Neurologic Examination in VaD

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1 Neurologic Examination in VaD 동아대학교의과대학 신경과학교실박경원

2 Contents General review of neurologic examination skills in SVaD Video clip for abnormal examination findings in SVaD patients

3 Subcortical vascular dementia

4 신경학적검사 (Neurologic Examination) Mental Status Examination Cranial Nerve Examination Motor System Sensory System Reflex Coordination (Cerebellar Function Test) Gait 혼수환자에서의신경학적검사

5 신경학적검사에필요한도구들 망치 (Hammer) 음차 (Tuning fork ) 검안경 (Ophthalmoscope) 시력표 (Near vision testing card) Pin, 털, 얼음 후각검사를위한방향제 설압자

6 정신상태검사 (Mental State Exam.)

7 정신기능검사 (Mental Status Examination) 의식수준 (Level of Consciousness) 지남력 (Orientation) 판단력 (Judgement) 기억력 (Memory) 계산력 (Calculation), 집중력 (Attention) 사고력 (Thought) 지각력 (Perception) 언어력 (Speech)

8 언어력 (Speech) 구음장애 Dysarthria.mp4 Lingual Palatal Labial 발성장애 (Dysphonia) 실어증 (Aphasia) Fluency Comprehension Repetition Naming

9 뇌신경검사 Cranial Nerve Exam.

10 뇌신경종류 (Cranial Nerves) CN1 (Olfactory N.) CN2 (Optic N.) CN3,4,6 (Ocular,Trochlear,Abducens N.) CN5 (Trigeminal N.) CN7 (Facial N.) CN8 (Acoustic N.) CN9 (Glossopharyngeal N.) CN10 (Vagus N.) CN11 (Accessory N.) CN12 (Hypoglossal N.)

11 동안신경및활차신경마비 (Ocular N. & Trochlear N. Palsy)

12 CNⅦ (Facial N.)

13 Facial palsy.mp4 안면신경마비

14 CNⅨ(Glossopharyngeal N.), CNⅩ(Vagus N.)

15 운동신경계

17 1) Hemisphere (cortical) 2) hemisphere (subcortical) 3) Brainstem 4) spinal cord 5) Spinal root 6) Peripheral nerve 7) Muscle

18 Motor System ( 운동신경계 ) Pyramidal pathway ( 추체로 ) 강력한운동 아버지역할 Extrapyramidal pathway ( 추체외로 ) 섬세한운동 어머니역할

19 운동계의신경학적검사 근육부피 (Muscle Bulk): 근위축을확인 근긴장도 (Muscle Tone): 관절을수동적으로움직여서확인 근긴장증가 : 뇌손상, 뇌졸중, 파킨슨병 경직 (spasticity) 경축 (rigidity) 근육긴장병성경축 (paratonic rigidity) 근긴장저하 : 말초신경질환, 근육질환 근력 (Muscle Power): 관절의힘을측정 불수의운동 (Involuntary Movement)

20 근육부피

21 Motor power test.mp4 근력 Grade 0 : no movement Grade 1 : minimal contraction Grade 2 : movement without gravity Grade 3 : movement against gravity but not against resistance Grade 4 : movement against some resistance Grade 5 : movement against full resistance, normal motor power

22 회내변이검사 (pronation drift test)

23 근긴장도및파킨슨병양상

24 불수의운동 (Involuntary Movement) Chorea ( 무도병 ) Athetosis ( 무정위운동 ) Dystonia ( 근육긴장이상 ) Myoclonus ( 간대성근경련 ) Tremor ( 진전 ) Ballism ( 반무도병 ) Oro-facial dyskinesia ( 운동이상증 )

25 가성숨뇌마비 (Pseudobulbar palsy) 병적울음및병적웃음 (Pathologic crying, pathologic laughing) Pathologic crying.mpg 심한구음장애, 삼킴장애 (Severe dysarthira, swallowing difficulty, decreased facial expression) severe dysarthria,swallowing difficulty.mpg

26 감각신경계

28 감각신경계검사 sensory system test.mp4 Primary sensory function: thalamus level 통각, 온도감각 진동각, 위치감각 촉각 Discriminative sensory functions: parietal 피질성감각 (cortical sense)

30 소뇌기능검사

31 Cerebellar function test.mp4 소뇌기능검사 Scanning speech Finger to nose test, Heel to knee to shin test: dysmetria Intentional tremor Rapid alternating movement: dysdiadokinesia Ataxia: falling tendency to lesion side Gaze dependent nystagmus

34 반사 Reflex

35 반사 (Reflex) 의종류 1. 심부건반사 (Deep Tendon Reflex) 2. 표재성피부반사 (Superficial Skin Reflex) superficial abdominal reflex cremasteric reflex 3. 병적반사 (Pathologic Reflex) 4. 뇌간반사 (Brain stem Reflex)

36 심부건반사 Deep tendon reflex.mp4

37 심부건반사 (DTR) 표시법 0 소실 + 저하 ++ 정상 +++ 항진 ++++ 과항진

39 병적반사 (Pathologic Reflex) 하지 (Lower extremities) Babinski sign, ankle clonus, Chaddock response Oppenheim response, Gordon response 상지 (Upper extremities) Hoffman sign, Tromner sign

40 Pathologic reflex.mp4 Pathologic reflex

43 전두엽해체증후 Frontal lobe releasing sign.mp4 grasp reflex, sucking reflex, snout reflex glabellar reflex, palmomental reflex

44 보행검사 Gait

45 Gait.mp4 보행장애 마비성보행 Hemiplegic circumductive gait 전두엽성보행 Frontal gait (gait apraxia) 파킨슨병보행 Parkinsonian gait (freezing gait) festinating gait shuffling gait propulsion 실조성보행 Ataxic gait: coordination 의장애

46 Abnormal Neurologic Exam. Findings in Subcortical VaD 1) Pyramidal tract sign DTR, Babinski, chaddock,. pronation drift facial palsy, dysarthria, dysphagia pathologic laughing & crying, jaw jerk gag reflex, facial expression 2) Vascular parkinsonism Rigidiy, bradykinesia Gait disturbance (stooped, decreased arm swing, short step, pivot turning, festiantion, shuffling)

47 SVaD 환자에서는, Conclusions 구음장애, 삼킴곤란, 얼굴마비, 시야결손, 근력약화, 감각저하 운동및감각신경장애 병적웃음, 병적울음및요실금이나원시반사 (primitive reflex) 탈억제및병적반사 경축 (rigidity), 운동완만 (bradykinesia), 보행장애, 운동장애 추체외로증상, 혹은파킨슨병증상

신경계 한림대학교간호학부장희정

신경계 한림대학교간호학부장희정 신경계 구조와기능 중추신경계 : 뇌. 척수 뇌 : 대뇌, 소뇌, 뇌간 대뇌아래간뇌, 변연계, 망상체 척수 : 안은회백질, 밖은백질 ( 상하행로 ) 회백질 : H 자. 전각 ( 운동 ), 후각 ( 감각성 ) 정보전달 백질 : 하행로 ( 추체로 - 세밀 : 추체외로 - 큰운동주관 ) 대뇌 좌우반구 뇌량에의해연합 ( 신경섬유덩어리 ) 4개엽 전두엽 : 운동영역과언어관련