exame neurolÓgico ppt

7/25/2019 EXAME NEUROLGICO ppt

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EXAMEEXAMENEUROLGICONEUROLGICO


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OBJETIVO

ESTABELECER O EXAMENEUROLGICO INICIAL NA

ADMISSO DO PACIENTE; IDENTIFICAR DISFUNES

PRESENTES NO SISTEMA NERVOSO;

DETERMINAR OS EFEITOS DESSASDISFUNES NA VIDA DIRIADESTE PACIENTE.


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ASPECTOS ABORDADOS

Avalia!" #a $"%&$i'%$ia; Avalia!" #a& ()(ila&; Avalia!" #"& (a*+& $*a%ia%"&; Avalia!" #" &i&,+-a -","*;

Avalia!" #" &i&,+-a &+%&"*ial; Avalia!" #+ *+l+/"& (*")%#"&.


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CONSCINCIA

E&,a#" +- 0)+ " i%#iv1#)" +&,2 $3%&$i"#+ &i -+&-" + #" a-4i+%,+; 5 $"%6+$+#"*

#a& $i*$)%&,7%$ia& 0)+ l6+ #i8+- *+&(+i," +#a0)+la& $"- 0)+ &+ *+la$i"%a 9,+-(":+&(a": (+&&"a& + a,"&.

$a*a$,+*1&,i$a& 42&i$a" #a $"%&$i'%$ia


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NVEL DE CONSCINCIA

? 4a&i$a-+%,+ a $a(a$i#a#+ #+ #+&(+*,a*#" (a$i+%,+: ") #a vi@1lia: #+,+*-i%a#a

(+l" %1v+l #+ a,ivi#a#+ 0)+ &+ "4,5- #"(a$i+%,+ $"-" *+&("&,a a +&,1-)l"&$*+&$+%,+& ("* (a*,+ #" +/a-i%a#"*.


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CLASSIFICAO DONVEL DE CONSCINCIA

Alerta!"#$l"a< 5 " i%#iv1#)" 0)+ +&,2 a$"*#a#": al+*,a: 0)+ *+&("%#+a#+0)a#a-+%,+ a" +&,1-)l" v+*4al: 0)+ +&,2 "*i+%,a#" %" ,+-(" +%" +&(a".

Letar#"a %"&er'()"a* +&,a#" #+ &"%" a%"*-al-+%,+ (*"l"%@a#".

O+),+"la-./* &"%"l+%,": #+&(+*,2v+l $"- +&,1-)l"& &"%"*"&: (+*#a#" &+%,i#" #+ "*i+%,a!" %" ,+-(" + %" +&(a": +&,a%#" %"*-ai& a&*+&("&,a & (+*@)%,a& + "*#+%& 4a%ai&.

T/r&/rE't,&/r*G*a) -ai& (*")%#" #a "4%)4ila!": %!" *+&("%#+

a& "*#+%& 4a%ai&.C/0a< i%#iv1#)" +- &"%" (*")%#": i%$"%&$i+%,+: $"- "& "l6"&

+$6a#"&: %!" +-i,+ &"- v+*4al: %!" i%,+*a@+ $"%&i@" ") $"- "a-4i+%,+.


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AVALIAO E DURAO

DO COMAE'1ala 2e C/0a 2e Gla'#/3 4ECGL5

Pa#*"%i8a!" #a avalia!" #" %1v+l #+ $"%&$i'%$ia; 5 a -ai&$"%6+$i#a. P"#+ &+* )&a#a %" ,*a)-a + %a $l1%i$a.Va%,a@+%&v)la + #+@l),i!". TESTE* P+a a" (a$i+%,+ (a*a #i8+* A6 ")

4"$++.


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X NERVO VAGO MISTO*M","*: &+%&i,iv": v+@+,a,iv" + &+%&"*ial.

FUNO*. P. -","*a H I%+*va- ->&$)l" #" (ala," -"l+: a*i%@+ + la*i%@+ 9"%a!";. P. &+%&i,iv"=&+%&"*iai& = &+%&i4ili#a#+ @+*al #+ 2*+a $),7%+a

*+,*"a)*i$)la* + #" $"%#)," +/,+*%" a)#i,iv": #a -)$"&a #a la*i%@+ +("*!" i%+*i"* #a a*i%@+.

