Neurology is a clinical discipline that developed in the 18th century to study the nervous system. It uses specialized investigation methods and has distinguished various neurological disorders. The nervous system regulates and coordinates the organism's activity and interaction with the external environment through interconnected nerve structures. It consists of the central nervous system (brain and spinal cord) and peripheral nervous system. The brain and spinal cord develop from ectoderm and mesoderm tissues during embryogenesis. Neurological examinations evaluate mental status, cranial nerves, motor strength, sensation, reflexes, coordination and gait to localize pathology. Neurological disorders are common causes of illness and can affect the brain, spinal cord or nerves.

1. Introduction to neurology

2. Neurology as a clinical discipline has existed since the 60s of the
18th century. In the process of its formation developed special methods
of investigation, passed the accumulation of information about
symptoms in the defeat of the individual structures of the central and
peripheral nervous system, distinguished nosological forms.
As a result, we developed a neurological theory, described a large
number of concepts, phenomena, terms, symptoms, syndromes, clinical
entities.

3. The nervous system is
a set of anatomically and functionally
interconnected structures that
ensure the
regulation and coordination of the
activity of the
organism as
a whole and
Interaction
its with the surrounding external environment.

4. Brain
Central nervous system
Somatic autonomic
Peripheral nervous
system
Nervous system
sympathetic
parasympathetic
Spinal cord

5. Ontogenesis of the brain
• Development of the human nervous system starts on
day 15 post-conception (p/c) when a primitive streak of
specialised neuroectoderm forms on the dorsal surface
of the embryo.
• Dorsal induction is responsible for the formation and
closure of the neural tube as well as the three primary
vesicles at the rostral end of the neural tube.
• Ventral induction leads to formation of the cerebral
hemispheres, eye vesicles, olfactory bulbs, pituitary
glands and part of the face while dorsal induction
includes primary and secondary neurulation.

6. Ontogenesis
• Primary neurulation
begins with formation of
the neural plate and tube,
ending when the neural
tube is separated from
the surface ectoderm by
the intervening
mesenchyme.
• Formation of the neural
plate starts on day 17 p/c
and is complete by day 18
p/c when the edges of
the neural plate begin to
elevate, folding over to
form the neural tube.

7. Ontogenesis of the brain
The nervous system develops from
the ectoderm (neurons and glia) and
mesoderm (vessels and membranes
of the brain) .
By 3 weeks – nervous plate.
By the end of 4 weeks – three brain
bladders.
12 weeks –common features of the
brain.
By week 20, the process of
myelination begins, which indicates
functional maturity.
First, myelination occurs in the
sensitive part of the nervous system,
then in the coordination part.
Immediately after birth, there is
myelination of the frontal lobes of
the brain, the pyramidal tract.

8. • Nervous tissue is the basis of the structure and activity of the nervous system. The
main properties of this tissue are excitability and conductivity. It consists of two
types of cells: nerve cells - neurons and auxiliary satellite cells (glial cells), as well
as Schwann cells. Between the cells of the nervous tissue, intercellular spaces are
well developed, filled with a fat - like intercellular substance- glia (neuroglia). Glia
and satellite cells perform auxiliary functions for neurons: supporting, protective,
trophic, and metabolic

9. co-ordination of work of mews,
tissues, organs and their systems
functions
of the nervous system
adjusting
of functions of
organs
connection of
organism with
an environment
basis
of higher psychical
processes
(thinking and speeches)

10. A typical neuron structure
dendrite axon terminal
branch
cell body
intercept
of Ranvie
kernel
axon
Schwann cell
myelin sheath

11. dendrite
axon
kernel
soma
synapse

12. Classification of neurons
By body shape: pyramidal, pear-shaped, etc.
By body size: small, medium, large
By the number of processes: unipolar,bipolar,
pseudo-unipolar,
multipolar
By functional significance:receptor, effector,
associative

13. nervous tissue
The main component of the nervous system
which is built
Neurons
nerve cells
Neuroglia
perceived annoyance,
becomes excited
and transmit nerve impulses
cells that in the space between
neurons
perform reference,
demarcation,
trophic, secretory,
protective functions

14. Microglia cells

15. Nerve fibers are
processes of nerve cells, covered with a glial membrane and conducting a nerve
impulse
myelinated myelin-free
there is myelin in the glial membrane myelin is absent

