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Introduction to
 Neurology



             Prof. Mamun Sarhan
             Head of Neurology
             Department
WHAT IS NEUROLOGY?
Neurology is the branch of medicine that
deals with diseases of the nervous system.
Major divisions
                 Central
                 nervous
                 system
Nervous
System
                Peripheral
                 nervous
                 system
Intracranial
  Intracranial      Spinal
                    Spinal
      part
      part           part
                     part




1.Cerebrum       Spinal cord &
2. Brain stem
                 Cauda equina
3. Cerebellum
Cerebrum

Two cerebral hemispheres
Connected to:

  1. each other by corpus
     callosum

  2. brain stem by cerebral
    peduncles
EACH CEREBRAL HEMISPHEREDEVIDED
INTO :

four lobes:
  1. Frontal
 2. Parietal
 3. Temporal
 4. Occipital
Brain stem
 Formed of :
           Midbrain
           Pons
           Medulla
Connected to:
 1. Cerebral hemisphere
    by cerebral peduncles

2. Cerbellum by cerebellar
   peduncles
Contains:

• CN 3,4 in midbrain
• CN 5,6,7,8 in pons
• CN 9,10,11,12 in medulla
Names of cranial nerves
•   Ⅰ Olfactory nerve
•   Ⅱ Optic nerve
•   Ⅲ Oculomotor nerve
•   Ⅳ Trochlear nerve
•   Ⅴ Trigeminal nerve
•   Ⅵ Abducent nerve
•   Ⅶ Facial nerve
•   Ⅷ Vestibulocochlear
    nerve
•   Ⅸ Glossopharyngeal
    nerve
•   Ⅹ Vagus nerve
•   Ⅺ Accessory nerve
•   Ⅻ Hypoglossal nerve
Classification of cranial nerves
•   Sensory cranial nerves: contain only afferent (sensory) fibers
     – ⅠOlfactory nerve
     – ⅡOptic nerve
     – Ⅷ Vestibulocochlear nerve
•   Motor cranial nerves: contain only efferent (motor) fibers
     – Ⅲ Oculomotor nerve
     – Ⅳ Trochlear nerve
     – ⅥAbducent nerve
     – Ⅺ Accessory nerv
     – Ⅻ Hypoglossal nerve
•   Mixed nerves: contain both sensory and motor fibers---
     – ⅤTrigeminal nerve,
     – Ⅶ Facial nerve,
     – ⅨGlossopharyngeal nerve
     – ⅩVagus nerve
Sensory cranial nerves
N.   Name         Function   Assessment
Ⅰ    Olfactory    Smell      Examination of
                             smell
Ⅱ    optic        Vision     Acuity, field &
                             fundus
Ⅷ    Vestibular   Equilibrim Caloric and
     part                    rotational chair
     Cochlear     Hearing    Watch test,
     part                    weber test
Motor cranial nerves
N.   Name         Function                       Assessment
Ⅲ    Oculomotor Motor to superior, inferior and Ptosis, pupil, eye
                medial recti; inferior oblique & movements &
                levator palpebrae superioris     squint

                  Parasympathetic to sphincter
                  papillae and ciliary muscle

Ⅳ    Trochlear    Motor to superior oblique      Look to opposite
                                                 shoulder
Ⅵ    Abducent     Motor to lateral rectus        Lateral eye
                                                 movement
Ⅺ    Accessory    Motor to sternocleidomastoid   Elevaton of
                  and trapezius                  shoulders and
                                                 neck rotation
Ⅻ    Hypoglossal Motor to muscles of tongue      Tongue
                                                 movements
Mixed cranial nerves
N.   Name            Function                Assessment
V    Trigeminal      Muscles of              Face sensations &
                     mastication &           power of muscles of
                     sensations of face      mastication

