Week 2 Neuro Objectives: 3/11 - Lecture 1: Radiology 1: Neuroradiology 1.

Basic familiarity with imaging modalities and the appearance of CNS structures with CT, MRI and angiography. 2. Know the major advantages and disadvantages of each of the 4 main image modalities - plain x-ray, CT, MRI, angiography. (Know what is best modality to use in basic clinical situations: trauma, suspected stroke, headache).
Plain X-Ray Advantages Cost, logistical (speed and ease) Disadvantages Little useful information, only shows bony structures and brad density differences of soft tissues Uses ionizing radiations, pt cannot move, less info about tissue compositions as MRI Scan acquisition times, strong magnetic fields limit use, claustrophopia, cost Invasice, ionizing radiation, contrast allergy, 2D info, only shows patent lumens of aneurysms, cost Best for?

CT

MRI

Speed, logistical ease, very good bony detail, lower cost than MRI, no magnetic field to disrupt pacemaker/metal, no claustrophobia More information, more sensitive, multiplanar scanning capability Greater spatial resolution, absence of artifacts

Acute situations: Trauma, acute stroke (hemorrhage) Non-acute: Trauma, stroke, tumors, all else

Angiography

3. Recognize a T1-weighted image, T2-weighted image and FLAIR (Fluid Attenuated Inversion Recovery) image.

T1 weighting: water is dark (hypointense); fat is bright (hyperintense); white matter is brighter than grey T2 weighting: water is bright; fat +/- dark (depends on type of T2 sequence); white matter darker than grey FLAIR: Fluid Attenuated Inversion Recovery T1 Weighted T2 Weighted FLAIR (T2)

4. Understand the general approach to developing a differential diagnosis in imaging. 5. Recognize the imaging appearance of gross anatomic structures: grey matter, white matter, basal ganglia, thalamus, ventricles, and meninges. 3/11 - Lecture 2: NA 3: Internal Anatomy of the Brain 1. Understand how development shapes the external and internal features of the cerebral hemispheres. 2. Learn the C-shaped anatomy of the lateral ventricle, hippocampal formation, and caudate nucleus in both coronal and horizontal slices. 3. Know the differences between association fibers, commissures, and projection fibers (where they are found, what do they connect, and what are their functions). 3/12 - Lecture 3: Pharm 1: Parasympathomimetics and Cholinesterase Inhibitors 1. List the effects of acetylcholine on organs that contain acetylcholine receptors. 2. Describe how direct acting parasympathomimetics mimic the actions of parasympathetic nerve stimulation and why drugs in this class are effective in parasympathetic denervated organs. 3. Compare the action of direct acting parasympathomimetic drugs with parasympathetic nerve stimulation on target tissues, specifically heart, respiratory tract, GI tract, urinary tract, arterioles, salivary and lacrimal glands. 4. List the important adverse reactions after treatment with direct acting parasympathomimetics.

5. Create a table that lists all the parasympathomimetics discussed in lecture and use the table to compare the drugs that are hydrolyzed by cholinesterase and those not hydrolyzed by cholinesterase. 6. Create a table that lists the organs that response to cholinergic stimulation. For each organ, list the drug that is best used a therapeutic drug for that organ and the side effects of that drug on that organ and other organs. 7. Describe the mechanism of action of a cholinesterase inhibitor and compare and contrast the actions for this class of drugs with direct acting parasympathomimetics. 8. List the two different types of cholinesterase inhibitors and compare their actions. 9. List the effects of organophosphate poisoning. 10. Describe the treatment for organophosphate poisoning.

3/12 - Lecture 4: NA 4: Blood Supply of the CNS 1. Impact and significance of stroke 2. Disproportionate blood supply of brain 3. Concepts of anterior vs posterior circulation, Circle of Willis collaterals 4. Basic embryology of CNS arteries 5. Course, branches and territories (superficial and deep) of: a. Internal carotid artery, ophthalmic artery, posterior communicating artery, anterior choroidal artery, middle cerebral artery, anterior cerebral artery b. Vertebral artery, posterior inferior cerebellar artery, basilar artery, anterior inferior cerebellar artery, superior cerebellar artery, posterior cerebral artery 6. Motif of brainstem perfusion: perforating arteries, paramedian arteries, etc. 7. Cerebral venous system a. Superficial venous system i. Vein of Labbe, vein of Trolard, superficial middle cerebral vein b. Deep venous system i. Vein of Galen, basal vein, internal cerebral vein, thalamostriate vein, septal vein c. Dural venous sinuses i. Confluence of sinuses, superior and inferior sagittal sinus, transverse sinus, sigmoid sinus, cavernous sinus, superior and inferior petrosal sinuses 8. Spinal cord blood supply origin and territory a. Anterior spinal artery; artery of Adamkiewicz, radicular arteries b. Posterior spinal arteries 3/13 - Lecture 5: Physiology 3: Sensory Receptors and Basic Sensory Physiology 1. Define the following terms: receptor or generator potential, adaptation or desensitization, recruitment, sensory modality, sensory unit, somatotopy, somatosensation, and viscerosensation. 2. Explain how tonic and phasic receptors work, and give examples. 3. Explain how different receptors transduce stimuli into action potentials in sensory neurons. 4. Describe the difference between a generator (graded) potential and an action potential in sensory neurons. 5. Describe the mechanism by which the intensity of a sensory stimulus is conveyed. 6. List and describe the 4 general features of sensory coding. 7. Explain in detail how sensory stimulus is localized and how different degrees of stimulus activity are achieved. 8. Describe how the CNS controls sensory perception in general terms. 3/13 - Lecture 6: NA 5: Sensory Pathways from the Neck, Trunk and Limbs 1. List the general principles of organization of the sensory pathways. 2. Name the two major pathways that convey sensation from the neck, truck and limbs, and know the sensory modalities conveyed by each. 3. Name the 2 major pathways that convey sensations from the head and know sensory modalities conveyed by each. 4. Trace the origin and course of the sensory pathways with emphasis on the level or their decussation. 5. Describe the somatotopic organization within the DC-ML pathway at the level of the spinal cord and brain stem, and the DC-ML and STT pathways in the internal capsule the primary sensory cortex.