K. P. v+@+,a,iva H i%+*va!" (a*a&&i-(2,i$a #+ v1&$+*a& ,"*2$i$a& +

a4#"-i%ai&. TESTE**+l+/" #" v3-i,": *+l+/" "$)l"$a*#1a$" + &i%"$a*",i#ia%". ALTERA;ES* V3-i," +- a," 9IC: *i,-" #+ $6+W%+=&,"+&:

&"l)"& + 4"$+"& (a,"l@i$"&. D+&vi" #" v5) #" (ala," (a*a " la#"$"-(*"-+,i#" i%&(+!" +&,2,i$a + (a*a " la#" "("&," i%&(+!"#i%7-i$a.


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XI NERVO ACESSRIO

MOTOR FUNO* M"vi-+%,a!" #" "-4*" +

*",a!" #a $a4+a $"%,*a )-a *+&i&,'%$ia+/+*$i#a.

TESTE*O4&+*v+ a (*+&+%a #+ a,*"ia ")

a&$i$)la+& %" ->&$)l" ,*a(58i".


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XII NERVO IPOGLOSSO

MOTOR FUNO*Si-+,*ia + ("&i!" #a l1%@)a.

TESTE* S"li$i,+ a" (a$i+%,+ 0)+ +/,+*i"*i8+ al1%@)a: "4&+*v+ &i-+,*ia: (*+&+%a #+a&$i$)la+& ") #+&vi" +- *+la!" a li%6a -5#ia.

S"li$i,+ 0)+ +-()**+ a l1%@)a $"%,*a a&

4"$6+$6a& #+ -"#" al,+*%a#": + (al(++/,+*%a-+%,+ (a*a &+%,i* a "*a #" -"vi-+%,".


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AVALIAOAVALIAOSENSITIVA E DESENSITIVA E DEREFLEXOSREFLEXOS

TENDINOSOSTENDINOSOSPROFUNDOSPROFUNDOS


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SENSIBILIDADE

I%+*va!" A+*+%,+; D+*-2,"-"&< 5 a ai/a #+ (+l+ i%+*va#a

(+la *ai8 &+%&i,iva #+ )- >%i$" %+*v"+&(i%6al


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CLASSIFICAO DASENSIBILIDADE

EXTEROCEPTIVA 9&)(+*i$ial< #"*&)(+*i$ial: ,5*-i$a 9*i" + $al"* + ,2$,il.

PROPRIOCEPTIVA 9(*")%#a< $i%5,i$"=("&,)*al: vi4*a,*ia: 4a*+&,5&i$a: #"* (*")%#a

+ +&,+*+"@%&,i$a.


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PONTOS IMPORTANTES

O +/a-+ #a &+%&i4ili#a#+ #+v+ &+* *+ali8a#" ("*+,a(a&: +vi,a%#" $a%&a* " (a$i+%,+;

E/(li$a* a" (a$i+%,+ (*+via-+%,+ $a#a )- #"&,i("& #+ (+&0)i&a 0)+ &+*!" +-(*+@a#"&: a i- #+0)+ a& *+&("&,a& &+a- (*+$i&a&.

A-4i+%,+ ,*a%0Yil"; O& "l6"& v+%#a#"& a i- #+ &+ +vi,a* " $"%,*"l+

vi&)al;


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E%,*+vi&,a< +vi,a* +-(*+@a* 0)al0)+*

(alav*a $a(a8 #+ &)@+&,i"%2=l"< %!" &+#+v+: ("* +/+-(l": (+*@)%,a* &+%,i) aa@)l6a#a #)*a%,+ a (+&0)i&a #a

&+%&i4ili#a#+ #"l"*"&a. I%&,*)i* " (a$i+%,+ aa$)&a* a& +/$i,a+& (*"v"$a#a&i%#+(+%#+%,+-+%,+ #+ 0)al0)+*i%,+**"@a,*i".


