1. 신경학적 검사 (Neurological Examination)
경희대학교 의과대학 부속병원 신경과학교실 이상훈

2. 병력청취(History Taking)
정신기능검사(Mental Status Examination)
뇌신경검사(Cranial Nerve Examination)
운동계검사(Motor System Examination)
감각계검사(Sensory System Examination)
반사(Reflexes)
운동조화(Coordination)
보행과 자세(Gait and Stance)
뇌막자극징후(Meningeal Irritation Sign)

3. 병력청취(History Taking) 환자의 주소와 현병력 과거력, 가족력, 사회력 계통적 문진과 신경학적 증상의 문진 목표
신경계 질환의 유무
병변의 위치(where is the lesion?)
질환의 병태생리(what is the lesion?)
감별진단(differential diagnosis)

4. Mental Status & Behavior
General appearance and behavior
(including level of consciousness & affection)
Attention and concentration
Memory
Orientation
Thought process (abstract thought, judgement, insight)
Thought content
Calculations
Language and speech

5. Functional Anatomy of Brain Cortex
Frontal lobe
Dominant, Nondominant, Bilateral
Parietal lobe
Temporal lobe
Occipital lobe

6. Mini-Mental Status Examination
지남력(시간) : 5점
지남력(장소) : 5점
기억등록 : 3점
주의집중 및 계산 : 5점
기억회상 : 3점
언어 및 시공간 구성 : 9점

8. Speech Examination Fluency of speech Comprehension
Naming letters, numbers, and objects
Repetition
Reading
Writing
Graphic

9. Classification of Aphasia
Global aphasia
Motor aphasia (Broca)
Sensory aphasia (Wernicke)
Conduction aphasia
Transcortical motor aphasia
Transcortical sensory aphasia

10. 뇌신경검사(Cranial Nerve Examination)
Olfactory nerve
Optic nerve
Fundus, visual field, visual acuity, color vision
Oculomotor, Trochlear, and Abducens nerve
Eye lids, pupils, extraocular movement
Trigeminal nerve : Facial sensory, corneal reflex
Facial nerve : Movement of forehead and cheek, taste
Vestibulocochlear nerve : Weber, Rinne test
Glossopharyngeal, Vagus nerve
Soft palate elevation, gag reflex(CN9 CN10)
Spinal Accessory nerve : SCM, Trapezius muscle
Hypoglossal nerve : Tongue movement

11. Olfactory Nerve Aromatic, nonirritative substance Test when
The patient complains of loss of smell or taste
Suspect frontal pathology
Trauma
Headache
Personality change
Dementia

12. Optic nerve Fundus, visual field, visual acuity, color vision
Confrontation Test

13. Not Cooperated or Stuporous Patient
Watch the patient’s eyes to see
Starting from behind the patient
 Your face or money, no sounds !
Visual Threat (threatening test)

14. Primary Gaze Red-Glass Test
Oculomotor, Trochlear, and Abducens nerve
Eye lids, pupils, extraocular movement
Primary Gaze Red-Glass Test

15. Pupillary Reflex Arc Afferent Pupillary Pathway
Light  Optic nerve  Optic chiasm  Optic tract
 Lateral geniculate body  Pretectal nucleus
 Bilateral Edinger-Westphal nucleus
Efferent Pupillary Pathway
Edinger-Westphal nucleus  Oculomotor nerve
 Ciliary ganglion
Direct or Indirect Light Reflex

16. Direct reflex Indirect reflex
Optic nerve
Optic tract or or -
Lateral geniculate
Optic radiation
Visual cortex
Oculomotor nerve

17. Pupil Examination “PERRL & A” P : Pupil E : Equal (Symmetricity)
R : Round (Shape)
R : Reflex to
L : Light
A : Acommodation

18. Eye Movement Examination
Observe the eyes for their position at rest.
Observe the spontaneous movement of the eye.
Ask the patient to follow a stimulus, such as penlight.
The test for convergence of the eyes.
Look for any adventitious (extraneous) movement, such as nystagmus

19. 탐구사항 The pathway of eye movement Frontal eye field
PPRF(paramedian pontine reticular formation)
MLF(medial longitudinal fasciculus)
Internuclear ophthalmoplegia
One-and-a-half syndrome

20. 뇌신경검사(Cranial Nerve Examination)
Trigeminal nerve : Facial sensory, corneal reflex
V1, V2, V3 division of trigeminal nerve

21. Corneal Reflex Arc Afferent Pupillary Pathway
Trigeminal nerve
Efferent Pupillary Pathway
Facial nerve

22. Corneal stimulus Right blink Left blink
Rt. stimulus
Lt. stimulus
Rt. stimulus
Lt. stimulus
Right Afferent lesion
Normal of Left Afferent and Both efferent
Right efferent lesion

23. 뇌신경검사(Cranial Nerve Examination)
Facial nerve : Movement of forehead and cheek, taste

24. 탐구사항 Peripheral Facial Palsy Central Facial Paralysis
Facial nerve function
Nerve to stapedius
Chorda tympani
Etc…

25. 뇌신경검사(Cranial Nerve Examination)
Vestibulocochlear nerve : Weber, Rinne test
Weber test Rinne test

26. 탐구사항
Nylen-Balani Test
Caloric test

27. 뇌신경검사(Cranial Nerve Examination)
Glossopharyngeal, Vagus nerve
Soft palate elevation, gag reflex(CN9 CN10)