6. Identify the connections that mediate the withdrawal reflex, the muscle stretch reflexes (Deep Tendon Reflexes or DTRs), the corneal blink reflex and the jaw jerk reflex. 7. Learn the pathways for taste. 3/14 - Lecture 7: Pharm 2: Ganglionic Blockers and Stimulants 1. Compare sites of action of ganglionic blocker with direct acting parasympathomimetic and cholinesterase inhibitor. 2. Compare and contrast the actions of ganglionic inhibitors on nicotinic receptors in ganglia and nicotinic receptors on muscle end plates. 3. List the overall effect of ganglion blockers on each of the target organs that are sympathetically or parasympathetically innervated after treatment with a ganglionic blocker. 4. Describe the effect of a low versus high-end diastolic volume and the effect of ventricular muscle stretching on cardiac output. 3/14 - Lecture 8: Pathology 1: Large Group Discussion: Cell and Tissue Response to Injury in the CNS 1. When provided with a histological section, identify neurons, astrocytes, oligodendroglial cells, microglial cells and ependymal cells. 2. Define four ways that neurons respond to injury. a. Ischemic cell change b. Central chromatolysis c. Wallerian degeneration d. Distal axonopathy 3. Describe the appearance and indicate a disease associated with each of the 5 neuronal inclusions. 4. List three mechanisms by which myelin in reduced in amount in the CNS. In which demyelinating disease are inclusions found in oligodendroglia? 5. Define astrogliosis (gliosis) and describe its appearance on histologic section. 6. Indicate the derivation of microglial cells in the CNS. 7. Define the four ways in which microglial cells respond to injury. a. Reactive microglial cell b. Macrophage response c. Microglial nodule d. Multinucleated giant cell 8. Describe the typical response of ependymal cells to disruption. 9. List three ways in which vasogenic edema differs from cytotoxic edema. 3/14 - Lecture 9: Embryology 1: Head and Neck Development 1. Know the different components of the pharyngeal arch and their late fates, be able to recognize the pharyngeal origin of mature structures and recognize which structures are non-pharyngeal. 2. Recognize the developmental significance of innervation patterns and transitions in terms of the developmental origins of the innervated structures. 3. Developmental terms of particular importance: a. Pharyngeal arch b. Pouch c. Cleft d. Frontonasal process 3/14 - Lecture 10: Neurology 1: Stroke and Vascular Neurology 1. Epidemiology of stroke a. Types of stroke b. Stroke risk factors 2. Diagnosis of stroke a. Clinical b. Imaging c. Localization

3. Treatment of acute stroke a. Thrombolysis 4. Prevention of stroke a. Treatment of risk factors 3/15 - Lecture 11: GA 3: Orbit, Eyelids, and Cranial Nerves III, IV & VI 1. List the neighboring anatomical regions and structures related to each wall of the orbit. 2. Describe the fascial structures of the orbit, their arrangement and their relationships to the bones, eyelids and eyeball. 3. List the five layers of the eyelids, discuss the primary structures that comprise each layer, describe the continuity of conjunctiva from eyelid onto the eyeball and name the nerves that provided sensory innervation to the skin of lids and their related mucous membranes. 4. Diagram the arrangement of the extraocular muscles within the orbit and around the eyeball, give their innervation and describe their anatomical actions. 5. Perform a basic clinical examination to test the function and innervation of the extraocular muscles and explain why you are doing each step. 6. Trace the pathways of the motor neurons that course through the oculomotor, trochlear, and abducent nerves. 7. Trace the pathways of the sensory neurons that innervate bulbar conjunctiva as opposed to the palpebral conjunctiva and skin of the eyelids. 8. Discuss the function and describe the pathways for sympathetic and parasympathetic innervation of the superior tarsal muscle, ciliary muscle, and dilator and sphincter of the pupil. 9. Describe the afferent and efferent pathways involved in the corneal and pupillary reflexes including the location of the neuronal cell bodies.