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SENSIBILIDADE SUPERFICIAL

A &+%&i4ili#a#+ ,2$,il #+v+ &+* (+&0)i&a#a),ili8a%#"=&+ )-a -+$6a #+ al@"#!" ") )-

(i%$+l; a &+%&i4ili#a#+ #"l"*"&a 5(+&0)i&a#a ("* -+i" #+ a@)l6a + a&+%&i4ili#a#+ ,5*-i$a 9*i" + $al"* #+v+ &+*

+/(l"*a#a ),ili8a%#"=&+ #"i& ,)4"& #++%&ai": )- $"%,+%#" 2@)a @+la#a + "),*"2@)a 0)+%,+ 9,+-(+*a,)*a +%,*+ Z + [C.


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SENSIBILIDADESSENSIBILIDADESPROFUNDASPROFUNDAS


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CINKTICO7POSTURAL

O*#+%a* a" (a$i+%,+ 0)+ a(*++%#a $"- a -!""("&,a " &+) ("l+@a*: $)a ("&i!" #+v+ &+*

-"#ii$a#a +- -a%"4*a& &)$+&&iva&. C"- a(*"va #"& 4*a"& +&,+%#i#"& ("#+*+-"& a(*+$ia*#+&vi"& ") 0)+#a #+ )- ") a-4"& "& -+-4*"&&+- 0)+ " (a$i+%,+ &+ a(+*$+4a #" a,": +&,a%#"

$"- "& "l6"& v+%#a#"&. I%#+/=%a*i8; $al$a%6a*="+l6".


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A %"!" #"& -"vi-+%,"& (a&&iv"& #+v+ &+*(+&0)i&a#a #+&l"$a%#"=&+: l+%,a + &)av+-+%,+: )-a

a*,i$)la!" 9#+#"& #"& (5& + #a& -!"&: ,"*%"8+l":"+l6"&: ()%6"& +- #i+*+%,+& #i*++&: ,+*-i%a%#"("* &+ #+,+* %)-a #a#a ("&i!" 0)+ " (a$i+%,+ #+v+#+,+*-i%a*. C"&,)-a-"& i%i$ia* +&,a (+&0)i&a (+l"62l)/: ,"-a%#" $)i#a#" #+ &+(a*2=l"& #"& "),*"&

a*,+l6"& + #+ i-(*i-i*=l6+& -"vi-+%,"& &)av+& (a*a$i-a + (a*a 4ai/": #+v+%#" " (a$i+%,+ i%#i$a* a("&i!" +- 0)+ " a*,+l6" 5 i/a#".


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VIBRATRIA

? (+&0)i&a#a $"- " a)/1li" #+ )-#ia(a&!" #+ vi4*a+& l+%,a& 9J

$i$l"&&+@)%#": 0)+ &+ a8 vi4*a* -+#ia%,+@"l(+ &"4*+ " *a-" U. O #ia(a&!" 5a(li$a#": &)$+&&iva-+%,+ %a& #iv+*&a&&ali'%$ia& &&+a& 9a*,+l6"&: -al5"l"&:

,)4+*"&i#a#+ a%,+*i"* #a ,14ia + #+#"&:#+v+%#" " (a$i+%,+ a$)&a* ") %!" a&vi4*a+&.


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BARESTKSICA

S+%&i4ili#a#+ (*+&&!" H +/+*$+%#"(*+&&!" (*"@*+&&iva: $"- a ("l(a #+ )-

#+#" ") )- "4+," *"-4": &"4*+ a (+l+


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DOLOROSA PROFUNDA

P+&0)i&a#a a(li$a%#" $"-(*+&&!" #a&-a&&a& -)&$)la*+&: #"& %+*v"& + #"&

,+%#+&.


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ESTEREOGNSTICA

? a $a(a$i#a#+ 0)+ " i%#iv1#)" a(*+&+%,a #+*+$"%6+$+* "4+,"& (+la (al(a!": +&,a%#" $"-"l6"& +$6a#"&.

O4+,"&< (+%,+: $6av+: -"+#a: l2(i&: "4+,"& #+-a#+i*a +%,*+ "),*"&.

Evi,a* "4+,"& $)" *+$"%6+$i-+%," ("&&a &+*

+i," ("* i%,+*-5#i" #a &+%&i4ili#a#+ &+%&"*ial:$"-" -"l6" #+ $6av+& (+la a)#i!" ") i&0)+i*":

(+l" "#"* #" l)1#".

