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 BLOCK TIME am am pm pm Aug 6 – Aug 10 Week 1 Overview PCM2/Pharm & Ther Orientation INTRODUCTION Quiz & its Review Lecture‐7 Quiz & its Review Lecture‐12 am am pm pm am am pm pm am am pm pm am am pm pm am am pm pm am am pm pm Aug 13 – Aug 17 Week 2 Spinal cord/Brainstem Pharm & Therapeutics Aug 20 – Aug 24 Week 3 CNs/Brainstem Pharm & Therapeutics Aug 27 – Aug 31 Week 4 CNs/Thalamus Pharm & Therapeutics Sep 3 – Sep 7 Week 5 Motor systems Pharm & Therapeutics Sep 10 – Sep 14 Week 6 Cerebral cortex/Motor Pharm & Therapeutics Sep 17 – Sep 21 Week 7 Neuropathology Neuropath/P&T MONDAY MID‐TERM EXAM (WEEKS 1‐3) Labor Day Quiz & its Review Lecture‐23 Rosh Hashanah TUESDAY Lecture‐1 Lecture‐2 PCM2‐exam (1pm) Lecture‐8 Lecture‐9 Lecture‐13 Lecture‐14 Week in preview Lecture‐17 Quiz & its Review Lecture‐20 Neuro OSCE (1‐5) Lecture‐24 Lecture‐25 Quiz & its Review Lecture‐28 Lecture‐29 WEDNESDAY Lecture‐3 Lecture‐4 Lecture‐10 Lecture‐11 Mass of Holy Spirit Lecture‐15 Lecture‐16 Lecture‐18 Lecture‐19 Lecture‐21 Lecture‐22 Neuro OSCE (1‐5) Lecture‐26 Lecture‐27 Lecture‐30 Lecture‐31 THURSDAY Lecture‐5 Lecture‐6 Clinical Correlation‐3 Clinical Correlation‐4 Clinical Correlation‐5 Clinical Correlation‐6 Small Group Exercise‐2 (Clinical Localization) FRIDAY Clinical Correlation‐1 Clinical Correlation‐2 PCM2‐MSR Workshop Small Group Exercise‐1 (Clinical Localization) Quiz & its Review Clinical Correlation‐9 Clinical Correlation‐7 Clinical Correlation‐8 Clinical Correlation‐10 Clinical Correlation‐11 Clinical Correlation‐12 Small Group Exercise‐3 (Clinical Localization) Clinical Correlation‐13 Clinical Correlation‐14 Clinical Correlation‐15 Clinical Correlation‐16 FINAL EXAM (1/3rd Weeks 1‐3) (2/3rd Weeks 4‐7) Foundational Neuroscience Course Calendar 2012‐2013 Date Time Session Aug 6 Aug 7 Aug 7 Aug 8 Aug 8 Aug 9 Aug 9 Aug 10 Aug 10 2:00p 9:30a 10:30a 9:30a 10:30a 9:30a 10:30a 9:30a 10:30a Introduction Lecture‐1 Lecture‐2 Lecture‐3 Lecture‐4 Lecture‐5 Lecture‐6 Clinical Correlation‐1
Clinical Correlation‐2
Aug 13 Aug 13 Aug 14 Aug 14 Aug 15 Aug 15 Aug 16 Aug 16 Aug 17 Aug 20 Aug 20 Aug 21 Aug 21 Aug 22 Aug 22 Aug 23 Aug 23 Aug 23 Aug 24 Aug 27 Aug 28 Aug 28 Aug 29 Aug 29 Aug 30 Aug 30 Aug 31 Aug 31 Topic Faculty Course Review (grading, expectations, etc) Introduction & General Organization (Chap 1, 3) Development of the Nervous System (Chap 2) Meningeal coverings, Ventricles & CSF (Chap 4, 5) Blood supply of the brain (Chap 6)
Sensory system and receptors (Chap 9) Spinal cord (Chap 10)
Spinal cord disorders
Neuromuscular junction (NMJ) disorders (patient) Dauzvardis
Dauzvardis
Doncarlos
Gruener
Gruener
Dauzvardis
Dauzvardis
Merchut
Merchut
8:30a Quiz & its Review
9:30a Lecture‐7 9:30a Lecture‐8 10:30a Lecture‐9 8:30a Lecture‐10 9:30a Lecture‐11 9:30a Clinical Correlation‐3
10:30a Clinical Correlation‐4
11:00a ‐ Small Group Exercise‐1 12:30p Quiz on Week 1 Material and Preview of the Week Organization of the brainstem (Chap 11) Cranial nerves and nuclei (Chap 12)
Brainstem summary (Chap 15)
Chemical senses of taste & smell (Chap 13) Hearing and Balance (Chapter 14)
Cranial nerves, Brain stem reflexes and disorders Multiple sclerosis (patient)
Dauzvardis
Dauzvardis
Dauzvardis
Dauzvardis
Gruener
Merchut
Merchut
8:30a 9:30a 9:30a 10:30a 9:30a 10:30a 9:30a 10:30a 2:00p ‐
3:30p 10:00a 11:00a‐
2:00p 9:30a 10:30a 9:30a 10:30a 9:30a 10:30a 9:30a 10:30a Quiz on Week 2 Material and Preview of the Week Hearing and Balance (Chapter 14) – “Once again” Cranial nerves and nuclei (Chap 12) ‐ “Once again” Brainstem summary (Chap 15) ‐ “Once again” Visual system I (Chap 17)
Visual system II (Chap 17)
Coma/Brain death/End‐of‐life
Neuroimaging essentials
Quiz & its Review
Lecture‐12 Lecture‐13 Lecture‐14 Lecture‐15 Lecture‐16 Clinical Correlation‐5
Clinical Correlation‐6
Clinical Localization Set #1 FACULTY Gruener
Dauzvardis
Dauzvardis
Stubbs
Stubbs
Merchut
Merchut
Small Group Exercise‐2 Clinical Localization Set #2 Quiz & its Review Mid‐Term Exam This week in Preview
