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1、NeurologicalExaminationConsciousness&HighCorticalfunctionConsciousnessConsciouslevel:wakefulness-alertness(GCS,drowsiness,stupor,coma)Consciouscontent:awareness(confusion)AscendingReticularactivatingsystem(ARAS):upperbrainstemtegmentumandmidlineandintralaminarnucleiofthethalamus
2、CorticalandsubcorticalstructureGlasgowComaScaleEyeopeningVerbalMotorresponse1NoneNoneNone2TopainSoundsDecerebrate3TospeechWordsDecorticate4SpontaneousConfusedWithdrawtopain5OrientedLocalizingtopain6ObeycommandsOrientationPersonPlaceTimeJudgementWhattodowhensmelledsmokeintheater?
3、Orientation&JudgementImmediatememory&attention~Digitspan:Normalsevenforward,fivebackwardRecentmomory~Recallthreeitemsorabriefstoryafteradelayof3to5minutesRemotemomory~historicalorverifiablepersonaleventsMemoryCalculation~(100–7)x7times~(20-3)x5times~AdjusttopremorbidAbstractthin
4、king"姚明比馬英九高,且馬英九比陳水扁高,誰最高?""甚麼叫『覆水難收』"?"車子跟飛機有甚麼共通點嗎?""你覺得空位該填甚麼:AZBYCXD_"?Calculation&AbstractthinkingCranialnerve選擇有特定氣味,例如:肥皂,薄荷,香煙及一有刺激性的物品，如ammonia.將這些物品置於相似瓶中,請病人指明這些氣味.一鼻孔受試時另一鼻孔應用手遮擋.Normal:allidentifiedOnlyrecognisedAmmonia:CNIimpaired,CNVpartlyintactAllnotrecognised:N
5、otorganicCranialnerveI:Olfactorynerveexophthalmosorenophthalmos,ptosisorlidretractionSize,outlineLightreflex請病人眼直視前方,以手掌或紙張至於兩眼之間隔檔光線,並以光照一眼.光點由眼外側斜斜照入.觀察時須同時注意受光照之眼與另一眼的瞳孔反應,正常應會出現協同反射(Consensualreflex)Accommodationreflex將手指或筆置於病人鼻前10cm,要求病人先注視遠方,再注視眼前物體,觀察病人瞳孔
6、調焦的反應PERRLA(D+C):PupilsEqualandRegular;ReactivetoLightandAccommodation(DirectandConsensual)CranialnerveII:OpticnerveWallorhandchart(Snellen’sChart)countfingersmovementlightRefractiveerror:IfacuityimprovedbylookingthrupinholecardConfrontationtest:約相距
7、一隻手臂長以30cm為半徑請病人試著回答你哪一邊的手指在動TestIndividualEye左眼注視你的右眼,以病人的眼睛為中心劃一半徑30cm的假想球面使用白色大頭針,要求病人告訴你何時最先看到大頭針改用紅色大頭針再測試一次CranialnerveII:OpticnerveSaccade(Frontal)FrontalgazecentertoPPRF(paramedianpontinereticularformation)forrapideyemovementstoviewnewobjectsontothefovea.Pursuit(Occ
8、ipitallobe)Parietal-occipitalgazecenterviacereb