ALTERA;ES DA


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ALTERA;ES DAS ESTEREOGNSTICA

A@%"&ia ") a&,+*+"@%"&ia Q a)&'%$ia #a&+%&i4ili#a#+ +&,+*+"@%&,i$a.

M"*"a@%"&ia< (+*#a #a $a(a$i#a#+ #+ #i&,i%@)i* a

"*-a #" "4+,"; il"a@%"&ia< i%$a(a$i#a#+ #+ *+$"%6+$+* a +&,*),)*a

-a,+*ial #" "4+," 9 vi#*": -+,al: -a#+i*a. A&&i-4"lia T2$,il< 0)ali#a#+& #" "4+," 9 "*-a:

,a-a%6": -a,+*ial: $"%&i&,'%$ia: &!" *+$"%6+$i#a&:("*5- " (a$i+%,+ 5 i%$a(a8 #+ *+$"%6+$+* " "4+,"#+%,*" #+ &)a &i@%ii$a!".

LOCALIAO E


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LOCALIAO EDISCRIMINAO TCTEIS

Ca(a$i#a#+ #+ l"$ali8a* )- +&,1-)l"$),7%+" 9,""@%"&ia + a #+ *+$"%6+$+* &+ "

+&,1-)l" a(li$a#" 5 >%i$" ") #)(l". G*a+&,+&ia H *+$"%6+$i-+%," #+ %>-+*"&

") l+,*a& %a (+l+ ("* -+i" #+ )- "4+,"*"-4".

G*a"a%+&,+&ia H i%$a(a$i#a#+ #+*+$"%6+$i-+%,".


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REFLEXOSREFLEXOSTENDINOSOSTENDINOSOS

PROFUNDOSPROFUNDOS


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DEFINIO

R+&("&,a -","*a ") &+$*+,"*a a )-+&,1-)l" a#+0)a#": +/,+*%" ") i%,+*%".

Ba&+ a%a,3-i$a #a -",*i$i#a#+ *+l+/a 5" a*$" *+l+/": &+%#";. Via a+*+%,+ 9 *+$+(,"* + %+*v" &+%&i,iv";

. C+%,*" 9 &)4&,7%$ia $i%8+%,a #" SNC;K. Via ++*+%,+ 9 %+*v" -","* + *@!"++,"*.


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POSICIONAMENTO

Ma%,+%6a " (a$i+%,+ *+la/a#": ("&i$i"%+ "&-+-4*"& $"**+,a + &i-+,*i$a-+%,+: + (+*$),a ",+%#!" #+ "*-a 4*)&$a: )&a%#" )- -"vi-+%,"

*2(i#" #" ()%6". A (a%$a#a #+v+ &+* *2(i#a +#i*+,a: &+- *+&vala*. P"#+=&+ )&a* a +/,*+-i#a#+("%,)#a ") a$6a,a#a #" -a*,+l" #+ D55*i%+. A+/,*+-i#a#+ ("%,)#a &+*v+ (a*a a,i%@i* 2*+a&

(+0)+%a&: $"-" " #+#" $"l"$a#" &"4*+ " ,+%#!"4i$i(i,al. A +/,*+-i#a#+ a$6a,a#a $a)&a -+%"+&$"%"*," a" (a$i+%,+ %a 2*+a 4*a0)i"**a#ial.


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TKCNICA

S+@)*+ " -a*,+l" #+ D55*i%+ +%,*+ "("l+@a* + " i%#i$a#"*: #+ -"#" 0)+ "&$il+

liv*+-+%,+ #+%,*" #"& li-i,+& #+i%i#"&(+la (al-a #a &)a -!" + "& #+#"&. O4&+*v+a v+l"$i#a#+: "*a + a-(li,)#+ #a *+&("&,a

*+l+/a. C"-(a*+ &+-(*+ )- la#" $"- ""),*".