Lecture‐17 Lecture‐18 Lecture‐19 Clinical Correlation‐7
Clinical Correlation‐8
Clinical Correlation‐9
Clinical Correlation‐10
Quiz on Week 3 Material Weeks 1‐3 to be covered Cranial nerves and thalamus
Control of eye movements (Chap 21)
Cranial nerves and nuclei (Chap 12) ‐ “Once again” Thalamus and internal capsule (Chap 16) Visual, Auditory and Vestibular Systems Headache
Cerebrovascular disease (clinical)
Neuropathy, Myopathy and MND (patient) FACULTY Dauzvardis
Stubbs
Dauzvardis
Dauzvardis
Merchut
Merchut
Merchut
Merchut
Foundational Neuroscience Course Calendar (cont) 2012‐2013 Date Sep 3 Sep 4 Sep 4 Sep 5 Sep 5 Sep 6 Sep 6 Sep 7 Time Session Faculty Gruener
Gruener
Gruener
Merchut
Merchut
9:30a Quiz & its Review
10:30a Lecture‐20 9:30a Lecture‐21 10:30a Lecture‐22 9:30a Clinical Correlation‐11
10:30a Clinical Correlation‐12
10:30a ‐ Small Group Exercise‐3 Clinical Localization Set #3 12:00p Sep 10 Sep 10 Sep 11 Sep 11 Sep 12 Sep 12 Sep 13 Sep 13 Sep 14 Sep 14 8:30a 9:30a 9:30a 10:30a 9:30a 10:30a 9:30a 10:30a 9:30a 10:30a Quiz & its Review
Lecture‐23 Lecture‐24 Lecture‐25 Lecture‐26 Lecture‐27 Clinical Correlation‐13
Clinical Correlation‐14
Clinical Correlation‐15
Clinical Correlation‐16
Sep 17 Sep 18 8:30a Quiz & its Review
Sep 18 9:30a Lecture‐28 Sep 18 Sep 19 Sep 19 10:30a 9:30a 10:30a Lecture‐29 Lecture‐30 Lecture‐31 Sep 21 8:00a ‐ 11:00a Neuroscience Final Exam Sep 24 Oct 1 Oct 6 Topic Labor Day
Quiz on Week 4 Material and Preview of the Week Overview of motor systems (Chap 18)
Basal ganglia (Chap 19)
Cerebellum (Chap 20)
Gait, Cerebellar function, and Movement disorders Disorders of Basal Ganglia (patient)
FACULTY Quiz on Week 5 Material and Preview of the Week Cerebral cortex (Chap 22)
Cerebral cortex (Chap 22)
Hypothalamus and limbic system (Chap 23) Spinal cord (Chap 10) ‐ “Once again”
BG & Cerebellum (Chap 19, 20) ‐ “Once again” Language
Behavior, Cortical function , and Dementia Intoxications and infections of the Nervous System Epilepsy
Gruener
Gruener
Don Carlos
Dauzvardis
Gruener
Merchut
Merchut
Merchut
Asconape
Rosh Hashanah
Quiz on the Week 6 Material Neuropathology – Trauma, Infections & inflammation Neuropathology – Neurodegenerative Neuropathology – Brain neoplasms
Neuropathology –Cerebrovascular Disease (CVD) Neuroscience covers Weeks 1‐3 (1/3rd of the exam) Weeks 4‐7 (2/3rds of the exam) Lee Lee
Lee
Lee
Mid‐Semester Break
Student Grade Assignment: There are 340 total points in the course: Quizzes: 120 (6 quizzes, 20 points each) Midterm Exam: 100 Final Exam: 120 There will be NO rounding of grades! (e.g. 305 points (89.7%) is a High Pass) Grade
Percentage Points Earned
Honors
90.0% ‐ 100% 306‐340
High Pass
80.0% ‐ 89.9% 272‐305
Pass
70.0% ‐ 79.9% 238‐271
Fail
< 70.0% < 238
COURSE FORMAT: Lectures 1.
2.
3.
4.
5.
6.
“Quality before quantity” Core group of lecturers Similar handout and lecture format among all lectures Content is linked to a required textbook (Nolte J. Essentials of the human brain, 2010 Mosby) Incorporate and begin to introduce different neurological investigation tools “Once again” sessions provide an opportunity to re‐visit, re‐explain and integrate sessions Small Groups 1. Current case discussions to be re‐deployed as three clinical localization cases 2. Students come to the session having already worked through the case, cases are discussed and then students are given an additional unknown to work‐on, closed book, followed by group discussion Quiz & it’s review 1. Weekly quiz, timed for ~ 30 minutes, followed by 20‐30 minutes for its review 2. Introduce students to self‐assessment, format of exam questions (some only recall, some problem solving) Foundational Neuroscience Course - Detailed Objectives
These objectives can be accomplished through reviewing the assigned material, attendance at lectures and participating in small group
case discussions. (This is a very unique course since it, more than others, clearly demonstrates the relevance of basic science through
its explicit clinical correlations.)
