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MindMap Gallery Neurological examination (skills examination requirement)
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Neurological examination (skills examination requirement)
This is a mind map about neurological examination (skills examination requirements), including meningeal irritation signs, pathological reflexes, deep reflexes, motor function examinations, etc.
Edited at 2023-11-21 10:56:45
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Neurological examination (skills examination requirement)
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- Outline
neurological examination
Motor function test
1. Voluntary movement and muscle strength
(1) Muscle strength: the maximum contraction force of muscles during voluntary movement
(2) Six grades (degrees) of muscle strength
Grade 0: Complete paralysis, no muscle contraction
Level 1: Muscle contraction but no body movement
Level 2: The limbs can move horizontally on the bed but cannot be lifted off the bed
Level 3: The limb can be lifted off the bed, but cannot resist resistance.
Level 4: The limbs can resist resistance activities, but their muscle strength is worse than normal.
Level 5: Normal muscle strength
Muscle strength test: Give resistance in the opposite direction, the person being tested resists the resistance, and the two sides are compared.
Muscle strength is active movement
Inspection method ① During the examination, the patient is asked to stretch and contract the limbs, and the examiner applies resistance from the opposite direction to test the patient's resistance to resistance, and pay attention to comparison between the two sides. Check the joints (flexion, extension, abduction, adduction), elbow joint (flexion, extension), wrist joint (dorsiflexion, palmar flexion), and medullary joints (flexion, extension, abduction, adduction) respectively. ), knee joint (flexion, extension), ankle joint (dorsiflexion, plantar flexion) and other surrounding large muscle groups
hand joints
elbow joint
upper arm
Press inwards to do a counter move
Make a confrontational movement outwards
Lift upwards for counter movement
Press down to make a counter move
forearm
Pulling outwards for counteraction
Flexion-extension
hip joint
Position: Lower limbs slightly apart
thigh
Press down to make a counter move
Confrontation moves inwards
Lift upwards for counter movement
Make a confrontational movement outwards
knee joint
calf
Lift upwards for counter movement
Press down to make a counter move
ankle joint
Instep extension
do counter moves
plantar flexion of foot
do counter moves
(3) Paralysis
complete paralysis, incomplete paralysis
①Monoplegia: paralysis of one limb
② Hemiplegia: Paralysis of one limb, which may be accompanied by damage to the cranial nerves on the same side
③ Paraplegia: Paralysis of both lower limbs or quadriplegia
④Crossed paralysis: cranial nerve paralysis on the affected side and paralysis of the contralateral limbs
2. Muscle tension
Muscle tone is a passive movement
Concept: Muscle tension at rest
(1) Increased muscle tone
① Ankylosing, also known as “lead tube” increased muscle tone, seen in extravertebral system damage
②Spasmodic, also known as "jackknife phenomenon", seen in vertebral tract damage
Concept: The muscles are firm and have high resistance to extension and flexion.
(2) Reduced muscle tone
Concept: Muscles are soft and have little resistance to extension and flexion
Seen in peripheral neuropathy, anterior horn poliomyelitis, cerebellar lesions
Muscle tone physical examination
Instruct the patient to relax his muscles. The doctor holds the patient's limbs with both hands and repeatedly performs passive extension, flexion and rotation movements at different speeds and amplitudes to feel the patient's resistance and pay attention to the comparison between the two sides.
upper limbs
Lower limbs
foot
Shallow reflection
Irritation of skin or mucous membranes
1. Corneal reflection
Inspection method: Instruct the examinee to gaze inward and upward, and gently touch the cornea from the outer edge of the cornea with a cotton swab. If the eyelid closes quickly, it is called a direct corneal reflex. If it also causes a closing reaction of the contralateral eyelid, it is called an indirect corneal reflex.
Check the opposite side in the same way
significance
① If the direct reflex disappears but the indirect reflex exists, it is facial nerve paralysis.
②Those who have both direct and indirect corneal reflexes disappear have trigeminal neuropathy, and patients with deep coma have also lost their corneal reflexes.
2. Abdominal wall reflex
Inspection method: The patient lies supine, with his knees bent. Use the blunt end of a cotton swab to slide quickly on the upper abdomen, middle abdomen, and lower abdomen. You will see local abdominal muscle contraction.
Draw along the costal arches on both sides, at the level of the navel, and in the direction of the groin, from outside to inside.