16. Electric Chemical
Синапсы
Synapses are places of
connectionnerve cells where
the nerve impulse is
transmitted.
This can happen directly
(electrical transmission), but
most often it is carried out
indirectly, using chemical
molecules -
neurotransmitters:
•Acetylcholine,
•Norepinephrine
•Aspartate
•Glutamate
•Gamma-aminobutyric acid
•Dopamine
•Serotonin
•Histamine
•Arginine

18. The Structure of the Nervous System
The Spinal Cord
• is encased in the bony vertebral
column
• is attached to the brain stem
• is the major conduit of
information from the skin,
joints, and muscles of the body
to the brain, and vice versa
• A transection of the spinal cord
results in anesthesia (lack of
feeling) in the skin and paralysis
of the muscles in parts of the
body caudal to the cut.

19. • 31 segments:
• 8 neck (C)
• 12 breast (T)
• 5 lumbar (L)
• 5 sacral (S)
• and 1 coccyx.

20. Gray matter of the spinal cord (nuclei of the posterior,
lateral and anterior horns)

21. White matter of the spinal cord (pathways)

22. White matter of the spinal cord
(pathways)
• Fasciculus gracilis et cuneatus

23. White matter (pathways) of the lateral cord
Tr. cortico-spinalis lateralis
Tr. spinocerebellaris anterior et posterior
Tr. spino-thalamicus lateralis
Tr. rubro-spinalis

24. White matter (pathways) of the anterior cord
White matter (pathways) of the anterior cord
Tr. spino-thalamicus anterior
Tr. vestibulo-spinalis
Tr. tecto-spinalis
Tr. reticulo-spinalis

25. Оболочки СМ
• имеет три оболочки: и
наружная – твердая
• средняя - паутинная
• внутренняя - мягкая
(сосудистая), Между твердой
оболочкой и надкостницей
позвоночного канала -
эпидуральное пространство,
между твердой и паутинной -
субдуральное пространство.
• От мягкой (сосудистой)
оболочки паутинную оболочку
отделяет подпаутинное
(субарахноидальное)
пространство, содержащее
спинномозговую жидкость
(до 150 мл)

26. brain
an elongated slit cerebrum
thalamus
cerebellum
frontal
lobe
hypothalamus
pituitary
brain axis
midbrain
pons
medulla
spinal cord

27. Кровоснабжение головного мозга

30. Neurologic disorders
• Neurologic disorders are globally among the
most important causes of human illness and
mortality.
• Neurologic diseases are notable for more
frequently causing disability than death.
• Current estimates of the burden of
neurological disorders indicate that they have
a huge impact on human health.

31. Neurologic disorders
• Primary neurologic disorders affecting the
nervous system only
• Secondary neurologic disorders, in which
injury or dysfunction of the nervous system
occurs as a result of a disease that primarily
affects another organ system

32. • Primary neurologic disorders (Alzheimer
disease, migraine, and multiple sclerosis)
• Secondary neurologic disorders include
seizures secondary to infection with malaria,
paraneoplastic syndromes associated with
primary systemic cancer, and peripheral
neuropathy occurring in the setting of
nutritional deficiencies

33. Neurologist
• A doctor who has specialisation in neurology is known as a
neurologist. The neurologist treats disorders that affect the
brain, spinal cord, and nerves, such as:
• Demyelinating diseases of the central nervous system, such
as multiple sclerosis
• Cerebrovascular disease, such as stroke
• Headache disorders
• Infections of the brain and peripheral nervous system
• Neurodegenerative disorders, such as Alzheimer’s disease,
Parkinson’s disease, and Amyotrophic Lateral Sclerosis (Lou
Gehrig’s disease)
• Movement disorders, such as Parkinson’s disease
• Seizure disorders, such as epilepsy
• Spinal cord disorders
• Speech and language disorders.

34. NEUROLOGICAL EXAMINATION
• During this examination, the health history of the patient is
reviewed by neurologist with special attention to the current
condition.
• The patient then takes a neurological exam. Typically, the exam tests
mental status, function of the cranial nerves (including vision), strength,
coordination, reflexes, and sensation.
• This information endorse the neurologist determine whether the
problem exists in the nervous system and the clinical localization.
• Localization of the pathology is the key process by which
neurologists develop their differential diagnosis.

35. NEUROLOGICAL EXAMINATION
Components of the neurological examination
include assessment of the patient’s cognitive
function, cranial nerves, motor strength,
sensation, reflexes, coordination, and gait. In few
examples, neurologists may order additional
diagnostic tests as part of the evaluation.

