semiologia de neurologia Dictada por el Dr.Manuel Hidalgo Yen

3. S.A.R.A Figure .- Brainstem reticular activating system and its ascending projections to the thalamus and cerebral hemispheres

8. PARALISIS FACIAL PERIFÉRICA

9. PARALISIS FACIAL PERIFERICA

10. PARALIS FACIAL CENTRAL

11. PARALISIS FACIAL PERIFÉRICA

28. MOVIMIENTO PASIVO TONO MUSCULAR .- Estado de semicontracción permanente, involuntario, no fatigante, de carácter reflejo, encaminado a conservar una actitud

30. MOVIMIENTO REFLEJO REFLEJO Respuesta estereotipada, motriz o secretora, independiente de la voluntad, provocada inmediatamente ante la aplicación de un estímulo sobre un determinado tipo de receptor

33. REFLEJO TRICIPITAL

34. REFLEJO TRICIPITAL

35. REFLEJO TRICIPITAL

36. REFLEJO TRICIPITAL

38. REFLEJO ROTULIANO

39. REFLEJO ROTULIANO

40. REFLEJO ROTULIANO

44. REFLEJO AQUILIANO

49. REFLEJOS SUPERFICIALES

61. OFTALMOPLEJIA INTERNUCLEAR Figure. - Eye movements in internuclear ophthalmoplegia (INO) resulting from a lesion of the medial longitudinal fasciculus bilaterally.

62. ATAXIA SENSORIAL Figure .- Principal sites of spinal cord disease (shading) in disorders producing sensory ataxia.

63. OFTALMOPLEJIA POR LESIÓN PONTINA Figure .- One-and-a-half syndrome. This results from a pontine lesion (shaded area) involving the paramedian pontine recticular formation (lateral gaze center) and medial longitudinal fasciculus, and sometimes also the abducens (VI) nucleus, and affecting the neuronal pathways indicated by dotted lines. Attempted gaze away from the lesion ( A ) activates the uninvolved right lateral gaze center and abducens (VI) nucleus; the right lateral rectus muscle contracts and the right eye abducts normally. Involvement of the medial longitudinal fasciculus interrupts the pathway to the left oculomotor (III) nucleus, and the left eye fails to adduct. On attempted gaze toward the lesion ( B ), the left lateral gaze center cannot be activated, and the eyes do not move. There is a complete (bilateral) gaze palsy in one direction (toward the lesion) and one-half (unilateral) gaze palsy in the other direction (away from the lesion), accounting for the name of the syndrome.

64. PUNCIÓN LUMBAR Figure 11–1. Lateral decubitus position for lumbar puncture.

65. FISIOPATOLOGIA DEL REFLEJO PUPILAR Figure. - Anatomic basis of the pupillary light reflex. The afferent visual pathways from the retina to the pretectal nuclei of the midbrain are represented by dashed lines and the efferent pupilloconstrictor pathways from the midbrain to the retinas by solid lines. Note that illumination of one eye results in bilateral pupillary constriction.

66. TIPOS DE RESPIRACION EN EL COMA Figure .- Ventilatory patterns in coma. Cheyne-Stokes respiration and central hyperventilation are seen with metabolic disturbances and with structural lesions at a variety of sites in the brain. They are therefore not useful for anatomic localization of disorders producing coma. Ataxic and gasping ventilatory patterns are most commonly seen with pontomedullary lesions.

67. SINDROME DE WALLENBERG Figure .- Lateral medullary infarction (Wallenberg's syndrome) showing the area of infarction (shaded), anatomic structures affected.

68. SIGNOS NEUROLOGICOS EN EL COMA Figure 10–2. Neurologic signs in coma with downward transtentorial herniation. In the early diencephalic phase, the pupils are small (about 2 mm in diameter) and reactive, reflex eye movements are intact, and the motor response to pain is purposeful or semipurposeful (localizing) and often asymmetric. The late diencephalic phase is associated with similar findings, except that painful stimulation results in decorticate (flexor) posturing, which may also be asymmetric. With midbrain involvement, the pupils are fixed and midsized (about 5 mm in diameter), reflex adduction of the eyes is impaired, and pain elicits decerebrate (extensor) posturing. Progression to involve the pons or medulla also produces fixed, midsized pupils, but these are accompanied by loss of reflex abduction as well as adduction of the eyes and by no motor response or only leg flexion upon painful stimulation. Note that although a lesion restricted to the pons produces pinpoint pupils as a result of the destruction of descending sympathetic (pupillodilator) pathways, downward herniation to the pontine level is associated with midsized pupils. This happens because herniation also interrupts parasympathetic (pupilloconstrictor) fibers in the oculomotor (III) nerve.

69. SINDROME DE HORNER

70. VIA VESTIBULAR PERIFERICA Y CENTRAL Figure 3–1. Peripheral and central vestibular pathways. The vestibular nerve terminates in the vestibular nucleus of the brainstem and in midline cerebellar structures that also project to the vestibular nucleus. From here, bilateral pathways in the medial longitudinal fasciculus ascend to the abducens and oculomotor nuclei and descend to the spinal cord.

71. MALFORMACION ARTERIOVENOSA Figure 34-23 Left temporal arteriovenous malformation (AVM), demonstrated by MRI (above), and angiography (below). The patient was a 59-year-old woman with longstanding complaints of headache.