Session Topic L‐1 Introduction & General Organization (Chap 1, 3) L‐2 Development of the Nervous System (Chap 2) L‐3 Meningeal coverings, Ventricles & CSF (Chap 4, 5) L‐4 Blood supply of the brain (Chap 6) Foundational Neuroscience Course ‐ Detailed Objectives 1. Be able to identify: cerebral hemisphere (frontal, temporal, parietal, occipital), brainstem (medulla, pons, midbrain), basal ganglia (caudate, putamen and globus pallidus), thalamus, hypothalamus, pituitary gland, pineal gland, cerebellum, spinal cord level (cervical, thoracic and lumbar) 2. Be able to identify: meninges (dura, arachnoid, and pia); ventricular system of the brain, choroid plexus 3. Be able to list: Sensory and motor system general patterns of connections 4. Be able to describe and contrast: Neurons and glial cells functions and roles; slow and fast axonal transport; cytoskeleton 1. Be able to define or describe : blastocyst, inner cell mass, bilaminar embryo, neural plate, neurulation, formation of neural tube; somites, dermatome, sclerotome, myotome 2. Be able to define or describe: three vesicles (prosencephalon, mesencephalon, rhombencephalon); five vesicles (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon); neural crest and derivatives, ventricular zone, mantle layer, marginal layer 3. Be able to describe: spina bifida, anencephaly, microcephaly, hydrencephaly, hydrocephalus 1. Be able to identify/describe the role: meninges (dura, arachnoid, and pia); ventricular system of the brain; choroid plexus; cerebrospinal fluid circulation; cisterns; epidural space 2. Be able to define or describe : Blood‐brain barrier; brain herniation
1. Be able to identify: Blood supply of the brain (including anterior and posterior circulation) and venous system drainage 2. Be able to define or describe: Blood‐brain barrier
L‐5 L‐6 CC‐1 1. Be able to describe the function: Merkel’s disks, Meissner's corpuscles, Pacinian corpuscles, free nerve endings, muscle spindles, Golgi tendon organs, hair follicle receptors; medial and lateral divisions of the dorsal root Sensory system and receptors 2. Be able to define: alpha and gamma motoneurons, motor unit; (size principle of (Chap 9) motoneuron recruitment; two muscle fiber types) 3. Be able to describe: muscle spindle and myotatic stretch reflex circuit; alpha‐gamma co‐
activation 1. Be able to identify within the cross section of a spinal cord: cervical/thoracic/lumbar level, dorsal horn, ventral horn, intermediate gray, intermediolateral cell column, substantia gelatinosa; nucleus proprius; nucleus dorsalis; dorsal columns 2. Be able to “identify” and describe the function of the major ascending sensory pathways: dorsal‐column/medial lemniscus system, spinothalamic tract, spinocerebellar tract Spinal cord (Chap 10) 3. Be able to “identify” and describe the function of the major descending motor pathways: pyramidal (corticospinal) tract, corticobulbar fibers, rubrospinal tract, vestibulospinal tract, reticulospinal tract, and tectospinal tract 4. Be able to describe/contrast: preganglionic and postganglionic; parasympathetic and sympathetic; referred pain; blood supply of the spinal cord 1. List the clinical signs: found with upper motor neuron (UMN) lesions versus lower motor neuron (LMN) lesions; use these findings to localize lesions to cervical, thoracic, or lumbar levels of the spinal cord. 2. Recognize: expected UMN signs from acute, severe spinal cord trauma may be temporarily absent due to spinal or neurogenic shock, where only LMN signs are present. 3. For a radiculopathy, be able to predict: root level is involved based on the dermatomal distribution of radicular pain and pattern of muscle weakness and reflex loss. 4. Recognize: an extramedullary spinal cord lesion is usually associated with radicular pain and sensory impairment of pain and temperature up to the level of the lesion without sacral sparing. Spinal cord disorders 5. Recognize: an intramedullary spinal cord lesion is usually associated with diffuse or no pain, with a suspended impairment of pain and temperature sensation with sacral sparing. 6. List the signs and symptoms: following spinal cord syndromes (involvement or sparing of spinal roots, lower motor neurons, upper motor neurons, posterior (dorsal) column pathways, or the spinothalamic tract): a.) spinal cord transection or transverse myelopathy (myelitis) b.) spinal cord hemisection (Brown‐Sequard syndrome) c.) syringomyelia or syrinx d.) anterior spinal artery syndrome e.) posterolateral syndrome or subacute combined degeneration CC‐2 L‐7 Neuromuscular junction (NMJ) disorders (patient) Organization of the brainstem (Chap 11) f.) amyotrophic lateral sclerosis g.) tabes dorsalis 7. List the common causes of the following spinal cord syndromes: a.) spinal cord transection or transverse myelopathy (myelitis) from trauma, extramedullary tumors, spinal stenosis, viral infections, multiple sclerosis b.) spinal cord hemisection (Brown‐Sequard syndrome) from trauma, extramedullary tumors, degenerative spine disease including herniated intervertebral discs c.) syringomyelia or syrinx from prior trauma, intramedullary tumors d.) anterior spinal artery syndrome from aortic atherosclerosis or aortic surgery e.) posterolateral syndrome or subacute combined degeneration from vitamin B12 deficiency f.) amyotrophic lateral sclerosis (motor neuron disease of unknown cause) g.) tabes dorsalis from syphilis 1. Explain: postsynaptic problem in myasthenia gravis (MG) and how acetylcholinesterase inhibiting drugs help these patients. 2. Explain: presynaptic problem in Lambert‐Eaton myasthenic syndrome (LEMS) and botulism. 3. Recognize: most common symptoms in myasthenia (ptosis, diplopia, dysarthria, and dysphagia, although all skeletal muscles may become weak or fatigable). 4. Contrast: restricted ocular form of myasthenia versus the generalized form. 5. Explain: how the diagnosis of MG is made, and recognizes that the most specific test is presence of serum acetylcholine receptor antibodies. 6. List the treatment options: for MG, including treatment of myasthenic crisis. 