semiologia neurológica matheus

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aula semiologia neurologica

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  • 1. SEMIOLOGIA DO SISTEMA NERVOSO MATHEUS FELIPE B. LOPES MEDICINA - UNIMONTES

2. 3. 4. REPERTRIO NOSOLGICO DO SNC

    • DOENAS:
  • CONGNITAS
  • INFECCIOSAS
  • NEOPLSICAS
  • VASCULARES
  • METABLICAS
  • TXICAS
  • TRAUMA
  • DESMIELINIZANTES
  • DEGENERATIVAS

5. 6. EFEITOS DE QUALQUER LESO NEURAL

  • PERDA OU DFICIT DA CAPACIDADE FUNCIONAL
  • LIBERAO OU DESINIBIO DE FUNO
  • IRRITAO OU EXCITAO

7. ANAMNESE

  • IDENTIFICAO
  • NOME
  • SEXO
  • IDADE
  • PROCEDNCIA:
      • ESQUISTOSSOMOSE
      • MENINGITES
      • ENCEFALITES
      • NEUROCISTICERCOSE
      • ETC...

8. ANAMNESE

    • QUEIXAS FREQUENTES:

9. ANAMNESE

  • HMA: DETALHAR CADA QUEIXA/SINTOMA:
  • INCIO, LOCALIZAO, DURAO, INTENSIDADE, TIPO, FREQUENCIA, IRRADIAO, FATORES DESENCADEANTES, AGRAVANTES, ATENUANTES
  • HP: Infeces, hipxia, trauma, transtornos psiquitricos, meningite, internaes, cirurgias

10.

  • HF:
    • Consaguinidade
    • Distrofias
    • Demncias
    • Cefalia
    • Epilepsia
    • Parkinson
    • AVC, HAS, DM, etc...

11.

  • HS: Profisso, residncia, intoxicaes, lcool, tabagismo, drogas.
  • ISDA.

12. PRINCIPAIS QUADROS DOLOROSOS EM NEUROLOGIA

  • DOR NEUROPTICA
  • DO MEMBRO AMPUTADO
  • FANTASMA
  • CAUSALGIA: leso parcial de um nervo >>> hipersensibilidade cutnea com exacerbao simptica
  • NEURALGIA DO TRIGMIO
  • NEURALGIA DO GLOSSOFARNGEO

13.

  • DOR FACIAL ATPICA
  • NEURALGIA OCCIPITAL
  • CEFALIA TENSIONAL
  • ENXAQUECA
  • CEFALIA PS-TRAUMTICA
  • SNDROME DO TNEL DO CARPO
  • MERALGIA PARESTSICA
  • CERVICOBRAQUIALGIA
  • LOMBOCIATALGIA

PRINCIPAIS QUADROS DOLOROSOS EM NEUROLOGIA 14. 15. OUTRAS QUEIXAS NEUROLGICAS

  • DISTRBIOS VISUAIS:
    • ESCOTOMAS
    • DIMINUIO DA ACUIDADE
    • DIMINUIO DO CAMPO VISUAL
    • DIPLOPIA
    • AMAUROSE FUGAZ
  • DISTRBIOS DO MOVIMENTO:
    • HIPO/HIPERCINTICOS

16.

  • DISTRBIOS AUDITIVOS:
    • ZUMBIDOS
    • DIMINUIO DA ACUIDADE
    • ALUCINAES AUDITIVAS
  • DISTRBIOS DE OUTROS NC:
    • OLFATO, PALADAR, SIALORRIA, PARALISIA FACIAL, DISARTRIA, DISFAGIA E REGURGITAO

OUTRAS QUEIXAS NEUROLGICAS 17.

  • SINTOMA/SINAIS AUTONMICOS
    • SUDORESE, VASOMOTORES, IMPOTNCIA, DISTURBIOS DA MICO/DEFECAO
  • DISTRBIOS DA LINGUAGEM:
    • DA COMPREENSO
    • DA EXPRESSO
    • AFASIAS

OUTRAS QUEIXAS NEUROLGICAS 18. ANAMNESE

  • EXEMPLO
  • HOMEM DE 30ANOS LEVADO AO PS E A IRM INFORMA QUE ELE TEVE UMA CONVULSO
  • O QUE IMPORTANTE QUESTIONAR?