72. HEMORRAGIA INTRACEREBRAL Figure 34-19 An unenhanced CT scan showing the typical picture of a massive primary (hypertensive) hemorrhage in the basal ganglia. The third ventricle and ipsilateral lateral ventricle are compressed and displaced by the expanding mass (12 h after onset of stroke).

73. INFARTO CEREBRAL Figure 34-17 Massive ischemic infarct of left cerebral hemisphere in the distribution of the middle cerebral artery. CT scans taken 24 h (left) and 72 h (right) following the onset of neurologic symptoms. The second scan demonstrates marked swelling of the infarcted tissue and displacement of central structures.

74. HEMORRAGIA SUBARACNOIDEA Figure 34-22 Subarachnoid hemorrhage due to rupture of a basilar artery aneurysm. Left. Axial CT scan image at the level of the lateral ventricles showing widespread blood in the subarachnoid spaces and layering within the ventricles with resultant hydrocephalus. Right. At the level of the basal cisterns blood can be seen surrounding the brainstem, in the anterior sylvian fissures and the anterior interhemispheric fissure. The temporal horns of the lateral ventricles are again enlarged, reflecting acute hydrocephalus.

75. HEMORRAGIA TALAM Figure .- CT scan of a left thalamic hemorrhage that caused hemiplegia and hemisensory loss in a hypertensive patient.

77. SENSIBILIDAD

79. ESPINOTALAMICO DORSAL

80. ESPINOTALAMICO VENTRAL

81. PROPIOCEPCION: TACTO Y PRESION

85. COORDINACION

87. PRUEBA INDICE NARIZ

88. PRUEBA TALON – RODILLA

92. SIGNO DE KERNING

93. SIGNO DE KERNING

94. SIGNO DE BRUDZINSKI

95. NERVIOS CRANEALES

100. CAMPOS VISUALES

101. CAMPOS VISUALES Figure . Normal limits of the visual field

102. FONDO DE OJO Figure .- The normal fundus. The diagram shows landmarks corresponding to the photograph. (Photo by Diane Beeston; reproduced with permission, from Vaughan D, Asbury T, Riordan-Eva P: General Ophthalmology, 15th ed. Appleton & Lange, 1992.)

103. PAPILEDEMA Figure 4–11. Appearance of the fundus in papilledema. A: In early papilledema, the superior and inferior margins of the optic disk are blurred by the thickened layer of nerve fibers entering the disk. B: Swollen nerve fibers (white patches) and hemorrhages can be seen. C: In fully developed papilledema, the optic disk is swollen, elevated, and congested, and the retinal veins are markedly dilated. D: In chronic atrophic papilledema, the optic disk is pale and slightly elevated, and its margins are blurred. The white areas surrounding the macula are reflected light from the vitreoretinal interface. The inferior temporal nerve fiber bundles are partially atrophic (arrows) . (Photos courtesy of WF Hoyt.)

106. OFTALMOPLEJIA III Figure 4–14. Clinical findings with oculomotor (III) nerve lesion. With the ptotic lid passively elevated, the affected ( right ) eye is abducted. On attempted downgaze, the unaffected superior oblique muscle, which is innervated by the trochlear (IV) nerve, causes the eye to turn inward.

107. OFTALMOPLEJIA VI PAR Figure 4–16. Clinical findings with abducens (VI) nerve lesion. The affected (right) eye is adducted at rest ( A ) and cannot be abducted ( B ).

108. DISTRIBUCION DEL NERVIO TRIGEMINO

121. AREAS DEL LENGUAJE

123. PRAXIA .Realización de actos que conllevan a un :fin determinado EXAMEN DE LA PRAXIA 1. Observar actos de la vida cotidiana, la actividad automática. 2. Observar el comportamiento de la persona al comando, ordenando en forma sistemática la ejecución de una orden.

124. GNOSIA Comprensión del mundo exterior. También se le define como el reconocimiento de los objetos. EXAMEN DE LA GNOSIA Gnosia Visual.­ o Reconocimiento de objetos o Identificación de colores Gnosia Auditiva.­ o Reconocimiento de objetos por el sonido o Reconocimiento de melodías Gnosia Perceptiva.­ o Estereognosia

151. ALTERACIONES MOTORAS o Las más frecuentes son las hemiplejías I hemiparesias: a. H. Global o DroDorcionaL-Cuando se afecta un hemicuerpo in toto. b. H. Predominante.- Cuando predomina en algunas de las extremidades. c. H. Comun.- Parálisis de miembros y par craneal son contralaterales. d. H. Alterna.- Parálisis de miembros es contralateral y el par craneal homolateral e. H. Cruciata.- Parálisis de un miembro superior es contralateral con respecto al otro inferior. f. H. Directa.- Parálisis es homolateral a la lesión.

154. SINDROMES MOTORES 1. Síndrome de la neurona motora central: o Parálisis o paresias o Conservación de algunos movimientos involuntarios(sincinesias) o Hipertonía piramidal: espasticidad o No hay atrofia muscular o No hay fibrilación muscular o Respuestas eléctricas normales (EMG) o ROT exaltados o Reflejos patológicos (Babinski y sucedáneo s) 2. Síndrome de la neurona Ileriférica: o Parálisis de distribución segmentaria o Ausencia de movimientos involuntario s o Hipotonía o flacidez o Presencia de atrofia muscular o Presencia de fasciculaciones musculares o Respuestas eléctricas de degeneración (EMG) o Abolición de reflejos o hiporreflexia. o No reflejos patológicos.

155. VIA SENSITIVA Figure 3–5. Pathway mediating proprioceptive sensation.