你真的会小脑体征检查吗?斯坦福大学教授来教你
Signs of cerebellar disease,
from head to foot
Scanning speech
Causes enunciation of individual syllables: “the British parliament” becomes “the Brit-tish Par-la-ment.”
在中文语境里,你可以选择合适的较为复杂的词语来测试
Nystagmus
眼球震颤
Fast phase toward side of cerebellar lesion.
Finger to nose &
finger to finger test
指鼻试验&对指试验
Ask patient to fully extend arm then touch nose or ask them to touch their nose then fully extend to touch your finger. You increase the difficulty of this test by adding resistance to the patient's movements or move your finger to different locations. Abnormality of this is called dysmetria.
Rapid alternating movements
快速轮替运动
Ask patient to place one hand over the next and have them flip one hand back and forth as fast as possible (alternatively you can ask the patient to quickly tap their foot on the floor as fast as possible) if abnormal, this is called dysdiadochokinesia.
Rebound phenomenon
(of Stewart & Holmes)
Have the patient pull on your hand and when they do, slip your hand out of their grasp. Normally the antagonists muscles will contract and stop their arm from moving in the desired direction. A positive sign is seen in a spastic limb where the exaggerated 'rebound' occurs with movement in the opposite direction. However in cerebellar disease this response is completely absent causing the limb to continue moving in the desired direction. (Be careful that you protect the patient from the unarrested movement causing them to strike themselves.)
这个体征用的比较少,中文教科书上基本没有提及,不过也是比较简单的检测方法。
Heel to shin test
跟胫试验
Have patient run their heel down the contralateral shin (this is equivalent the finger to nose test). Abnormal exam occurs when they are unable to keep their foot on the shin.
Hypotonia
肌张力减退
“Pendular” knee jerk, leg keeps swinging after knee jerk more than 4 times (4 or less is normal).
Gait (Acute Cerebellar Ataxia)
步态改变(急性小脑共济失调)
Acute cerebellar ataxia is a wide based and staggering gait.
They may fall to the side of the lesion
关于步态,我们之前和大家分享过:
NOTE: THE ROMBERG TEST(闭目难立征) IS NOT A SIGN OF CEREBELLAR DISEASE.
It is a sign of a disturbance of proprioception, either from neuropathy or posterior column disease. The patient does not know where their joint is in space and so uses their eyes. In the dark or with eyes closed they have problems.
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