7. Recognize: proximal weakness typical of LEMS is similar to that of a myopathy, and most of the LEMS patients have an underlying small cell carcinoma of the lung. 1. Describe and recognize: brainstem levels’ names for gross anatomical features and significance of external characteristics 2. Within each brainstem level be able to identify the location: Corticospinal tract, medial lemniscus, and spinothalamic tract; MLF 3. Describe the function/role/location: reticular formation versus reticular activating system; nuclei that contain norepinephrine, dopamine, serotonin, acetylcholine 4. Be able to identify within the respective brainstem level: superior and inferior colliculi, periaqueductal gray, cerebral aqueduct, red nucleus, substantia nigra, cerebral peduncle, decussation of SCP; pons, cerebellar peduncles, deep cerebellar nuclei, fourth ventricle; inferior olive, pyramid, internal arcuate fibers, nucleus gracilis and cuneatus, spinal trigeminal nucleus/tract L‐8 Cranial nerves and nuclei (Chap 12) L‐9 Brainstem summary (Chap 15) 1. Be able to describe: functional groups (GSE, SVE, GVE, GVA, SVA, GSA, and SSA) 2. Be able to describe the function of the cranial nerves: a.) Oculomotor (III), Trochlear (IV), and Abducens (VI): extraocular eye movements, pupillary response b.) Trigeminal (V): sensory and motor innervation of the face and muscles of mastication c.) Facial (VII): innervation of muscles of facial expression d.) Vestibular (VIII): otolithic organs, semicircular canals, and hair cells e.) Cochlear (VII): cochlear nuclei; central auditory pathway including inferior colliculus, medial geniculate, and Heschl's gyrus f.) Glossopharyngeal (IX): baroreflex circuitry g.) Vagus (X) nerve: visceral function h.) Spinal accessory (XI): innervation of sternocleidomastoid and trapezius i.) Hypoglossal (XII): innervation of the tongue Lecture # 7 and 8 objectives and 1. Be able to describe: major functions of the brainstem cranial nerves; PPRF 2. Be able to explain: crossed findings with brainstem lesions; Symptoms of a medial versus lateral medullary syndrome: Symptoms of a medial versus lateral midbrain lesion. 3. Be able to explain: major organizational divisions and functions of the reticular formation; describe the ascending reticular activating system. L‐10 L‐11 1. Be able to describe: taste receptors, papillae types, tongue innervation 2. Be able to define/describe: gustatory pathway; olfactory pathway
1. Be able to identify the anatomical structures or describe their (dys)function: hair cells; cochlea, central auditory pathway; conductive versus nerve (sensorineural) hearing loss Hearing and Balance (Chapter 2. Be able to describe: structure and function of the otolithic organs, semicircular canals and 14) sensory receptors; Diagram the vestibular pathways (primary afferent projections to and from the vestibular nuclei, vestibulospinal pathways and cerebellar input) Chemical senses of taste & smell (Chap 13) CC ‐3 Cranial nerves, Brain stem reflexes and disorders CC ‐4 Multiple sclerosis (patient) SG ‐1 Clinical Localization Set #1 1. Describe: typical clinical deficits found with lesions of the oculomotor, trochlear, and abducens nerves (CN III, IV and VI). 2. Define: concepts and significance of "diplopia," "nystagmus," and "internuclear ophthalmoplegia (MLF syndrome)." 3. Explain: normal reactions of the pupil (light reflex, near reflex) and explanation for an afferent pupillary defect (RAPD). 4. Explain: clinical signs of Horner's syndrome (how it can be caused by neck trauma, an apical lung tumor, or a lateral medullary infarction). 5. Explain: syndrome of trigeminal neuralgia and how it may be treated. 6. Contrast: clinical features of an UMN versus LMN cause of facial paralysis. 7. List: signs and symptoms which may accompany facial paralysis in lesions of the facial nerve or its nucleus. 8. Recognize: lesions of vagal nerve branches may cause ipsilateral sagging of the palatal arch or vocal cord paralysis. 9. Contrast: clinical features of an upper motor neuron versus lower motor neuron cause of unilateral tongue weakness. 10. Recognize: crossed brain stem syndrome consists of cranial nerve involvement on one side and a clinical sensory or motor deficit on the opposite side of the body. 11. List: signs and symptoms of the medial midbrain (Weber) syndrome and the lateral medullary (Wallenberg) syndrome. 1. Recognize: multiple sclerosis (MS) is an autoimmune, demyelinating disorder of the central nervous system. 2. List: risk factors for MS regarding age of onset, gender, family history, and geography. 3. Explain: the frequent signs and symptoms of MS. 4. Explain: how the clinical diagnosis of MS is made, and how various ancillary tests support the diagnosis. 5. List: available treatments for MS, particularly for severe, acute attacks and for long‐term disease modification. Application of foundational knowledge to clinical cases L‐12 L‐13 L‐14 Hearing and Balance (Chapter Lecture 11 objectives 14) – “Once again” Cranial nerves and nuclei Lecture 8 objectives (Chap 12) ‐ “Once again” Brainstem summary (Chap Lecture 7, 8 and 9 objectives 15) ‐ “Once again” L‐15 Visual system (Chap 17) 1. Be able to identify the anatomical structures or describe their (dys)function: neuronal circuitry of the retina, center‐surround inhibition in the retina; central visual pathways (lateral geniculate and primary visual cortex); dorsal and ventral streams of visual processing, visual cortical organization; anatomy of the eye, lacrimal gland and tearing; glaucoma; blink reflex; fundus exam 2. Be able to define: cause and correction of myopia, hyperopia, and presbyopia; papilledema,
3. Be able to explain: visual pathway lesions (homonymous and heteronomous hemianopsias, quadrantanopsia) and scotoma L‐16 Visual system (Chap 17) Lecture 15 objectives
CC‐5 1. Define and contrast: the conditions of "coma," "persistent vegetative state," and "brain death." 2. Explain how: lesions of the brain or brain stem produce coma and understand that a solitary, unilateral cerebral lesion does not produce coma unless it adversely affects the opposite hemisphere via brain edema or herniation. 3. Explain how: to examine an unresponsive patient and understand that asymmetrical neurological findings strongly suggest that a structural lesion is the cause of coma. Coma/Brain death/End‐of‐life 4. Define: "decorticate posturing" and "decerebrate posturing." 5. Explain: the significance of pinpoint pupils and a unilaterally, large, fixed pupil in a comatose patient. 6. Explain: the oculocephalic and oculovestibular reflexes and the normal responses of each. 7. Recognize: the emergent need to treat hypoglycemia, shock, hypothermia, and drug intoxication or overdose in the unresponsive patient. 8. Define "brain death" and how it is diagnosed or declared. CC‐6 Neuroimaging essentials 1. Contrast: Appearance of an acute hemorrhage versus ischemic infarction on a brain CT scan. 2. Recognize: most brain lesions are high signal ("bright" or "white") on the T2 weighted or FLAIR sequences of an MRI scan. 3. Recognize: an acute infarction is seen sooner with an MRI than a CT brain scan. 4. Contrast: appearances of brain edema on a CT versus MRI scan. 5. Define: "obstructive hydrocephalus" and "hydrocephalus ex vacuo." 6. Recognize: primary brain tumors are typically solitary lesion (may be hemorrhagic, heterogeneous, or irregular in shape) while metastatic tumors are often multiple (spherical in shape, usually found at the gray‐white matter junction of the brain). 