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小兒神經學理學檢查

小兒神經學理學檢查. Fellow 黃意評 2010-11-25. 檢查大綱. Mental status Cranial nerve, Motor, Cerebellar, Sensory examinations Newborn: Primitive reflex Jitterness and clonus. GCS:E4M6V5 Vital sign: 36.9 ℃/94bpm/24/min, BP:113/81 mmHg 1. J udgement : 紅綠燈過馬路、火災時會打 119

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小兒神經學理學檢查

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  1. 小兒神經學理學檢查 Fellow 黃意評 2010-11-25

  2. 檢查大綱 • Mental status • Cranial nerve, • Motor, • Cerebellar, • Sensory examinations • Newborn: • Primitive reflex • Jitterness and clonus

  3. 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119 2. 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 3 6.Language: Fluency: OK Comprehension: OK Naming: OK Repetition: OK 7.Hallucination: Visual: denied Auditory: denied Sensory: denied

  4. 純感覺: CN1,2,8 ; 純運動: 3,4,6,11,12 • CN 1 : anosmia (Frontal lobe tumor) • CN 2 : 20/15020/20(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(-)

  5. Cranial Nerves ( I ) • Olfactory nerve (I) • Optic nerve (II): • Visual acuity • Visual field: confrontation test

  6. Cranial Nerves ( II ) • Extra-Ocular Muscles: • Oculomotor nerve (III) • Trochlear nerve (IV) • Abducens nerve (VI) • Trigeminal Nerve (V): • Three divisions • Motor: masseter, temporalis

  7. Cranial Nerves ( III ) • Facial Nerve (VII): • Motor – • Facial expression • Naso-labial fold • Eye blinking • Wrinkles • Sound damping, taste • Central vs peripheral facial palsy

  8. Cranial Nerves ( IV ) • Vestibulo-Cochlear Nerve (VIII) • Glossopharyngeal (IX) & Vagus (X) Nerves • Taste • Voice • Gag reflex

  9. Cranial Nerves ( V ) • Spinoaccessory Nerve (XI): • Trapezius muscles • Sternocleidomastoid muscles • Hypoglossal Nerve (XII): • Tongue atrophy • Fasciculation • Deviation • Strength

  10. Cranial Reflex • Light reflex (II-III) • Corneal reflex (V-VII) • Gag reflex (IX, X)

  11. Motor Pyramidal: no rigidity, no cross DTR, no ankle clonus Extra-pyramidal:no hypotonia, no spasticity, no dystonia, no chorea, no athetoid • Muscle power/muscle tone • DTR/ pathologic reflex • Babinskin’s sign • Hoffmann's sign • Involuntary movement • Tremor • Clonus/Myoclonus • Chorea • Cerebellar sign: • Finger-nose-finger • Romberg test • Gait

  12. 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

  13. Upper motor neuron sign

  14. DTR (Knee jerk, strech reflex)

  15. 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

  16. 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.

  17. Motor Pyramidal: no rigidity, no cross DTR, no ankle clonus Extra-pyramidal: no hypotonia, no spasticity, no dystonia, no chorea, no athetoid • Muscle power/muscle tone • DTR/ pathologic reflex • Babinskin’s sign • Hoffmann's sign • Involuntary movement • Tremor • Clonus/Myoclonus • Chorea • Cerebellar sign: • Finger-nose-finger • Romberg test • Gait

  18. Pyramidal tract

  19. Movement disorder= Extrapyramidal disorders

  20. Coordination • Romberg test : • Cerebellar dysmetria: • Finger-nose-finger test • Heel-to-shin test • Rapid alternating movement (RAM) ex. • Gait: ataxia • Limb ataxia = cerebellar lobes • Gait ataxia = anterior vermis • Truncal ataxia = posterior vermis

  21. 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)

  22. Sensory Examination a. Light touch :OK • Pinprick :OK • Joint position sense :OK (fingers and toes) • Vibration • Temprature :

  23. Newborn Neurology examination

  24. http://library.med.utah.edu/pedineurologicexam/html/home_exam.htmlhttp://library.med.utah.edu/pedineurologicexam/html/home_exam.html

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