KHM LM SNG THN KINH

TS Nguyn Hu Cng su tm

1. Khm chc nng thn kinh cao cp:

tnh to.
Ngn ng
2. Cc dy TK s
3. Khm vn ng: sc c, trng lc c, teo c ?
4. Cc phn x (gn xng v thp).
5. Khm cm gic
6. Cc hi chng tiu no, mng no
7. Dng i v ng
8. Cc xt nghim

Khm cc dy s: dy I

Nhm mt li, bt tng bn mi, ngi v phn bit chnh xc mi

C th cho ngi 1 ming gc thm cn cch 10 cm, nhng thng
dng mi nh (nc hoa, x bng, kem nh rng) trnh cht c mi
kch thch mnh (gy kch thch dy V)

Dy II: th lc

Dng bng ch Snellen treo tng hay cm tay (t cch bnh

nhn 14 inch), nu bnh nhn c tt khc x (cn, vin) th cho
php eo knh.

Khm cc dy s: dy II th trng

Thy thuc ngi i din bnh nhn, cch khang 8-12 inch, mt
bnh nhn nhn chm chm vo mt thy thuc, thy thuc ngn
tay ca mnh khang gia 2 ngi, di chuyn t pha ngoi vo pha
trong, ngn tay mp my, bnh thng c hai ngi phi gn nh
cng lc nhn thy ngn tay. Sau i t gc trn v di i vo.

Khm vn nhn: III, IV, VI

tn thng dy III

Khm phn x ng t vi
nh sng trc tip: co ng
t

Cung phn x: dy II, III

v trung no
Khm phn x ng t vi nh
sng: mt bn kia (phn x
ng cm (consensual reflex)

Khm hi t: 2 mt hI t li v ng t co nh

Lit dy III

Lit III bn phi: quan st v tr nhn cu, sp mi trn, gin ng t

tn thng dy VI bn phi

Lt dy VI bn tri: khng th a mt ra ngai c

Khm dy V
Chm kim vo vng da ca tng nhnh ca
dy V: vng trn, g m, v cm, so snh 2
bn.
Phn x gic mc
Vn ng: c thi dng (nghin rng) v
c cn (a cm sang bn)

Khm dy V

cm gic

phn x gic mc

KHM DY VII
Quan st nt mt: np nhn trn, np mi
m, mp. Xem 2 bn c cn i khng.
Cho nhn trn v nhm 2 cht mt li.
Cho nhe rng: hai mp cn i
Phng m: hai bn cn i v khng ph hi
ra.

Khm dy VII

du hiu Bell trong lit VII (bn phI)

lit dy VII: trung ng & ngoi bin

Khm thnh lc: bng tay v nghe ng h. Nu c bt thng:

Weber v Rinne test.
1. ic do tn thng dy VIII (do thn kinh): do tui cao, do
thuc, do u dy VIII.
2. ic do dn truyn: vim tai gia, x cng tai.

Weber test: m thanh nghe thy chnh gia v 2 bn bng nhau.

1. ic do tn thng dy VIII: m nghe c lch v tai bn
lnh.
2. ic do dn truyn: m thanh nghe c lc v bn bnh
512 Hz Tuning Fork

Rinne test: c trn xng chm (nghe qua xng), khi khng nghe
thy m thanh th lp tc t st vo tai (nghe qua khng kh).
Bnh thng: ht nghe qua xng, nhng vn cn nghe qua khng
kh.
1. ic do tn thng dy thn kinh: qua khng kh tt hn qua
xng.
2. ic do dn truyn: qua xng tt hn qua khng kh

Khm dy IX v dy X: h ming ku A vm ming nng cao

cn I 2 bn v lI g nm chnh gia
Chm que tm bng vo thnh sau hng

lit IX v X

Lit dy IX tri: lch li g sang phi

C thang (trapezius)

C c n chm (sternomastoid

lit dy XI (bn phi)

Khm dy XII: th di li,

quan st xem c mt cn i 2
bn, teo c hay rung git c. Ri
a li sang 1 bn v chng
sc cn.

lit dy XII (bn phi)

Lit dy XII tri: khi th li th u li lch sang tri

Khm sc c: quan st

Teo c: bnh c

Khm sc c: quan st

Khm sc c: thang (trapezius), delta (deltoid), ngc

Khm sc c: tam u (triceps), c dui c tay, c nm bn tay

Khm sc c: kp ngn ci v tr, kp ngn t v ci, khp 2 ngn

Khm sc c: gp hng (tht lng - chu), gp gi (c hamstrings)

Khm sc c: dui gi (t u i), gp mu chn (chy trc)

Khm trng lc c

Khm trng lc c

Khm cm gic

Phn x c nh u (biceps)

Khm phn da gan chn v du

hiu Babinski

Nghim php ngn tay tr

Nghim php ngn tay tr - mi

nghim php
gt - gi

Du hiu Brudzinski

Khm dng i bnh thng,

bng mi chn, v bng gt chn

i trn 1 ng thng (tandem walk)

Ataxia: dng i hi ci ra trc, 2 chn dng, bc i khng

u ging nh thy th i trn thuyn khi c sng ln, hay
ging dng i ca ngi say ru

Hemiplegic gait: dng i ca ngi lit na ngi

sau tai bin mch mu no, dng Werdnicke - Mann

Parkinsonian gait:
Dng i ca ngi b bnh parkinson

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