VII Facial           Muscles of facial       Muscles of facial
                     expression & taste      expression & taste
                     sensation in ant. 1/3   sensation in ant. 1/3 of
                     of tongue               tongue
X    Vagus           Sensation and           Palatal and pharyngeal
                     movements of            reflexes & movements of
                     Larynx, pharynx,        uvula
                     thoracic and
                     abdominal organs
XII Glossopharyng- Taste in post 2/3 of      Taste & general
    eal            tongue & gen.             sensation and
                   sensation                 pharyngeal reflex
Cerebellum
• Behind the brain stem
• Formed of : medline vermis
              two cerebellar hemispheres
• Composed of :
             outer grey matter and inner
             White matter
Cerebellar peduncles




                          MB


                      Pons            C




                             MO




   Superior peduncle connects cerebellum with midbrain.
   Middle peduncle connects cerebellum with pons.
   Inferior peduncle connects cerebellum with medulla oblongata
Hemispheres and vermis


 left                                                     right
 hemisphere                                         hemisphere




                            vermis



   Cerebellar hemispheres are the two bilateral structures.
     Vermis is the unpaired midline structure between
                   the two hemispheres.
Spinal cord
•   Inside spinal canal
•   End at lower border of L1
•   The lowest 3 segments = Conus
•   The above 4 segments = Epiconus
•   Inner grey matter and outer white
    matter
Cauda equina

• Lumbosacral roots collection fills
  the lower part of the spinal canal
  bellow L1
Cauda equina
Brachial plexus
Lumbosacral plexus
Cervical enlargement
Lumbosacral enlargement
Peripheral nervous system
•   A.H.Cs
•   Roots
•   Plexuses
•   Peripheral nerves
mo
                              to
                                 r
                                        Upper




                               co
                                        motor




                                 rte
                                    x
                                        neuron
        internal capsule


            Medulla




anterior horn cell
                                        Lower
                                        motor
                                        neuron
Motor pathway
UMNL                    LMNL
Tone              Increased, with         Decreased
                  ‘clasp knife’ quality
Clonus            Present                 Absent
Fasciculations    Absent                  Present
Muscle Wasting    Absent, but disuse      Present (within 2-3
                  atrophy eventually      weeks)
                  results
Tendon Reflexes   Increased. Extensor Decreased or
                  plantar reflexes.   absent. Flexor
                                      plantar reflexes.
Distribution      Whole limbs, with   Specific muscle
                  more weakness in    groups affected (e.g.
                  the upper limb      in the distribution of
                  extensors and lower a spinal segment, or
                  limb flexors        just the proximal
                                      muscles, etc.)
Thank You!!!