7. Recognize: multiple sclerosis (MS) plaques are detected as high signal lesions in the white matter of the cerebral hemispheres, brain stem and spinal cord, yet may appear similar to the subcortical infarctions seen in older adults. SG‐2 Clinical Localization Set #2 Application of foundational knowledge to clinical cases L‐17 Control of eye movements (Chap 21) 1. Be able to define/describe: EOM activity on the movement of the eye; fast and slow conjugate movements 2. Be able to describe: Effect of Basal Ganglia and Cerebellum on eye movements 3. Be able to describe or demonstrate: optokinetic response, saccadic eye movement, smooth pursuit, vergence eye movement, vestibuloocular reflex; reflex righting movements (i.e. “slipping on the ice”). L‐18 Cranial nerves and nuclei (Chap 12) ‐ “Once again” Lecture 8 objectives Thalamus and internal capsule (Chap 16) 1. Be able to identify the anatomical structures and describe their function: outline the major organizational divisions of the thalamus; describe the major functional divisions of the thalamus 2. Be able to list: major interconnections between thalamus and cerebral cortex (“four thalamic peduncles”; relationships of the thalamus to the internal capsule, basal ganglia and third ventricle. 3. Be able to list the source of the afferents and efferents: specific (or relay) nuclei of the thalamus; association nuclei of the thalamus; non‐specific thalamic nuclei of the thalamus. 4. Describe the clinical features seen with thalamic lesions 5. Describe the blood supply to the thalamus L‐19 CC‐7 Visual, Auditory and Vestibular Systems CC‐8 Headache CC‐9 Cerebrovascular disease (clinical) 1. Contrast: typical clinical findings when visual loss is from an optic nerve lesion to that from a lesion of the occipital cortex, with respect to visual acuity, visual fields, the pupillary light reflex, and the appearance of the optic disc. 2. Define: "scotomas" and "papilledema." 3. Describe: anatomical localization of lesions causing a heteronymous hemianopsia, homonymous hemianopsia, and quadrantic visual field defects (quadrantanopsia). 4. List: common causes of conductive versus nerve (sensorineural) hearing loss. 5. Explain: how to perform the Dix‐Hallpike maneuver and its diagnostic utility. 1. Describe: clinical features of migraine, including the aura, photophobia and phonophobia. Recognize that female gender and positive family history are risk factors for migraine, which begins early in adult life. 2. Describe: clinical features of cluster headache. Recognize that male gender is a risk factor for cluster headache. 3. List: abortive and prophylactic treatments for migraine. Recognize that several chemically unrelated drugs here have therapeutic effects on serotonin receptors. 4. Describe: clinical features of tension headache and treatments for it. 5. Explain: why headaches occur after lumbar puncture (traction headaches), from pseudotumor cerebri, or in temporal arteritis. 1. Recognize: basic mechanisms of ischemia involve embolic occlusions of large arteries or branches (from proximal arterial or cardiac sources) or thrombotic occlusions of small lenticulostriate arteries or large arteries at typical bifurcation points. 2. Define: “transient ischemic attack (TIA),” “collateral blood flow,” “lacunar infarction,” and “amaurosis fugax (monocular blindness).” 3. Explain: diagnosis and treatment of a TIA or ischemic infarction. 4. Explain: how degree of cervical internal carotid stenosis determines surgical or interventional treatment in symptomatic patients with TIAs/mild ischemic deficits versus asymptomatic patients. 5. Recognize: that future strokes may be prevented with warfarin in patients with atrial fibrillation, and most other stroke‐prone patients are treated with antiplatelet drugs. 6. List: treatments for increased intracranial pressure related to ischemic infarction or hemorrhage. 7. Recognize: severe headache, impairment or loss of consciousness, and a focal neurological deficit strongly suggest a cerebral hemorrhage. 8. List: causes of cerebral hemorrhage. 9. Recognize: deep cerebral hemorrhages in the striatum or thalamus are most likely from hypertension. 10. Explain: how you would diagnose/treat a patient with nontraumatic SAH. CC‐10 Neuropathy, Myopathy and MND (patient) L‐20 Overview of motor systems (Chap 18) L‐21 Basal ganglia (Chap 19) L‐22 Cerebellum (Chap 20) 1. Describe: common signs and symptoms of polyneuropathy, and which features suggest a hereditary polyneuropathy. 2. List: examples of polyneuropathy due to endocrine or metabolic disorders, systemic disease, infections, nutritional deficiencies, toxins, and medications. 3. Recognize: Guillain‐Barré syndrome usually manifests as an ascending, areflexic paralysis and explain how it is diagnosed and treated. 4. Recognize: axonal degeneration is the most common pathology for polyneuropathies. 5. Describe: typical signs and symptoms of myopathy. 6. List: examples of myopathy due to endocrine disorders, systemic disease, infections, medications, and hereditary syndromes. 7. Explain: how immune‐mediated polymyositis is diagnosed and treated. 8. Explain: common presentations of amyotrophic lateral sclerosis (ALS) and how it is diagnosed. 1. Be able to define: alpha and gamma motoneurons, motor unit; motor unit types; size principle of motoneuron recruitment; two muscle fiber types 2. Be able to describe: muscle spindle and myotatic stretch reflex circuit; alpha‐gamma co‐
activation; clonus, clasp‐knife reflex 3. Define or explain: “upper motor neuron”; descending systems input on LMN; corticospinal and bulbar system origins and terminations 4. List: four major motor decussations 1. Define: major divisions, circuits/loops and functions of the basal ganglia 2. Identify: basal ganglia on CT/MRI or brainstem sections 3. Describe: “direct” and “indirect” pathways for movement; changes in pathways in Parkinson and Huntington disease 4. Contrast: dorsal versus ventral striatal pathway 5. Define: hypokinesia, bradykinesia, chorea, hemiballism, dystonia, myoclonus 1. Outline the major organizational divisions of the cerebellum: transverse and longitudinal; somatotopic maps; cerebellar peduncles and deep nuclei 2. List: afferent and efferent contributions to each cerebellar peduncle; describe the functional components of the cerebellar cortex; origins of the mossy and climbing fibers. 3. Define or describe: ataxia, dysmetria, kinetic tremor, dysdiadochokinesia, dysarthria, and nystagmus 4. Describe clinical manifestations of lesions: midline (vermal) and hemispheric cerebellar damage 5. Identify on MRI: Structures within the posterior fossa on MRI or CT scans of the brain CC‐11 CC‐12 1. List: systems/components of the nervous system required to adequately stand up and walk.