28. 뇌신경검사(Cranial Nerve Examination)
Spinal Accessory nerve : SCM, Trapezius muscle
Shoulder Elevation Power Check

29. 뇌신경검사(Cranial Nerve Examination)
Hypoglossal nerve : Tongue movement
Tongue Deviate or Not

30. 운동계검사(Motor System Examination)
시진(Inspection)
Muscle bulk
Abnormal movement
근긴장도(Muscle tone) : spasticity, rigidity, hypotonia
근력(Muscle power)
Screening tests for hemiparesis
Pronator drift
Rapid finger taps
Arm-rolling test

31. Functional Anatomy of Motor System

32. Abnormal Movements Fasciculation Tremor Myoclonus
Asterixis(Negative myoclonus)
Chorea
Athetosis
Ballism

33. Abnormal Movements
Fasciculation

34. Abnormal Movements
Tremor

35. Abnormal Movements
Myoclonus

36. Abnormal Movements
Asterixis(Negative myoclonus)

37. Abnormal Movements
Choreoathetosis

38. Abnormal Movements
Ballism

39. 근긴장도(Muscle Tone)
Spasticity

40. 근긴장도(Muscle Tone)
Rigidity

41. 근긴장도(Muscle Tone)
Hypotonia

42. 근력(Muscle Power) 0 No muscle contraction detected
1 A barely detectable flicker or trace of contraction
2 Movement occurs only in the plane of gravity
3 Active movement against gravity but not against resistance
4 Active movement against resistancebut less than normal strength (may be graded as 4+, 4, or 4-)
5 Normal strength

43. Screening Tests for Hemiparesis
Pronator drift

44. Screening Tests for Hemiparesis
Rapid finger taps

45. Screening Tests for Hemiparesis
Arm-rolling test

46. 감각계검사(Sensory System Examination)
Primary sensory modalities
Light touch
Pinprick, Temperature
Vibration
Joint position(proprioception)
Cortical sensory modalities
Simultanagnosia
Graphesthesia
Stereognosis
Two-point discrimination
Baresthesia

47. Functional Anatomy of Sensory System

48. Cortical Sensory Modalities
Graphesthesia

49. Cortical Sensory Modalities
Stereognosis

50. Cortical Sensory Modalities
Two-point discrimination

51. Cortical Sensory Modalities
Baresthesia

52. 반사(Reflexes) 심부건반사(Deep tendon reflexes) 족부반사(Plantar reflexes)
피부반사(Cutaneous reflexes)
전두엽 해체징후(Frontal releasing signs)

53. 심부건반사(Deep tendon reflexes)
Jaw jerk

54. 심부건반사(Deep tendon reflexes)
Biceps

55. 심부건반사(Deep tendon reflexes)
Triceps

56. 심부건반사(Deep tendon reflexes)
Finger flexion (Hoffman’s) reflex

57. 심부건반사(Deep tendon reflexes)
Knee jerk

58. 심부건반사(Deep tendon reflexes)
Ankle jerk

59. 족부반사(Plantar reflexes)
Babinski’s sign
Chaddock’s sign
Oppenheim’s sign
Gordon’s sign

60. 족부반사(Plantar reflexes)
Babinski’s sign

61. 족부반사(Plantar reflexes)
Chaddock’s sign

62. 족부반사(Plantar reflexes)
Oppenheim’s sign

63. 족부반사(Plantar reflexes)
Gordon’s sign

64. 피부반사(Cutaneous reflexes)
복부반사(Abdominal reflexes)
T8-9
T11-12
고환올림근반사(Cremasteric reflex)
L1-2 S1
구해면체근반사(Bulbocavenous reflex and anal wink)
S2-4 S3-4

65. 전두엽 해체징후(Frontal releasing signs)
Snout, suck, and root reflexes
Palmomental reflex
Grasp reflex
Glabellar reflex

66. 전두엽 해체징후(Frontal releasing signs)
Snout reflex

67. 전두엽 해체징후(Frontal releasing signs)
Palmomental reflex

68. 전두엽 해체징후(Frontal releasing signs)
Grasp reflex

69. 전두엽 해체징후(Frontal releasing signs)
Glabellar reflex

70. 운동조화(Coordination) Coordination of movement Maintenance of muscle tone
Dysmetria : finger-to-nose test, heel-to-shin test
Dysdiadochokinesia : rapid alternating movement
Maintenance of muscle tone
Hypotonia : pendular knee jerk
Equilibrium
Gait and Stance ataxia : tandem gait

71. Functional Anatomy of Cerebellum
Embryologic classification of cerebellum
Archcerebellum, Paleocerebellum, Neocerebellum
Functional classification of cerebellum
Vestibulocerebellum, spinocerebellum, cerebrocerebellum
Deep nuclei of cerebellum
Dentate, Interposed(emboliform, globose), fastigial

72. Coordination of Movement
Dysmetria
finger-to-nose test heel-to-shin test

73. Coordination of Movement
Dysdiadochokinesia
Rapid alternating movement

74. Maintenance of Muscle Tone
Hypotonia
Pendular knee jerk

75. Equilibrium
Gait and Stance ataxia
Tandem gait

76. Abnormal Gait Cerebellar gait Gait of sensory ataxia Hemiplegic gait
Festinating gait
Steppage gait
Waddling gait
Staggering or Drunken gait
Hysteric gait (Astasia-abasia)
Gait in Normal Pressure Hydrocephalus

77. Meningeal Irritation Signs
Neck stiffness
Kernig sign
Brudzinski sign