1Nervoussystem

--physicalexaminationofcommondisease

外科學(xué)精品課程組BasicIntroduction姓名：陳廣永學(xué)歷：博士在讀來自：中日聯(lián)誼醫(yī)院神經(jīng)外科電話箱：155214721@2GeneralconsiderationsP641cerebralventricles、cranialnerves→basalganglia→thecerebellarpedunclesandthepons→cerebralcirculation、striatebody、theinternalcapsule→tracts、nuclei、gyri→???thefunctionofthecerebralcortex→cerebrum→motoractivity→???severaldiseases(PD/Bell'splasy)→neuronaldisease→cerebrovasculardisease→???

structure→function→diseases

SystemretrospectionP6424BasicstructureofNervoussystemBrain：CerebralhemispheresBrainstemcerebellumSpinalcord

Cerebralbone5A:顱骨正面觀B:顱骨側(cè)面觀C:顱底上面觀Membrane6D：腦膜結(jié)構(gòu)subarachnoidspacebetweenarachnoidmembraneandleptomeninges，containsCSF（cerebrospinalfluid），Intracranialvascularcontortsinthis.CN：cranialnerveP661I嗅神經(jīng)olfactorynerveII視神經(jīng)opticnerveIII動眼神經(jīng)oculomotornerveIV滑車神經(jīng)trochlearnerveV三叉神經(jīng)trigeminalnerveVI展神經(jīng)abducentnerveVII面神經(jīng)facialnerveVIII前庭蝸神經(jīng)vestibulo-cochlearnerveIX舌咽神經(jīng)glossopharyngealnerveX迷走神經(jīng)vagusnerveXI副神經(jīng)accessorynerveXII舌下神經(jīng)hypoglossalnerve（一）Frontalofskullandbrainskull：frontalbone、anteriolskullbasebrain：frontallobe、I、IIcranialnerve？CommonDiseasesSignsandsymptomsheadache、vomit、opticdiscedemaCerebrospinalfluidleakageTemper、characterchangehemiplegiaanosmia、amaurosis、motoraphasiaepilepsyNuchalrigidityreflction：physiological&pathologicalPyramidalsignReflction：physiological&pathologicalP663Reflction：physiological&pathologicalP669-679

（二）Middleofskullandbrain

skull：paritalandtemprolbone、middleskullbasebrain：

paritalandtemporallobeCommondiseases

Commondiseases

HighcranialpressureComa：GCSvalueCerebrospinalfluidleakageFeelingfunctionThreepartialsyndrome：hemiplegia、hemianopia、hemidysesthesiaepilepsyNuchalrigidityReflction

Signsandsymptoms

（三）posteriorofskullandbrain

skull：occupitalbone、posteriorskullbasebrain：occupitallobe、

cerebellum

Commondiseases

Signsandsymptoms

HighcranialpressureComa：GCSvalueHemianopiaEpilepsyReflctionLanguageGaitabnormalitiesCoordinatemovementP689CoordinatemovementP686-687

Finger-to-nosetest.

Finger-to-nosetest.Heel-to-kneetest.Resistancetest（四）CoreareaBrainstemMidbrainPonsMedullaoblongataSomeendocrineorgansPituitaryglandPinealgland......

Commondiseases

Commondiseases

Signsandsymptoms-MidbrainComa

PupillaryreflexConvergencereflexPupillaryreflex

Signsandsymptoms-Midbrain

EyemovementSignsandsymptoms-PonsDiplopiaEyemovementFacefeelingChewmovementAreasinnervatedbydivisionsofthetrigeminalnerve.TestingthemotorfunctionofthetrigeminalnerveFacioplegia

TasteTinnitusDeafnessvertigoSignsandsymptoms-PonsLesionAproducesanuppermotornervepalsythatcausescontralateralweaknessofthelowerfacebutsparesthecontralateralforehead.LesionBproducesalowermotornervepalsythatcausestotalparalysisoftheipsilateralface.Innervationsofthefacialnerveandtypesoffacialweakness.

Testingthefacialnerve

Testingthestrengthofeyelidclosure.Signsandsymptoms-PonsSignsandsymptoms-PonsRomberg'ssignbrainstemcerebe-llumopen_+close+++BasicvitalcenterTasteGagreflexDysphonia&dysarthriaMusclesparalysisPyramidalsignEndocrineorganSignsandsymptoms-MedullaoblongataSignsandsymptoms-Medullaoblongata

Evaluatingtheaccessorynerve.Evaluatingthehypoglossalnerve.Amyotrophiclateralsclerosis.Notethescallopingofthetongue.(五)Spine&SpinalcordspineCervicalvertebraeThoracicvertebraeLumbarvertebraeSacralvertebraespinalcord

Cross-sectionalviewthroughthespinalcord.Spine&Spinalcord

Commondiseases

MotorfunctionReflexesSensoryfunctionExcretionfunctionSexualfunction

Signsandsymptoms

P693

Signsandsymptoms

EffectUppermotorneuronlesionlowwermotorneuronlesionvoluntarycontrol--muscletonespastic，increasedflaccid，decreasedreflexarcs+-pathologicalreflexes+-muscleastrophylittleornonesignificantComparisonofEffectsofUpperandLowerMotorNeuronLesionsUsefulvocabularyROOTpertainingtoExampledefinitionesthe-feelinganesthesialossoffeeling-gnosiarecognitionagnosialossofthepowertorecognizesensorystimulimyelo-spinalcordmyelogramradiographicstudyofthespina