2. Explain: Romberg sign and its significance. 3. Explain: lesion(s) associated with these abnormal gait patterns and describe how they appear clinically: broad‐based ataxic, hemiplegic, tabetic, steppage, waddling, scissors, and Parkinsonian gaits. 4. Describe: clinical features of cerebellar dysfunction (gait ataxia, dysmetria, kinetic tremor, dysdiadochokinesia, rebound phenomenon, dysarthria, and nystagmus) and which bedside tests demonstrate them. Gait, Cerebellar function, and 5. Contrast: clinical deficits in the cerebellar hemispheral versus vermian syndromes. Movement disorders 6. Recognize: spinocerebellar degenerations or ataxias are a group of hereditary disorders where there is progressive loss of nuclei and tracts in the cerebellum and dorsal (posterior) spinal cord. 7. List: neurological disorders associated with resting tremor, postural tremor, and kinetic tremor. 8. Describe: following movement disorders and the related lesion or disorder, if known: choreoathetosis, hemiballismus, dystonia, tic, myoclonus, and asterixis. 9. List: currently available treatments for these movement disorders. 1. Recognize: basal ganglia have an inhibitory effect on the motor cortex via the medial globus pallidus (GPm). In hypokinetic disorders (Parkinson's disease), GPm activity is further increased, while in hyperkinetic disorders (hemiballismus, Huntington's disease) GPm activity is further decreased. 2. List: four primary clinical signs of Parkinson's disease (resting tremor, rigidity, bradykinesia, and impaired postural reflexes). Disorders of Basal Ganglia (patient) 3. Explain: characteristic pathological findings in Parkinson's disease. 4. List: available medical and surgical treatments of Parkinson's disease and explain which medication is the most effective. 5. Recognize: Huntington's disease is a hereditary degenerative disease with a symptom triad of choreoathetosis, dementia and behavioral syndromes. 6. List: available medical treatments of Huntington's disease. SG‐3 Clinical Localization Set #3 L‐23 Cerebral cortex (Chap 22) L‐24 Cerebral cortex (Chap 22) Application of foundational knowledge to clinical cases 1. Describe: Cellular organization of neocortex; columnar organization of cortical neurons; 2. Identify: Neocortical areas and Brodmann’s number (motor, somatosensory, visual, auditory); association and multimodality neocortical areas; association and commisural white matter connections 3. Describe or explain: reticular activating system; sleep stages and mechanism of sleep/wake cycle Lecture #23 Objectives
L‐25 Hypothalamus and limbic system (Chap 23) 1. With respect to the hypothalamus list: subdivisions; inputs/outputs; functions/roles 2. Describe the control of micturition: parasympathetic, sympathetic, pontine micturition center, detrusor/sphincter muscles 3. Be able to define or describe: hippocampal anatomy and function in memory; role of long‐
term potentiation for synaptic memory 4. Describe: Wernicke‐Korsakoff syndrome; amygdala function in emotion; Klüver‐Bucy syndrome; 5. Be able to define or describe: pain processing by brain; subdivisions of the spinothalamic tract and their terminations; functional significance of opiate receptor locations within the central nervous system; role of the reticular formation in pain modulation. L‐26 L‐27 Spinal cord (Chap 10) ‐ “Once again” BG & Cerebellum (Chap 19, 20) ‐ “Once again” CC‐13 Language CC‐14 Behavior, Cortical function, and Dementia Lecture #6 Objectives Lecture #21 & 22 Objectives 1. Contrast: functions of speech (articulation and phonation) versus language (multimodal communication). 2. Define: clinical elements of language and aphasia, particularly "fluency" and "paraphasia." 3. Explain: clinical features of perisylvian aphasias (Broca's, Wernicke's, conduction, and global aphasias), recognizing that imperfect repetition is common to all these types. 4. Define: "prosody" and "aprosodia." 1. Explain: “immediate memory,” recent memory, and remote memory, and how to test for them. 2. Recognize: bilateral “memory circuitry” involves the hippocampus, mammillary body, and thalamus. Give clinical examples of lesions affecting these structures or areas. 3. Define: “apraxia” and “agnosia” and give examples of each. 4. Explain: features of the frontal (or prefrontal) and parietal lobe syndromes. 5. Contrast: clinical features of the acute confusional state versus dementia, coma. 6. Explain: how you would evaluate a patient who appears to have dementia. What is the differential diagnosis? 7. List: typical clinical features of Alzheimer’s Disease and available treatments. CC‐15 Intoxications and infections of the Nervous System CC‐16 Epilepsy 1. Contrast: clinical features of tetanus (inhibition of the release of GABA and glycine at interneurons) versus botulism (inhibition of release of acetylcholine at motor nerves). 2. List: neurotoxic effects of: carbon monoxide, lead poisoning (adults versus children), and stimulant drugs like cocaine. 3. Define: neurological syndromes caused by alcohol and how to treat them: acute intoxication, alcohol withdrawal, and Wernicke‐Korsakoff syndrome. 4. Contrast: acute meningitis, chronic meningitis, and encephalitis with regards to: typical signs and symptoms, cerebrospinal fluid (CSF) abnormalities, CT or MRI brain scan results, and initial empirical antibiotic or antiviral treatment. 5. Recognize: CSF abnormalities most suggestive of acute bacterial meningitis are increased polymorphonuclear WBCs and decreased glucose. 6. Explain: circumstances where a brain CT scan should be performed prior to urgent lumbar puncture in a patient suspected of meningitis. 7. Define: "shingles" and "post‐polio muscular atrophy." 8. List: neurological syndromes involving peripheral nerve, muscle, spinal cord, and brain in patients with acquired immunodeficiency syndrome (AIDS). 9. Explain: how an abscess adversely affects the nervous system. 10. List: signs and symptoms typical of Creutzfeldt‐Jakob dementia in a patient with rapidly progressive cognitive decline. 1. Explain: clinical features of simple partial seizures, complex partial seizures, generalized nonconvulsive seizures (absence), and generalized tonic‐clonic seizures. 2. Contrast: how consciousness, recall of event, and postictal state are affected in simple partial seizures, complex partial seizures, generalized nonconvulsive seizures (absence), and generalized tonic‐clonic seizures. 3. Define: "aura," "automatisms," and "pseudoseizure." 4. Explain: causes of primarily generalized seizures, secondarily generalized seizures and which diagnostic tests are done for each. 5. Define: "generalized tonic‐clonic status epilepticus" and the general treatment approach. 