36. Principles of neurological history taking
The usual approach to a clinical problem is to ask the
following:
- Where is the lesion, e.g. brain, spinal cord, anterior
horn cell, peripheral nerve, neuromuscular
junction, muscle?
- What is the aetiology, e.g. vascular, degenerative,
toxic, infective genetic, inflammatory, neoplastic,
functional?
- What is the differential diagnosis?
- Is treatment possible?
- What is the prognosis?

37. A detailed history usually will yield more information than the
neurological examination and ancillary tests
• Family members and eyewitness
accounts are essential, e.g in patients
with dementia and blackouts.
• Obtain a history by telephone if
necessary.
• A review of the case notes if available is
very useful.

38. Analysis of symptoms will follow a
similar plan:
date/week/month/year of onset;
- character and severity;
- location and radiation;
- time course;
- associated symptoms;
- aggravating and alleviating factors;
- previous treatments;
- remissions and relapses.

39. Past medical history
• Do not always accept the patient’s diagnostic
terms—enquire into specific symptoms, e.g.
‘migraine’, ‘seizure’, ‘stroke’.
Family history
• Draw a family tree. Document specific
illnesses and cause of death if known.
• In certain communities enquire about
consanguinity.

40. Social history
This should include:
• - alcohol;
• - smoking;
• - recreational drug use;
• - risk factors for HIV;
• - detailed travel history;
• - dietary habits.

41. The general examination
• This starts on first meeting the patient—it is useful
practice to collect patients from the waiting room.
• - Assess gait—broad-based, unsteady, reduced arm
swing on one side?
• - Look for tremor—may only be evident when walking.
• - Look for loss of facial expression.
• - Assess speech—dysarthria
• General examination is essential: ideally all patients
should be stripped to the underclothes.

42. Examination
• Cardiovascular system. Pulse, heart sounds,
blood pressure (lying down and standing after
3 minutes if any suggestion of autonomic
involvement).
• - Respiratory system. Diaphragmatic
movement. May need to measure forced vital
capacity (FVC).
• - Gastrointestinal system. Palpate for
hepatosplenomegaly or abdominal masses.

43. Examination
• Genitalia. In men testicular examination should be
considered. PR examination if malignancy
suspected or assessment of anal tone andsensation
if cord or cauda equina compression in differential
diagnosis.
• - Breasts. Essential if neoplastic or paraneoplastic
conditions are considered.
• - Examine the spine—hairy patch may indicate
underlying spinal disorder or a dermal sinus.
• Auscultation over spine may reveal the bruit of a
dural AVM.

44. Examination
• Skin—melanoma. Vitiligo indicating
underlying autoimmune disorder, e.g. MG.
• - Head. Remember to palpate the temporal
arteries in elderly headache patients;
auscultation may reveal a bruit.
• Palpate the trapezii for evidence of tenderness
in muscle tension and cervicogenic headache.

45. Methods for studying brain functions:
• Сlinical method - study of
cortical damage disorders
electrical stimulation of various
areas of the cortex the method of
conditioned reflexes EEG
registration of biopotentials of
the brain
• Echoencephaloscopy rapid
removal of individual sections
of the cortex.
• Carotid artery Doppler
• Transcranial Doppler performed using
a high-frequency probe over the thin
portion of the temporal bone using it
as an acoustic window.

46. Nerve conduction studies (NCS) and needle
electromyography (EMG):
- Study of sensory and motor peripheral nerve
disorders, e.g. neuropathies, radiculopathies,
dorsal root ganglionopathies, and anterior
horn cell disorders.
- Neuromuscular junction disorders.
- Skeletal muscle disorders.
- Cranial nerve disorders, e.g. facial nerve,
trigeminal nerve.

47. Evoked potentials (EPs).
- Study sensory and motor pathways in the
peripheral and central nervous systems.
- Useful in investigation of multiple sclerosis,
other spinal cord and brainstem disorders, and
cranial neuropathies.
- Monitoring of spinal cord function during
surgery for scoliosis and of the facial nerve
during acoustic neuroma surgery.

48. Neuro Radiological Examinations
• Computerized tomography (CT)
• Magnetic resonance angiography (MRA)
• Magnetic resonance imaging (MRI)
• Magnetic resonance spectroscopy (MRS)
• Functional MRI (fMRI)
• Catheter angiography

49. Thank you