clinical neurology for undergraduate medical student including nervous system organisation and clinical examination

1. Introduction to clinical
neurology
Osama a. ragab
Neurology md
2016

2. Organization of the nervous system

5.  Frontal – motor control of the opposite side of
the body, insight and control of emotions and, in
the dominant hemisphere, output of speech.
 Temporal – memory and emotions and, in the
dominant hemisphere, comprehension of speech.
Parietal – sensation of the opposite side of the
body and appreciation of space, especially in the
non-dominant hemisphere.
Occipital – appreciation of vision.

8. The basal ganglia are interconnected deep
nuclei including the putamen, caudate,
globus pallidum and substantia nigra with
complicated interrelations.
They are involved in the integration of
motor and sensory inputs. when things go
wrong, they produce clinical syndromes of
involuntary movement.

9.  The cerebellum coordinates movement and
is important in the control of balance and
posture.
The cerebellar hemispheres control
coordination on the same side of the body.
The central cerebellar structures are
important in gait and sitting balance.

10. The brain stem contains nuclei, including the
reticular formation, which maintains
consciousness, and those for the cranial nerves (3–
12), and the large white matter tracts running from
the spinal cord to more central structures and vice
versa.
The descending motor tract, the corticospinal
tract, mostly crosses over (decussates) in the
pyramids in the medulla. The ascending dorsal
column crosses in the medulla.
The fact that these tracts cross in the brain stem is
helpful in localization of any lesion. A brain stem
lesion can produce a cranial nerve lesion on one
side and limb signs on the other side

11. Spinal cord is made up of 31
segments which are
regionally subdivided from
above downwards as
follows—
Cervical – 8
Thoracic – 12
Lumbar – 5
Sacral – 5
Coccygeal – 1

12. The nerve roots leave the spinal canal through their
exit foramina. In the lumbar spine the nerve roots
from the lower end of the spinal cord form the cauda
equina before leaving the lumbosacral spinal canal.
The roots combine in the cervical and lumbosacral
regions to form the brachial plexus and lumbosacral
plexus.
The brachial and lumbosacral plexuses then divide
into named nerves.
Stimulation of the motor nerves will then lead to the
release of acetylcholine at the neuromuscular
junction, which binds to acetylcholine receptors,
leading to muscle contraction.

13. The autonomic nervous system t is
classified into two divisions:
Sympathetic ‘alarm’ system, which
arises from the spinal segments T1 to
L2.
Parasympathetic ‘holiday’ system,
which arises from the brain stem
(associated with cranial nerves 3, 7
and 9) and the spinal segments S2–4.

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33. • positive (parathesia, ,. dysthesia ,. Pain, unpleasant sensation indicating
ongoing tissue destruction. Allydonia. Hyperalgesia painful stimuli
produce more pain.
• Negative sensory complaint such as hypothesia , anesthesia or analgesia .
• Sensory loss may be associative.or dissociative .
• It may affect one side of body , both lower limb , face only, one dermatome
or overlapping dermatomes, jacket distribution, gloves and stocking and
patch of sensory ( leprosy ).

34. • Urinary ( urge– incontinence , hesitancy---- retention).
• Rectal complaint such as constipation or incontinence .
• Sexual dysfunction .

35. • Cognitive dysfunctions .
• Dyscalculia, Dysphasia, dyslexia, agnosia and apraxia.
• Alterations of level of consciousness .
• Seziures

36. • fever (infection), vomiting ( increased intracranial tension) , rash(
HZ, meningitis) ,abdominal pain ( epilepsy, porphyria , migraine )
headache , skeletal deformities ( long standing neuropathy) , skin and
oral ulcers (vasculitis).

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