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1、神经反射检查,西南医院神就内科 罗春霞,检查方法检查内容异常体征的临床意义,重点：,神 经 反 射 检 查,Examination of the Relexs,反射（Reflex）：反射是由于刺激诱发出的自发的一种运动反应.是通过反射弧（包括外周感受器、传入神经、神经中枢、传出神经及外周效应器组成）的完成的。,Reflex：Reflex action is an automatic motor response through reflex arc,that is elicted by a stimulus.Confomation of reflex arc:Sensor,Afferent n
2、erve,Nerve centre,Efferent nerve Effector,神经反射:浅反射 深反射 病理反射,Reflex:Superficial reflex Myotasis reflex Pathologic reflex,浅反射：,角膜反射腹壁反射提睾反射跖 反 射肛门反射,Superficial reflex:Corneal reflex Abdominal reflex Cremasteric reflex Plantar reflex Anal reflex,角膜反射Corneal reflex,Corneal reflex:Sensor:corneal Afferen
3、t nerve：Trigeminal nerve Nerve centre：pons Efferent nerve：Facial nerve Effector：Orbicularis oculi muscle,角膜反射：感受器：角膜传入神经：三叉神经中枢：桥脑传出神经：面神经效应器：眼轮匝肌,临床意义:一侧直接、对侧间接反射均消失同侧三叉N病变；一侧直接消失，对侧间接存在同侧面N病变。一侧直接消失间接反射消失 面神经或三叉神经病变。,Clinical significance:one lateral direct and contralateral indirect reflex extinc
4、tation:ipsilateral trigeminal nerve damage;one lateral direct reflex and contralateral indirect reflex extinctation:ipsilateral facial nerve damage;one lateral direct and indirect reflex extinctation:ipsilateral trigeminal and facial nerve damage,腹壁反射(Abdominal reflex,AR)：上腹壁反射：胸7-8；中腹壁反射：胸9-10；下腹壁反
5、射：胸11-12。临床意义：上、中、下均消失：昏迷，急腹症或神经系统病变。一侧消失：同侧锥体束病变或脊神经损伤。,Clinical significance:All abdominal reflex extinction:Coma,Acute abdomen and nerve system disease;Unilateral extinction:isolateral pyramidal tract injuried or spinal nerves injuried.,提睾反射：腰1-2。临床意义：双侧消失：腰1-2病损；一侧消失：锥体束受损。,Cremasteric reflex(CR
6、):Nerves centre:Lumbal spinal cord 1-2.Clinical significance:Bislateral CR extinction:L1-2 injuried;Unilateral CR edtinction:Pyramidal tract injurid.,CR,跖反射(Plantar reflex)：骶1-2,肛门反射,骶4、5节段骶4、5病变或肛尾神经损伤,深反射：,肱二头肌反射肱三头肌反射桡骨骨膜反射膝反射跟腱反射,Myotasis reflex:Biceps reflexTriceps jerk reflexRadioperiosteal re
7、flexKnee jerk reflexAchilles tendon reflex,肱二头肌反射(Biceps reflex)（C5、6）,肱三头肌反射Triceps jerk reflex（C7、8）,桡骨骨膜反射(Radioperiosteal reflex)（C5、6）,膝腱反射(Knee jerk reflex)（L2-4）,跟腱反射(Achilles tendon reflex)（S1、2）,临床意义：,深反射减弱或消失：周围神经病变、肌肉病变及中枢神经病变的休克期；深反射亢进：中枢神经系统病变（伴有病理征）或引起神经系统兴奋性增高的病变(如甲亢)（不伴有病理征）。,Clinica
8、l SignificanceHyporeflexia or absent deep reflex:Peripheral neuropathy,Myopathy and shock stage of central nerve disease;Hyperreflexia:central nerve disease(with pathologic sign often)or Diseases inducing hyperexcitation of nerve system(e.g Hyperthyreosis)(Without pathologic sign).,病理反射:锥体束病损时，失去了对脑
9、干和脊髓的抑制功能，而出现的异常反射。主要的病理征有：,Pathologic reflex:It is abnormal reflex due to deinhibition of mortor neuron in brain stem or spinal cord by pyramidal tract injuried.,Babinski sign，Chaddock sign，Gordon sign，Gonda sign，Oppenheim sign，Hoffmann sign。,Babinski sign,拇趾缓缓背伸，其它四趾呈扇形展开。见于锥体束损害。,Manifestation:Gr
10、eat toe dorsum extension and other four toes sectorly outspreading.Significance:Pyramidal tract injuried,Oppenheim sign,Gordon sign,Hoffmann sign,阵挛（Clonus）：腱反射增强的极度表现，是拉长某一肌腱后该肌肉所发生的节律性收缩，见于锥体束损害。,That is a manifestation of incresed tendon reflex。When one muscle tendon is dragged sharply，the muscle
11、 could contact rhythmly。,髌阵挛（Patella clonus）股四头肌节律性收缩,踝阵挛（ankle clonus）：腓肠肌与比目鱼肌节律性收缩。,Irritation of the menings and spinal root caused by inflammation,hemorroge etc can cause head retraction,neck stiffness,and spinal rigidity,which is named as mening stimulation sign,which elicits protective reflex
12、es intended to shorted the spinal axis and immobilize the irritated tissue.,脑膜刺激征：脑膜和脊神经根由于炎症、出血等的刺激从而引起的头缩、颈强直及脊柱僵硬的反应。它是一种保护性的反射，可以使脊柱缩短稳定受刺激的组织。,颈项强直 Neck Rigidity,Brudzinski&Kernig sign,Flexion at the hip and knee in response to forward flexion of the neck(Brudzinski sign)and inability to completely extend the leg(Kernig sign).,Kernig sign,135度,Brudzinski sign,Lasegue sign,70度,1.浅反射、深反射各包括哪些？2.浅反射减弱或消失有何意义？3.深反射减弱、消失、亢进的临床意义。4.常见病理反射包括哪些？有何意义？5.何谓脑膜刺激征，常见体征有哪些？,思考题,Thanks,