1. Describe pathological features and correlate with typical clinical presentations: epidural/subdural hematoma; cerebral concussion, diffuse axonal injury; hypoxic brain injury; elevated intracranial pressure, brain herniation syndromes 2. Describe pathological features: Bacterial, viral, fungal, parasitic, HIV infections L‐28 Neuropathology – Trauma and infections L‐29 Neuropathology – Treatment 1. Be able to define or describe: rationale for treatment of Parkinson’s disease of Parkinsonism and 2. Be able to define or describe: rationale of treatment of Dementias Dementia L‐30 L‐31 Neuropathology – Brain neoplasms 1. Be able to define or describe: neurons (soma, axon, dendrite), astrocytes, radial glia, oligodendrocytes, microglia, Schwann cells, myelin sheath, satellite cells 2. List gross and microscopic characteristic and key epidemiologic features of the following brain tumors: Primary brain tumors (astrocytoma, glioblastoma multiforme, oligodendroglioma, meningioma, CNS lymphoma, medulloblastoma), metastatic (brain and leptomeninges) Neuropathology – Degenerative disease & CVD 1. Describe and identify pathological features: muscular dystrophy, myositis, mitochondrial myopathy 2. Describe and identify pathological features: Axonal and demyelinative neuropathy; Guillain‐ Barré syndrome 3. Describe and identify pathological features: Parkinson disease, Huntington disease 4. Describe and identify pathological feature: Alzheimer disease, Frontotemporal lobar degeneration 5. Describe and identify pathological feature: Ischemic large vessel and small vessel (lacunar) infarction, hemorrhagic stroke, subarachnoid hemorrhage (berry aneurysm) For all of the above describe typical clinical presentations Foundational & Correlative Neuroscience Course - Summative Objectives
Normal processes – embryonic development
o Be able to define or describe : blastocyst, inner cell mass, bilaminar embryo, neural plate, neurulation, formation of neural tube;
somites, dermatome, sclerotome, myotome
o Be able to define or describe: three vesicles (prosencephalon, mesencephalon, rhombencephalon); five vesicles (telencephalon,
diencephalon, mesencephalon, metencephalon, myelencephalon); neural crest and derivatives, ventricular zone, mantle layer,
marginal layer
o Be able to describe: spina bifida, anencephaly, microcephaly, hydrencephaly, hydrocephalus
Normal processes – organ structure and function (cell/tissue)
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Electrical events and transmitters
o Be able to define or describe: ionic basis of resting membrane potential and action potential; saltatory conduction; spatial summation,
temporal summation, posttetanic potentiation, presynaptic inhibition; glutamate and EPSPs; GABA and IPSPs; neuromuscular
junction
o Be able to describe the effect: botulinum toxin, tetanus toxin, black widow spider toxin
Neurons and neuroglia
o Be able to define or describe: neurons (soma, axon, dendrite), astrocytes, radial glia, oligodendrocytes, microglia, Schwann cells,
myelin sheath, satellite cells, synapses, neuromuscular junction, and blood-brain barrier
Peripheral somatosensory receptors and reflexes
o Be able to describe the function: Merkel’s disks, Meissner's corpuscles, Pacinian corpuscles, free nerve endings, muscle spindles,
Golgi tendon organs, hair follicle receptors; medial and lateral divisions of the dorsal root
o Be able to define: alpha and gamma motoneurons, motor unit; size principle of motoneuron recruitment; two muscle fiber types
o Be able to describe: muscle spindle and myotatic stretch reflex circuit; alpha-gamma co-activation; withdrawal reflex; clasp-knife reflex
Normal processes – organ structure and function (gross anatomy)
 Gross anatomical structure
o Be able to identify: cerebral hemisphere (frontal, temporal, parietal, occipital), brainstem (medulla, pons, midbrain), basal ganglia
(caudate, putamen and globus pallidus), thalamus, hypothalamus, pituitary gland, pineal gland, cerebellum spinal cord (cervical,
thoracic and lumbar), and cerebral cortex
o Be able to identify: meninges (dura, arachnoid, and pia); peripheral nerve epineurium, perineurium, and endoneurium; ventricular
system of the brain; choroid plexus; cerebrospinal fluid circulation
o Be able to identify: Blood supply of the brain (including anterior and posterior circulation) and spinal cord
 Cranial nerves
o Be able to describe: functional groups (GSE, SVE, GVE, GVA, SVA, GSA, and SSA
o Be able to describe the function and clinical examination:
 Oculomotor (III), Trochlear (IV), and Abducens (VI): horizontal gaze paralysis; internuclear ophthalmoplegia; MLF; vestibuloocular reflex; nystagmus; diplopia; pupillary light reflex; Horner's syndrome
 Trigeminal (V): sensory and motor innervation of the face and muscles of mastication; jaw closing and jaw opening reflexes;
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organization of pain afferents in spinal trigeminal nucleus; trigeminal neuralgia and its treatment;
Facial (VII): innervation of muscles of facial expression; facial paralysis after stroke vs. facial nerve damage;
Vestibular (VIII): otolithic organs, semicircular canals, and hair cells; vestibular nuclei and pathways; vestibulospinal tract;
optokinetic response; saccadic and smooth pursuit eye movements; vestibuloocular reflex
Cochlea (VII): cochlear nuclei; central auditory pathway including inferior colliculus, medial geniculate, and Heschl's gyrus
Glossopharyngeal (IX): baroreflex circuitry
Vagus (X) nerve: visceral function
Spinal accessory (XI): innervation of sternocleidomastoid and trapezius
Hypoglossal (XII): innervation of the tongue
Normal processes – Pathways & functional/clinical correlates
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Be able to identify within the spinal cord: cross-section appearance of the spinal cord, dorsal horn, ventral horn, intermediate gray,
intermediolateral cell column, substantia gelatinosa; nucleus proprius; nucleus dorsalis; dorsal columns, spinothalamic tract, dorsal and
ventral spinocerebellar tracts, corticospinal tract
Be able to identify and describe the function of the major ascending sensory pathways: dorsal-column/medial lemniscus system,
spinothalamic tract
Be able to identify and describe the function of the major descending motor pathways: pyramidal (corticospinal) tract, corticobulbar fibers,
rubrospinal tract, vestibulospinal tract, reticulospinal tract, and tectospinal tract
Be able to identify the anatomical structures and describe their function: thalamic nuclei of termination of important sensory, cerebellar,
and basal ganglia pathways; origin of thalamocortical projections
Be able to identify the anatomical structures and describe their (dys)function: basal ganglia nuclei; direct and indirect pathways;
Parkinson's disease; dopaminergic system in schizophrenia; ventral striatal-pallidal system in reward (resting tremor, rigidity,
bradykinesia, impaired postural reflexes); hemiballismus, dystonia, myoclonus, asterixis
Be able to define terminology. identify the anatomical structures or describe their (dys)function: cerebellar cortex, deep cerebellar nuclei,
transverse (anterior lobe, posterior lobe, flocculonodular lobe ) and longitudinal (vermal, paravermal, lateral) organization of cerebellum;
origin and termination of three cerebellar peduncles, mossy fiber system, climbing fiber system; midline (vermal) and hemispheric
cerebellar damage; ataxia, dysmetria, kinetic tremor, dysdiadochokinesia, dysarthria, and nystagmus
Be able to identify the anatomical structures or describe their (dys)function: cochlea, central auditory pathway; conductive versus nerve
(sensorineural) hearing loss
Be able to identify the anatomical structures or describe their (dys)function: organization of the parasympathetic (craniosacral) and