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Introduction to neurology

  • 1. Introduction to Neurology Prof. Mamun Sarhan Head of Neurology Department
  • 2. WHAT IS NEUROLOGY? Neurology is the branch of medicine that deals with diseases of the nervous system.
  • 3. Major divisions Central nervous system Nervous System Peripheral nervous system
  • 4. Intracranial Intracranial Spinal Spinal part part part part 1.Cerebrum Spinal cord & 2. Brain stem Cauda equina 3. Cerebellum
  • 5. Cerebrum Two cerebral hemispheres Connected to: 1. each other by corpus callosum 2. brain stem by cerebral peduncles
  • 6. EACH CEREBRAL HEMISPHEREDEVIDED INTO : four lobes: 1. Frontal 2. Parietal 3. Temporal 4. Occipital
  • 7.
  • 8. Brain stem Formed of : Midbrain Pons Medulla Connected to: 1. Cerebral hemisphere by cerebral peduncles 2. Cerbellum by cerebellar peduncles
  • 9. Contains: • CN 3,4 in midbrain • CN 5,6,7,8 in pons • CN 9,10,11,12 in medulla
  • 10. Names of cranial nerves • Ⅰ Olfactory nerve • Ⅱ Optic nerve • Ⅲ Oculomotor nerve • Ⅳ Trochlear nerve • Ⅴ Trigeminal nerve • Ⅵ Abducent nerve • Ⅶ Facial nerve • Ⅷ Vestibulocochlear nerve • Ⅸ Glossopharyngeal nerve • Ⅹ Vagus nerve • Ⅺ Accessory nerve • Ⅻ Hypoglossal nerve
  • 11. Classification of cranial nerves • Sensory cranial nerves: contain only afferent (sensory) fibers – ⅠOlfactory nerve – ⅡOptic nerve – Ⅷ Vestibulocochlear nerve • Motor cranial nerves: contain only efferent (motor) fibers – Ⅲ Oculomotor nerve – Ⅳ Trochlear nerve – ⅥAbducent nerve – Ⅺ Accessory nerv – Ⅻ Hypoglossal nerve • Mixed nerves: contain both sensory and motor fibers--- – ⅤTrigeminal nerve, – Ⅶ Facial nerve, – ⅨGlossopharyngeal nerve – ⅩVagus nerve
  • 12. Sensory cranial nerves N. Name Function Assessment Ⅰ Olfactory Smell Examination of smell Ⅱ optic Vision Acuity, field & fundus Ⅷ Vestibular Equilibrim Caloric and part rotational chair Cochlear Hearing Watch test, part weber test
  • 13. Motor cranial nerves N. Name Function Assessment Ⅲ Oculomotor Motor to superior, inferior and Ptosis, pupil, eye medial recti; inferior oblique & movements & levator palpebrae superioris squint Parasympathetic to sphincter papillae and ciliary muscle Ⅳ Trochlear Motor to superior oblique Look to opposite shoulder Ⅵ Abducent Motor to lateral rectus Lateral eye movement Ⅺ Accessory Motor to sternocleidomastoid Elevaton of and trapezius shoulders and neck rotation Ⅻ Hypoglossal Motor to muscles of tongue Tongue movements
  • 14. Mixed cranial nerves N. Name Function Assessment V Trigeminal Muscles of Face sensations & mastication & power of muscles of sensations of face mastication VII Facial Muscles of facial Muscles of facial expression & taste expression & taste sensation in ant. 1/3 sensation in ant. 1/3 of of tongue tongue X Vagus Sensation and Palatal and pharyngeal movements of reflexes & movements of Larynx, pharynx, uvula thoracic and abdominal organs XII Glossopharyng- Taste in post 2/3 of Taste & general eal tongue & gen. sensation and sensation pharyngeal reflex
  • 15. Cerebellum • Behind the brain stem • Formed of : medline vermis two cerebellar hemispheres • Composed of : outer grey matter and inner White matter
  • 16. Cerebellar peduncles MB Pons C MO  Superior peduncle connects cerebellum with midbrain.  Middle peduncle connects cerebellum with pons.  Inferior peduncle connects cerebellum with medulla oblongata
  • 17. Hemispheres and vermis left right hemisphere hemisphere vermis Cerebellar hemispheres are the two bilateral structures. Vermis is the unpaired midline structure between the two hemispheres.
  • 18. Spinal cord • Inside spinal canal • End at lower border of L1 • The lowest 3 segments = Conus • The above 4 segments = Epiconus • Inner grey matter and outer white matter
  • 19. Cauda equina • Lumbosacral roots collection fills the lower part of the spinal canal bellow L1
  • 20. Cauda equina Brachial plexus Lumbosacral plexus Cervical enlargement Lumbosacral enlargement
  • 21.
  • 22. Peripheral nervous system • A.H.Cs • Roots • Plexuses • Peripheral nerves
  • 23. mo to r Upper co motor rte x neuron internal capsule Medulla anterior horn cell Lower motor neuron
  • 25. UMNL LMNL Tone Increased, with Decreased ‘clasp knife’ quality Clonus Present Absent Fasciculations Absent Present Muscle Wasting Absent, but disuse Present (within 2-3 atrophy eventually weeks) results Tendon Reflexes Increased. Extensor Decreased or plantar reflexes. absent. Flexor plantar reflexes. Distribution Whole limbs, with Specific muscle more weakness in groups affected (e.g. the upper limb in the distribution of extensors and lower a spinal segment, or limb flexors just the proximal muscles, etc.)