PRDROMOS FATORES PRECIPITANTES AURA COMPONENTES DA CRISE FENMENOS PS-ICTAIS FREQUENCIAMEDICAMENTOS 19. 20. 21. EXAME FSICO 22. ESTADO MENTAL

  • Conscincia:resposta verbal e motora ao comando e estimulao dolorosa
  • Orientao:dados pessoais, tempo, espao
  • Ateno:repetir palavras e nmeros
  • Memria:recente e remota
  • Humor:observar fisionomia, atitude e reaes emocionais
  • Linguagem:compreenso e expresso
  • Praxia:execuo de gestos e atos motores
  • Gnosia:reconhecimento de objetos, partes do corpo e sons

23. 24. ALTERAO DO SENSRIO

  • A 24-year-old male graduate student is brought into the ER following a two-vehicle MVA. He is on a backboard and has obvious bruises and lacerations to his head and extremities. On exam,
  • he does not respond to either conversation or even shaking. He does arouse to a deep sternal chest rub and mumbles incoherently. When the stimulus ceases, he lapses back into an unresponsive state. What level of consciousness best describes his response?
  • (A) Lethargic
  • (B) Obtunded
  • (C) Stuporous
  • (D) Comatose

25. EXAME FSICO

  • ECTOSCOPIA
  • EXAME GERAL
  • EXAME NEUROLGICO
    • CONSCINCIA
    • NERVOS CRANIANOS
    • MOTRICIDADE
    • COORDENAO
    • SENSIBILIDADE
    • MARCHA

26. INSPEO

  • Kayser-Fleischer ring. Wilson's disease is an autosomal recessive disorder of copper metabolism that can present with hepatic failure, psychiatric or personality disorder, or neurologic signs, including dysarthria, dystonia, rigidity, and tremor. Serum ceruloplasmin and urinary copper levels are elevated, and hepatic copper level is increased. The abnormality is the golden brown ring contrasted against the blue-gray iris bilaterally. (From Finelli [6]; with permission.)

27. NEUROFIBROMATOSE 28. 29. Patient with dermatomyositis. There is evidence of a hyperememic rash on the upper chest, face and palm 30. Sturge-weber Syndrome 31. PELAGRA 32. DISTROFIA MIOTNICA A patient with myotonic dystrophy who has the typical symptoms of muscle wasting, ptosis, and frontal balding. Myotonic dystrophy is a relatively common form of muscular dystrophy. It can present in children and adults and is inherited as an autosomal dominant trait. The characteristic myotonic discharges correlate with clinical myotonia. Weakness is also a feature of myotonic dystrophy and often affects distal as well as proximal muscles. Other features common in adults with myotonic dystrophy include cataracts, testicular atrophy, and an organic mental syndrome. Skeletal muscle biopsy usually shows nonspecific myopathic changes 33. 34. TCE Battle's Sign Raccoon Eyes 35. 36. Inferior Rectus EntrapmentThe inferior rectus muscle is entrapped within the blowout fracture. When the patient tries to look upward, the affected eye has limited upward gaze. The patient experiences diplopia with this maneuver. (Courtesy of Lawrence B. Stack, MD.) 37. MOTRICIDADE

  • EXAME DA FUNO MOTORA:
    • MOTRICIDADE VOLUNTRIA
    • AUTOMTICA
    • TNUS E REFLEXOS
    • COORDENAO
    • EQUILBRIO

38. Generalized myasthenia gravis, key features.A Ptosis BAttempted gaze to the right. Only right eye abducts incompletely.C Demonstrates proximal weakness upon attempt to raise the arms.D Holding the arms and fingers extended theextensor muscles weaken and finger drop occurs 39. 40. MOTRICIDADE

  • MOVIMENTOS ESPONTNEOS OU ATIVOS
  • FORA MUSCULAR SEGMENTAR

41. 42. CONTINUA... 43. 44. MANOBRAS DE SENSIBILIZAO OU PARA TESTAR DFICITS

  • MANOBRA DOS BRAOS ESTENDIDOS
  • MANOBRA DE MINGAZZINI
  • MANOBRA DE BARR
  • MANOBRA DO P: IMPORTANTE NO PACIENTE EM COMA

45. 46. Test extension at the knee (L2, L3, L4quadriceps). Test flexion at the knee (L4, L5, S1, S2hamstrings) Test flexion at the hip (L2, L3, L4iliopsoas) 47. Test dorsiflexion (mainly L4, L5) and plantar flexion (mainly S1) 48. A boy with Duchenne muscular dystrophy (DMD) demonstrating pseudohypertrophy of his calves and a positive Gower's maneuver (climbing from a sitting position because of proximal muscle weakness). DMD is the most common inherited form of muscle disease 49. EXAME DOS NC 50. Oculomotor nerve paresis: A Complete ptosis; B Upon lifting of the lid lateral deviation of left bulbus. Pupillary dilatation (mydriasis) signals the parasympathetic fibers for the sphincter pupillae are affected 51. 52. 53. MOTRICIDADE:INSPEO, PALPAO, MANOBRAS

  • PESQUISA DE MOVIMENTOS ANORMAIS
    • BRADICINESIA
    • CORIA
    • DISTONIA
    • TREMOR DE REPOUSO
    • TREMOR DE MOVIMENTO

54. REFLEXOS

  • MUSCULARES PROFUNDOS OU MIOTTICOS

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