This document provides an introduction to neurology. It discusses the categories of neurological diseases as hereditary or acquired. It reviews important neuroanatomy including the divisions of the nervous system and functions of the cerebral cortex, cerebellum, and spinal cord. It emphasizes the importance of neurological history and physical examination in diagnosis, including determining the problem location and lesion site. Finally, it outlines common neurological investigations such as lumbar puncture, electroencephalography, nerve conduction studies, biopsy, and various imaging tools.

1. Introduction to
Neurology
Dr. yahya almashhadani
F.I.B.M.S (Neurology)

2. Objectives
 Know categories of neurological diseases.
 Review important points in neuro-anatomy.
 Emphasize the importance of ( history ) in diagnosis; What is the problem ?
 Emphasize the importance of ( physical signs ) in diagnosis; Where is the lesion ?
 Review the significance of investigations in neurology

3. Categories of neurological diseases
● Hereditary or congenital
● Acquired

4. Divisions of the nervous system

5. Anatomy and function of cerebral cortex
c

6. Each cerebral hemisphere consist of :
● Gray matter (cortex) : neuronal cell bodies
● white matter (composed of neuronal axons), are known as
● The basal ganglia which is collections of neurons that are concerned with
motor control
● The thalamus, which is responsible for the level of attention to sensory
perception;
● The limbic system, concerned with emotion and memory;
● The hypothalamus, responsible for homeostasis, such as temperature
and appetite control.
● The cerebral ventricles contain cerebrospinal fluid (CSF), which cushions
the brain during cranial movement

8. The cerebellum fine-tunes and coordinates movement initiated by the motor
cortex, including articulation of speech.
The spinal cord is the route for virtually all communication between the extra-
cranial structures and the CNS.

9. The motor system
● A programmed movement formulated
by the pre-motor cortex is converted
into a series signals in the motor
cortex that are transmitted to the
spinal cord in the pyramidal tract. This
passes through the internal capsule
and the ventral brainstem before
crossing (decussating) in the medulla
to enter the lateral columns of the
spinal cord. The pyramidal tract ‘upper
motor neurons’ synapse with the
anterior horn cells of the spinal cord
grey matter, which form the lower
motor neurons.

10. Patterns of motor loss according
to the anatomical site of the
lesion
● From the cortex to the
anterior horn cells of spinal
cord or motor nuclei of cranial
nerves in brain stem called
UMNL.
● From the nuclei or anterior
horn cells to the muscles
called LMNL

12. The main somatic sensory
pathways
● Pain and temperature : ascend in the
contralateral spinal cord through the
lateral spinothalamic tract
● Position and vibration sensation :
ascend in the ipsilateral spinal cord
through the dorsal column to decussate
at lower medulla
● Fine touch sensation :ascend through
the anterior spinothalamic tract
All sensory modalities reach the thalamus
and project to the cortex of the parietal
lobe

13. Patterns of sensory loss

16. The extrapyramidal system
● Circuits between the basal
ganglia and the motor cortex
constitute the extrapyramidal
system, which controls muscle
tone, body posture and the
initiation of movement.

17. How to take a neurological history
• Age and sex
• Handedness
Presenting complaint
• Symptoms
• Overall pattern: intermittent or persistent?
• If intermittent, how often do symptoms occur and how long do they
last?
• Speed of onset: seconds, minutes, hours, days, weeks, months,
years, decades?
• Better, worse or the same over time?
• Associated symptoms (including non-neurological)
• Disability caused by symptoms
• Change in walking
• Difficulty with fine hand movements, e.g. writing, fastening buttons,
• Effect on work, family life and leisure

19. Neurological Examination
High mental functions
Speech
Gait
Cranial nerves
Signs of meningeal irritations
Motor system examination
Sensory system examination

20. Cranial nerves examinations

22. Investigations
Lumbar puncture
● Lumbar puncture (LP) is the technique used to obtain both a CSF sample
and an indirect measure of intracranial pressure.
After local anesthetic injection, a needle is inserted between lumbar spinuos
processes (usually between L3 and L4) through the dura and into the spinal
canal.
● CSF is normally clear and colorless, and the tests that are usually
performed include a naked eye examination of the CSF and centrifugation
to determine the color of the supernatant (yellow, or xanthochromic, some
hours after subarachnoid hemorrhage).
Routine analysis involves a cell count, as well as glucose and protein
concentrations.
● CSF assessment is important in investigating infections (meningitis or
encephalitis), subarachnoid hemorrhage and inflammatory conditions
(multiple sclerosis, sarcoidosis and cerebral lupus).

23. ● If there is a cranial space-occupying lesion causing raised intracranial
pressure, LP presents a theoretical risk of downward shift of intra-cerebral
contents, a potentially fatal process known as coning.
● Consequently, LP is contraindicated if there is any clinical suggestion of
raised intracranial pressure (papilledema), depressed level of
consciousness, or focal neurological signs suggesting a cerebral lesion,
until imaging (by CT or MRI) has excluded a space-occupying lesion or
hydrocephalus.
● When there is a risk of local hemorrhage (thrombocytopenia, disseminated
intravascular coagulation or anticoagulant treatment), then caution should
be exercised or specific measures should be taken. LP can be safely
performed in patients on antiplatelet drugs or low-dose heparin, but may
be unsafe in patients who are fully anti-coagulated due to the increased
risk of epidural hematoma.

24. Electroencephalography
The electroencephalogram (EEG) detects electrical activity arising in the
cerebral cortex via electrodes placed on the scalp to record the amplitude and
frequency of the resulting waveforms.
Nerve conduction studies
Electrical stimulation of a nerve causes an impulse to travel both efferently
and afferent along the underlying axons.
Biopsy
Biopsies of nervous tissue (peripheral nerve, muscle,
meninges or brain) are occasionally
required for diagnosis.
Imaging
X Ray, Ultrasound, CT Scan, MRI,, PET

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