| 词条 | Neurological examination | |||||||||||||||||
| 释义 |
| Name = Neurological examination | Image = TE-Nervous system diagram.svg | Caption = The human nervous system | ICD10 = | ICD9 = {{ICD9proc|89.13}} | MeshID = D009460 | OtherCodes = }} A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history,[1] but not deeper investigation such as neuroimaging. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which when examining a patient where you do expect to find abnormalities.[2] If a problem is found either in an investigative or screening process, then further tests can be carried out to focus on a particular aspect of the nervous system (such as lumbar punctures and blood tests). In general, a neurological examination is focused on finding out whether there are lesions in the central and peripheral nervous systems or there is another diffuse process that is troubling the patient.[2] Once the patient has been thoroughly tested, it is then the role of the physician to determine whether these findings combine to form a recognizable medical syndrome or neurological disorder such as Parkinson's disease or motor neurone disease.[2] Finally, it is the role of the physician to find the cause for why such a problem has occurred, for example finding whether the problem is due to inflammation or is congenital.[2] IndicationsA neurological examination is indicated whenever a physician suspects that a patient may have a neurological disorder. Any new symptom of any neurological order may be an indication for performing a neurological examination. Patient's historyA patient's history is the most important part of a neurological examination[2] and must be performed before any other procedures unless impossible (i.e., if the patient is unconscious certain aspects of a patient's history will become more important depending upon the complaint issued).[2] Important factors to be taken in the medical history include:
Handedness is important in establishing the area of the brain important for language (as almost all right-handed people have a left hemisphere, which is responsible for language). As patients answer questions, it is important to gain an idea of the complaint thoroughly and understand its time course. Understanding the patient's neurological state at the time of questioning is important, and an idea of how competent the patient is with various tasks and his/her level of impairment in carrying out these tasks should be obtained. The interval of a complaint is important as it can help aid the diagnosis. For example, vascular disorders (such as strokes) occur very frequently over minutes or hours, whereas chronic disorders (such as Alzheimer's disease) occur over a matter of years.[2] Carrying out a 'general' examination is just as important as the neurological exam, as it may lead to clues to the cause of the complaint. This is shown by cases of cerebral metastases where the initial complaint was of a mass in the breast.[2] List of testsSpecific tests in a neurological examination include the following:
InterpretationThe results of the examination are taken together to anatomically identify the lesion. This may be diffuse (e.g., neuromuscular diseases, encephalopathy) or highly specific (e.g., abnormal sensation in one dermatome due to compression of a specific spinal nerve by a tumor deposit). General principles[5] include:
A differential diagnosis may then be constructed that takes into account the patient's background (e.g., previous cancer, autoimmune diathesis) and present findings to include the most likely causes. Examinations are aimed at ruling out the most clinically significant causes (even if relatively rare, e.g., brain tumor in a patient with subtle word-finding abnormalities but no increased intracranial pressure) and ruling in the most likely causes.{{Citation needed|date=April 2008}} References1. ^{{cite journal|vauthors=Nicholl DJ, appleton JP | title=Clinical neurology: why this still matters in the 21st century | journal=J Neurol Neurosurg Psychiatry | date=May 29, 2014| volume= 86| doi=10.1136/jnnp-2013-306881 | pmid=24879832 | pmc=4316836 | pages=229–33}} 2. ^1 2 3 4 5 6 7 8 9 10 11 {{cite book | last = Fuller | first = Geraint | title = Neurological Examination Made Easy | publisher = Churchill Livingstone | year = 2004 | isbn = 0-443-07420-8 | page = 1 }} 3. ^{{cite web | last = Oommen | first = Kalarickal | title = Neurological History and Physical Examination | url=http://www.emedicine.com/neuro/topic632.htm | accessdate = 2008-04-22 }} 4. ^{{cite journal|author=Medical Research Council|title=Medical Research Council scale. Aids to examination of the peripheral nervous system. Memorandum no. 45.|year=1976}} 5. ^Murray ED, Price BH. "The Neurological Examination." In: Comprehensive Clinical Psychiatry, First Edition. Stern TA, Rosenbaum JF, Fava M, Rauch S, Biederman J. (eds.) Philadelphia: Mosby/Elsevier. April 25, 2008. {{ISBN|0323047432}}. {{ISBN|978-0323047432}} External links
2 : Neurology procedures|Physical examination |
|||||||||||||||||
| 随便看 |
|
开放百科全书收录14589846条英语、德语、日语等多语种百科知识，基本涵盖了大多数领域的百科知识，是一部内容自由、开放的电子版国际百科全书。