Efferent nerves: intercostal nerves, upper, middle and lower abdominal wall reflex centers in thoracic cord segments 7-8, 9-10, 11-12 respectively
significance
① The upper, middle and lower abdominal wall reflexes on one side are weakened or disappeared: seen in pyramidal tract damage
② Bilateral upper, middle and lower abdominal wall reflexes weaken or disappear: coma, acute peritonitis
3. Plantar reflex
Inspection method: The examiner uses a cotton swab to lightly scratch the lateral edge of the patient's foot, from the heel forward to the bulge at the base of the little toe, turning inward. Normally, each toe can be seen to be plantarflexed. If the above reaction is weakened or does not occur, it means that the plantar reflex is weakened or disappeared.
Check the opposite side in the same way
Afferent and efferent nerves: tibial nerve, the center is sacral spinal cord segments 1-2
Oral content: Cremasteric reflex
Inspection method: Use a blunt-edged bamboo stick to lightly scratch the skin above the inner thigh from top to bottom, which can cause the cremaster muscle on the same side to contract and lift the testicles.
Afferent and efferent nerves: genitofemoral nerve, the center is lumbar spinal cord segments 1-2
deep reflection
Stimulates periosteum and tendons
1. Biceps reflex
Inspection method: Support the patient's forearm with the left forearm, then press the left thumb on the patient's biceps tendon, and tap the thumb with a percussion hammer. Normally, the biceps brachii contracts and the forearm flexes rapidly. During the examination, if the above reactions are hyperactive, weakened or disappear, it is an abnormality of the biceps reflex.
Check the opposite side in the same way
Afferent and efferent nerves: musculocutaneous nerves, the center is cervical spinal cord segments 5-6
2. Knee reflex
Inspection method: Use a percussion hammer to quickly tap the quadriceps tendon under the knee joint (or describe it as tapping the infrapatellar ligament) to induce a knee jerk reflex. The normal reaction is contraction of the quadriceps and extension of the calf.
Check the opposite side in the same way
Afferent efferent nerve: femoral nerve, the center is in the spinal cord 2-4
3. Achilles tendon (ankle) reflex
Examination method: The patient lies on his back, with the hip and knee joints slightly flexed, and the lower limbs in an external rotation and abduction position. The examiner uses his left hand to gently hold the patient's foot so that the foot is in a hyperextension position, and the right hand holds a percussion mallet to tap the Achilles tendon. The normal response is gastrocnemius contraction and foot flexion toward the plantar surface. If the test cannot be performed in the recumbent position, the patient can be asked to kneel on the chair with his feet dangling from the edge of the chair, and then tap the Achilles tendon lightly. The reaction will be the same as before.
Check the opposite side in the same way
Afferent and efferent nerves: tibial nerve, center in sacral spinal cord 1-2
After operation
Report examiner results
The muscle strength of both upper and lower limbs of a normal person is level 5
Normal muscle tone is normal, with no obvious enhancement or weakening.
The examinee has both direct corneal reflex and indirect corneal reflex.
The subject's abdominal wall reflexes were normal and not significantly weakened or disappeared. If a certain abdominal wall reflex disappears, it may indicate damage to the corresponding spinal cord segment.
The patient's plantar reflex was present, and each toe was plantar flexed.
The examinee's biceps muscle contracted, his forearm flexed rapidly, and his biceps reflex was present.
The subject's quadriceps muscles are contracted, the calf is extended forward, and the knee reflex is present.
The subject's gastrocnemius was contracted, the foot was flexed toward the plantar surface, and the Achilles tendon reflex was present.
Organizing patients’ clothes (humanistic care)
Record examination results (write medical records)
Clinical significance of abnormal signs
Summarize common mistakes and things to pay attention to
① Talk and do at the same time
②The swiping direction is incorrect and the swiping method is wrong
③Percussion position is incorrect
④ Unable to pronounce the corresponding section correctly, and the number memory is inaccurate
⑤ Failure to allow the patient to fully relax the area (positioning) being examined
Especially the muscle tone test
The description is simple and has no valid points.
Unable to correctly describe normal reactions
pathological reflex
Concept: Refers to the abnormal reflexes that occur when the brain loses its inhibitory effect on the brainstem and spinal cord when there is a vertebral tract lesion. Infants under 1 and a half years old do not have pathological reflexes
1.Babinski/Babinski sign
Examination method: The subject is placed in a supine position, with both upper limbs naturally straightened on both sides of the trunk and both lower limbs naturally straightened. The examinee stands on the right side of the subject and asks the subject to relax. The examinee holds the subject's ankle with his left hand, and draws the blunt cotton swab in his right hand back and forward along the outer edge of the sole of the foot to the base of the little toe and then turns to the inner toe.