sympathetic (thoracolumbar) division; location of major parasympathetic and sympathetic ganglia; autonomic reflexes (pupillary light
reflex, accommodation reflex, baroreflex, micturition, penile erection and ejaculation)
Be able to define terminology, identify the anatomical structures or describe their (dys)function: neuronal circuitry of the retina, centersurround inhibition in the retina; central visual pathways (lateral geniculate and primary visual cortex); anatomy of the eye, lacrimal gland
and tearing; glaucoma; blink reflex; fundus exam; cause and correction of myopia, hyperopia, and presbyopia; papilledema, scotoma,
visual pathway lesions (homonymous and heteronomous hemianopsias, quadrantanopsia)
Be able to define terminology, identify the anatomical structures or describe their (dys)function: reticular activating system, states of
awareness (coma, persistent vegetative state, and brain death); brain stem monoaminergic pathways [noradrenergic (locus ceruleus),
serotonergic (raphe), and dopaminergic (substantia nigra)]
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Be able to define terminology, identify the anatomical structures or describe their (dys)function: sleep (different phases of sleep and their
EEG pattern, changes in sleep pattern with age); sleep disorders (sleep apnea, restless legs, narcolepsy, insomnia); orexin/hypocretin
system and sleep
Normal processes – repair, regeneration and age related changes
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Be able to define or describe: end of life issues related to brain damage and disease; nutrition or sedation in patients with dementia or
amyotrophic lateral sclerosis; role of physician in palliative care
Abnormal processes
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Brain neoplasms
o Be able to define or describe: histology of different types of brain tumors (astrocytoma, ependymoma, medulloblastoma;
meningioma); radiotherapy versus surgical treatment of brain tumors; primary and secondary brain tumors
Hypothalamus and neuroendocrine
o Be able to define or describe: releasing factors; energy homeostasis; water balance; reproduction; stress responses;
thermoregulation; circadian rhythms
Limbic system
o Be able to define or describe: hippocampal anatomy and function in memory; Wernicke-Korsakoff syndrome; role of long-term
potentiation for synaptic memory; amygdala function in emotion; Klüver-Bucy syndrome;
o Be able to define or describe: pain processing by brain; subdivisions of the spinothalamic tract and their terminations; treatment of
pain; types of headache (migraine, cluster, tension, post-lumbar puncture, arteritis) and their treatment
Clinical & therapeutic correlation
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Cerebrovascular disease
o Be able to define or describe: transient ischemic attacks (TIA), collateral blood flow; lacunar infarction; amaurosis fugax, embolic
causes of stroke, development of increased intracranial pressure in stroke, headache development in cerebral hemorrhage
o Be able to explain treatment or rationale of care: TIA or ischemic stroke, carotid stenosis, use of warfarin (Coumadin) and antiplatelet
drugs, nontraumatic subarachnoid hemorrhage
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Cortical disorders
o Define or describe the cortical localization: somatosensory, visual, and auditory sensory areas, motor cortex, prefrontal cortical
function
o Describe the clinical features: lateral brainstem syndrome (Wallenberg) and medial midbrain (Weber) syndromes
o Define or contrast: Broca's, Wernicke's, conduction or global aphasia; articulation, phonation, fluency, paraphasia, prosody and
"aprosodia"
o Define or describe: contralateral neglect, catastrophic reaction, hemispheric specialization; dorsal and ventral streams of visual
processing, visual cortical organization
o Define and contrast: dementia versus acute confusional state; coma, persistent vegetative state and brain death; decorticate
posturing, decerebrate posturing
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Epilepsy and paroxysmal disorders
o Explain and contrast the clinical features: simple partial seizures, complex partial seizures, generalized nonconvulsive seizures
(absence), generalized tonic-clonic seizures
o Define or describe: automatism, status epilepticus, “pseudoseizure”, primary versus secondarily generalized seizures, EEG
abnormalities in patients with epilepsy
o Define: generalized tonic-clonic status epilepticus, general treatment approach to status epilepticus
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Peripheral nervous system
o Explain or contrast: upper versus lower motor neuron signs and symptoms; radicular versus referred pain; weakness of muscle versus
neuromuscular junction.
o Define or describe the clinical features, etiology an treatment: myasthenia gravis, Lambert Eaton myasthenic syndrome; myopathies;
neuropathies (polyneuropathies, Guillain-Barré); amyotrophic lateral sclerosis
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Spinal cord
o Contrast hemiplegia caused by lesions: cervical spinal cord, brain stem, subcortical areas, or cortical area
o Define or describe the clinical features and etiology: intramedullary versus extramedullary spinal lesions; Brown-Sequard hemicord
syndrome, syringomyelia, amyotrophic lateral sclerosis, tabes dorsalis, anterior spinal artery syndrome, subacute combined
degeneration, spinal shock
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Specific Clinical Disorders
o Define and contrast: tetanus versus botulism; viral versus bacterial meningitis
o Describe features: carbon monoxide poisoning, lead poisoning, shingles, post-polio muscular atrophy, Creutzfeldt-Jakob dementia
o Describe features, diagnosis and treatment: Alzheimer’s disease, headache (migraine, cluster, post-lumbar puncture), multiple
sclerosis, Parkinson disease
o Describe or define the etiology or current pathophysiology: Alzheimer's disease, Pick's disease, frontotemporal lobar dementia;
Parkinson's disease, Huntington's disease, progressive supranuclear palsy, multiple system atrophy; multiple sclerosis;
spinocerebellar degenerations (Friedreich’s ataxia); amyotrophic lateral sclerosis
o Describe features, diagnosis or treatment: skull fracture, epidural hematoma, cerebral concussion, diffuse axonal injury, hypoxic brain
injury, elevated intracranial pressure, brain herniation syndromes
o Describe features, diagnosis or treatment: hypoglycemia, shock, hypothermia, and drug intoxication or overdose in the unresponsive
patient
o Describe features, diagnosis: brain death
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Neuroimaging (CT and MRI)
o Be able to identify: cerebrum, cerebellum, basal ganglia (caudate and lentiform), internal capsule, thalamus, lateral and fourth
ventricles, cerebellopontine angle, sella turcica, cavernous sinus
o Be able to distinguish or recognize: "bright" high signal appearance of brain lesions on T2 or FLAIR MRI, acute hemorrhage on CT
versus ischemic infarction, brain edema on CT versus MRI, obstructive hydrocephalus versus hydrocephalus ex vacuo, typical
appearance of a primary versus metastatic brain tumor, multiple sclerosis plaques on MRI