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OS REFLEXOS COSTUMAM SER GRADUADOS SEGUNDOUMA ESCALA DE O A *

M)i," vi@"*"&"&: 6i(+*a,iv"&: $"-$l"%" 9"&$ila+& *1,-i$a& +%,*+ l+/!"+ +/,+%&!"9 Mai& vi@"*"&"& 0)+ a -5#ia: ("&&1v+l:

("*5- %!" %+$+&&a*ia-+%,+ i%#i$a,iv"&

#+ (a,"l"@ia.8 M5#i"&;%"*-ai&6 U- (")$" #i-i%)1#"&< li-i,+ i%+*i"*

#a %"*-ali#a#+O A)&'%$ia #+ *+&("&,a


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REFLEXO BICIPITAL 4C CQ5

O 4*a" #" (a$i+%,+ #+v+ &+* (a*$ial-+%,+l+,i#" %" $","v+l": $"- a (al-a #a -!"

(a*a 4ai/". C"l"0)+ &+) ("l+@a* ") "),*"#+#" i*-+-+%,+ &"4*+ " ,+%#!" 4i$i(i,al.G"l(+i+ $"- " -a*,+l" #+ *+l+/": #+

-"#" 0)+ " @"l(+ vi&+ #i*+,a-+%,+ " &+)#+#" %a #i*+!" #" ,+%#!" 4i$i(i,al.


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REFLEXO TRICIPITAL 4CQ

C5 Fl+/i"%+ " 4*a" #" (a$i+%,+ %" $","v+l":

$"- a (al-a #a -!" vi*a#a (a*a " $"*(": +

()/+ " 4*a" )- (")$" ("* &"4*+ " ,*a/.P+*$),a " ,+%#!" #" ,*1$+(& a$i-a #"$","v+l". D' )- @"l(+ #i*+," ("* #+,*2& #"

,+%#!". O4&+*v+ a $"%,*a!" #" ->&$)l",*1$+(& + a +/,+%&!" #" $","v+l".


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REFLEXO SUPINADOR OU


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REFLEXO SUPINADOR OU

BRAQUIORRADIAL (C5, CQ5

O (a$i+%,+ #+v+ -a%,+* a -!" &"4*+ "a4#"-+ ") $"l": $"- " a%,+4*a"

(a*$ial-+%,+ (*"%a#". P+*$),a " *2#i"$+*$a #+ : a $- a$i-a #" ()%6".O4&+*v+ a l+/!" + a &)(i%a!" #"

a%,+4*a".


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REFLEXO PATELAR


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REFLEXO PATELAR4L8 L9 L5

O (a$i+%,+ ("#+ i$a* &+%,a#" ") #+i,a#":$"%,a%," 0)+ " "+l6" +&,+a l+,i#".

P+*$),a 4*)&$a-+%,+ " ,+%#!" (a,+la* l"@"a4ai/" #a (a,+la. O4&+*v+ a $"%,*a!" #"0)a#*1$+(& $"- a +/,+%&!" #" "+l6". A

$"l"$a!" #a -!" &"4*+ a *+@i!" a%,+*i"*#a $"/a #" (a$i+%,+ a)#a*2 a &+%,i* +&,+*+l+/".


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REFLEXO AUILEU 4S65

Se o paciente estiver sentado,faa a dorsiflexo do p ao nveldo tornozelo. Consiga que opaciente relaxe, e percuta otendo de Aquiles. Observe epalpe a presena de flexo plantarno tornozelo. erifique, ta!b!, avelocidade de relaxa!ento ap"s acontrao !uscular.


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RESPOSTA PLANTAR 4L


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RESPOSTA PLANTAR 4L

S65 C"- )- "4+," $"-" )-a $6av+ ") )-

a4ai/a#"* #+ l1%@)a +i," #+ -a#+i*a:

(+*$"**a a a$+ la,+*al #a *+@i!" (la%,a*:#++ " $al$7%+" a,5 a $"%$avi#a#+:a8+%#" )-a $)*va %" &+%,i#" -+#iala,*av5& #a $"%$avi#a#+.

M"vi-+%," #"& a*,+l6"&: 0)+ %"*-al-+%,+$"**+&("%#+ a )-a l+/!".


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A dorsiflexo do grande artel#o !uitas


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A dorsiflexo do grande artel#o, !uitasvezes aco!pan#ada do afasta!ento dosde!ais artel#os, constitui o sinal de

$abins%i positivo. Sua presena costu!aindicar leso do siste!a nervoso central notrato corticospin#al.

O sinal de $abins%i positivo ta!b! ocorrenos estados de inconsci'ncia associados (

exame neurolÓgico ppt

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