Both sides of the reflex need to be checked. Points will be deducted if only one side is checked.
Normally, the toes flex toward the plantar surface, which is called a negative Babinski sign (i.e., plantar reflex).
Positive symptoms include dorsiflexion of the big toe and fan-shaped expansion of the remaining toes.
2.Chaddock/Chaddock sign
Inspection method: Use a bamboo stick to draw from the outer edge of the instep below the ankle from back to front to the metatarsal joint.
A positive reaction is when the toes are dorsiflexed and the other four toes are fan-shaped toward the back. A negative reaction is when the toes are flexed toward the plantar surface.
3.Oppenheim/Oppenheim levy
Inspection Method
① Position: The subject lies on his back with both lower limbs straight
②Inspection technique: The examiner uses his thumb and index finger (or index and middle finger) to press hard along the front edge of the tibia from top to bottom.
A positive reaction is when the toes are dorsiflexed and the other four toes are fan-shaped toward the back. A negative reaction is when the toes are flexed toward the plantar surface.
4.Gordon/Gordon sign
Inspection Method
① Position: The subject lies on his back with both lower limbs straight
②Examination technique: The examiner slightly lifts the knee joint of the subject with his left hand, and pinches the gastrocnemius muscle with a certain force with his right hand.
A positive reaction is when the toes are dorsiflexed and the other four toes are fan-shaped toward the back. A negative reaction is when the toes are flexed toward the plantar surface.
5.Hoffmann/Hoffmann sign
Inspection method: Hold the middle section of the patient's middle finger between the two middle fingers, dorsiflexing the wrist joint, and keep the other fingers in a naturally relaxed and semi-flexed state. Then the examiner quickly scrapes the nail of the patient's middle finger with his thumb. If there is any abnormality in the other fingers, Palm flexion movement is a positive Hoffman sign
meningeal irritation
Signs of damage to the meninges, mainly seen in subarachnoid hemorrhage, encephalitis, and meningitis
1. Neck ankylosis
Check method steps
(1) Inform the subject to lie on his back with the pillow removed, with both upper limbs naturally straightened on both sides of the trunk, and both lower limbs naturally straightened. The examinee stands on the right side of the subject, and asks the subject to relax.
(2) The examinee places his left hand on the subject's pillow, supports and turns the subject's head left and right, and learns whether the subject has neck muscles or pain by observing or feeling the resistance during passive movement and asking if there is any pain. Vertebral body lesions
(3) The examinee gently presses the subject's chest with his right hand, puts his left hand on the subject's pillow and performs neck flexion movements to feel whether there is any resistance in the subject's neck and its degree.
If there is increased resistance when passively flexing the neck, and the mandible cannot be close to the chest, it indicates cervical ankylosis. Patients with cervical spondylosis need to be excluded
Positive nuchal ankylosis: manifested by increased resistance when passively flexing the neck
2.Kernig’s sign/Kernig’s sign
The patient is placed in a supine position without pillows, with the hip and knee joints on one side bent at an angle of 90°. The examiner lifts the patient's calf and straightens it. Normally it should be able to reach 135°.
Positive if resistance or pain is encountered
When checking Kernig's sign, points will be deducted if only one side is checked.
Positive Kernig sign: manifested as obstruction of knee extension accompanied by pain or stretch spasm of lower limb flexor muscles
3.Brudzinski sign/Brudzinski sign
The examinee lies on his back. The examiner uses his left hand to support his occiput and perform neck flexion. He puts his right hand on his chest, then flexes his head toward the chest with force, and observes whether there is any flexion of the examinee's hip and knee joints.
Positive BrudzinSki sign: bilateral knee and hip flexion
After operation
Report examiner results
The examined patient's pathological reflexes and meningeal irritation signs were negative.
Organizing patients’ clothes (humanistic care)
Record examination results (write medical records)
Clinical significance of abnormal signs
Summarize common mistakes and things to pay attention to
① Talk and do at the same time
②The swiping direction is incorrect and the swiping method is wrong
③If the other side is missing, a bilateral inspection must be done
④The meaning of this reflection is not described
⑤ There are many English names, which can easily cause confusion in memory, especially pathological reflexes.
Unable to describe the disease in which this pathological sign occurs
Unable to correctly describe specific positive manifestations
Meningeal irritation syndrome: always forget the basic posture - lie on your back without pillows