自主地收缩所发生的 一些无目的的异常动作。 v不随意运动由锥体外束和小脑司 理。 v不随意运动大多为锥体外系损害 的表现。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 1 1. .震颤 v震颤是两组拮抗肌交替收缩引起的 不自主运动。 表现为肢体摆动动作。 v震颤可以有以下类型: Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑴静止性震颤 v较粗大的震颤,在静止及肌肉放松时震 颤明显,在作意向性动作时震颤减轻或 暂时消失,入睡后消失。手部动作如同 “搓丸”样。造成写字、语言及吞咽困难 。 v见于震颤麻痹即Parkinson’s 病。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑵意向性震颤 v又称动作性震颤 v意向性震颤的颤动在随意运动时出 现,在动作终末愈接近目的时愈明 显。 v见于小脑疾患。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑶扑翼样震颤 v扑翼样震颤的震颤动作多在腕掌 部,振幅粗大。 v见于肝豆状核变性(Wilson病, 有凯-费环)、慢性肝病、早期 肝昏迷等。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 扑翼样震颤的患者 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑷老年性震颤 v与震颤麻痹相似,常表现为点头、 摇头动作或手抖,一般不伴有肌张 力增高的改变。 v多见于老年动脉硬化患者。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ⑸甲亢 双手指细微震颤。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 2 2. .舞蹈样运动舞蹈样运动 v舞蹈样运动为肢体的一种快速、不规 则、无目的、不对称的运动,持续时 间不长,在静止时可以发生,也可因 外界刺激、精神紧张而引起发作。睡 眠时发作较轻或消失。 v动作也可表现在表面部。如作鬼脸。 v多见于儿童有脑风湿病。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 3 3. .手足徐动手足徐动 v手足徐动为手指或足趾的一种缓慢持 续的伸展扭屈动作,可重复出现且较 有规则。 v见于脑性瘫痪、肝豆状核变性、脑基 底节变性(脑炎或中毒所致)等。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 4.4.手足搐搦手足搐搦 v发作时手足肌肉呈紧张性痉挛,在上肢 表现为腕部屈曲、手指伸展、指掌关节 屈曲、拇指内收靠近掌心并与小指相对 ,形成“助产士手”。 v下肢的踝关节与趾关节皆呈屈曲状。 v发作间隙激发试验阳性,称Trousseau 征。 v见于低血钙症和碱中毒。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 手足搐搦示意图 典型发作-助产士手 手足搐搦手足搐搦激发试验 (Trousseau征)阳性 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 四、共济运动四、共济运动 v任何一个动作的完成都必须需有一定的 肌群参加,如主动肌、对抗肌、协同肌 及固定肌等。 v这些肌群的协调一致主要靠小脑功能。 此外,前庭神经、视觉、深感觉、锥体 外系均参与肌群的协调,动作才得以平 衡和协调。 v协调机制发生病变时,动作协调发生障 碍,称为共济失调。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ㈠共济运动的检查方法㈠共济运动的检查方法 被检查者分开双上肢,双手示指由远而 近,互碰指尖,观察动作是否稳准。 2.指指试验 被检查者上肢伸直外展,然后以示指尖 碰自己的鼻尖,观察其动作是否稳准。 1.指鼻试验 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 被检查者双手反复作旋前和旋后运 动,或用双手反复作手掌和手背的 快速翻转运动。 观察是否有交替运动困难或不能。 3.轮替试验 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 被检查者取仰卧位,双下肢伸直 ,举起一侧下肢,将该下肢足跟放 在对侧膝部,再将足跟沿胫骨逐渐 往远端滑移达踝部。 双下肢分别检测,观察动作是否 稳准。 4.跟膝胫试验 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 共济运动检查阳性的患者 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 5.躯干共济运动检查 v嘱患者睁眼直立,双足平行靠拢,双 上肢向前平伸,如出现躯干摇晃或倾斜 不稳,为阳性。 见于小脑性躯干共济失调。 v睁眼时能正常站稳,闭眼时站立不稳 ,为闭目难立征闭目难立征或罗姆伯格征(罗姆伯格征( RombergRomberg征)阳性征)阳性。 见于脊髓后索受损所致的感觉性躯干 共济失调。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ㈡共济失调的种类:㈡共济失调的种类: v由于脊髓后根后束损害造成深感 觉障碍,其特征是作上述检查时, 睁眼时轻,闭目时加重。 v见于多发性神经炎、脊髓联合变 性、脑部病变等。 1.感觉性共济失调 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to
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