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SEMIOLOGÍA CLÍNICAEXAMEN FÍSICO DE LA
CABEZA
Dra Mayra Fuertes Flores
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Para la exploración clínica de cabeza se utilizan las 4 técnicas básicas de la exploración: inspección, palpación, percusión y auscultación .
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Estetoscopio , Oftalmoscopio (fondoscopía), Otoscopio (nariz y oído externo), Lámpara (senos paranasales, cavidad oral y
faringe), Baja lenguas, Diapasón (para explorar sensibilidad
vibratoria).
Instrumentos
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Tamaño: macrocefalia ,microcefalia Adulto = 1/9 volumen total del cuerpo,
Niño = 40%, RN = 30%. Simetría Ej. cráneo es asimétrico (hemangioma o
quiste). Anomalías: prominencias o depresiones.
Craneóstosis. (frontal,parietal,ocipital)
Cráneo: Inspección y Palpación
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Cráneo: Inspección y Palpación
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AFECTACIÓN PRIMARIA DE LOS HUESOS CON
OXIFICACIÓN PRECOZ O TARDÍA DE LAS
SUTURAS
ANORMALIDAD CEREBRAL
DEFORMACIONES CRANEALES
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MICROCEFALIA
MACROCEFALIA
HIDROCEFALIA
ANENCEFALIA
ANORMALIDADES CEREBRALES
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ESCAFOCEFALIA: SUTURA SAGITAL CERRADA NO DESARROLLO LATERAL (DESARROLLO EN SENTIDO ANTEROPOSTERIOR).
OXICEFALIA: SUTURA CORONARIA (CRANEO EN TORRE O CAMPANARIO)
SINOSTOSIS
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cicatrices Lesiones abrasiones escaras nódulos quistes sebáceos, masas mencionando su
localización y tamaño
Cuero Cabelludo
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Color: negro, castaño, rojo, rubio. Ej: canicie prematura o mechones blancos son característicos del Síndrome de Wallenburg.
Consistencia: fino, grueso o normal . Implantación
Cabello
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Hemorragia cerebral: asimetría de la cara ,una mejillas esta
completamente flácida ( fumador de pipa).boca entreabierta.
FACIES
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Atrofia músculo región inferior de la cara (boca entreabierta, la comisura labial dirigida hacia abajo y los lados ,y el labio inferior colgante, afilado y agitado por contracciones.
PARALISIS BULBAR (glosolabiofaringolaringea)
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Facies llorosa ,inexpresiva, con la boca entreabierta de la que se derrama un flujo de saliva.
FACIES TUMORAL:Perdida de los móv.,delicado de la expresión
(la cara con aspecto apático ,embrutecido ,la mímica desaparece)
FACIES SEUDOBULBAR.
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Los pacientes evidencia rostro en mascara , con mirada fija sin parpadeo de reptil.(piel grasosa,con excreción seborreica, cuero cabelludo, cejas y nariz.
Facies pakinsoniana
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FACIES COREICA corea de huntington lo
movimiento se localizarse en un lado de la cara .(muescas ,viraje ,y proyección de la lengua hacia fuera ,móv. de succión.
FACIES TABETICA: Frecuente parálisis de los
músculo oculares .La parálisis del tercer par craneal da lugar ala facie de Huchinson .Las pupila son mioticas (signo de LEYDEN).anisocoria de contornos irregula(signo de B ergo)
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Ptosis bilateral del parpado superior el enfermo para poder ver debe fruncir fuertemente el músculo frontal.(oftalmoplejia nuclear progresiva, agenesia del elevador de parpados).
FACIES DE HUTCHINSON
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TICS: son movimiento breves, brusco, involuntario, reiterativo ,que pueden tomar los músculo de la cabeza.
SIGNO DE MUSET: pequeño movimiento rítmico de la cabeza coincidiendo con el pulso.
MOVIMIENTOS INVOLUNTARIO DE LA CABEZA
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La auscultación del cráneo puede revela infamación de primera magnitud.
Lugar de auscultar :globo ocular y zonas temporal (soplos ,MAV).
AUSCULTACION