Clinical Anatomy of the Nervous

System

Clinical Anatomy of the Nervous

SystemProf. Abdelmoniem

Sahal

IssuesIssues

Introduction Background knowledge Imaging Anatomy Interviewing Physical examination

IntroductionIntroduction

Relating structure to applications is called Correlational Anatomy

Includes developmental anatomy, functional anatomy, imaging anatomy, surgical anatomy & clinical anatomy

This correlation can be exercised through seminars (topic-based & case-based), and practical (clinical) sessions

IssuesIssues

Introduction Background knowledge Imaging Anatomy Interviewing Physical examination

Background knowledgeBackground knowledge Knowledge of the basic neuroanatomy and

physiology is the cornerstone of neurologic diagnosis

The knowledge is used to understand the pathoanatomy & pathophysiology of the features of clinical problems

Most important aspects are developmental anomalies, functional anatomy of the various areas of the nervous system

Details of the blood supply are most important

IssuesIssues

Introduction Background knowledge Imaging Anatomy Interviewing Physical examination

Imaging anatomyImaging anatomy The various imaging modalities used to

investigate the nervous system How normal structures appear in these

images How do abnormalities appear in these

images and how are they interpreted Usually for confirmation & to investigate the

extent of the lesion Include plain & contrast radiography, CT, PET

& MRI

IssuesIssues

Introduction Background knowledge Imaging Anatomy Interviewing Physical examination

InterviewingInterviewing Part of the consultation framework Has two purposes

The establishment & building of rapport Information gathering

Has agreed upon content & techniques Practitioners need to acquire certain

communication skill to apply the techniques

Include interpersonal skills & language skills (e.g. active listening)

Clinical EncountersClinical Encounters

Primary health care facilities

Hospitals Casualty (A & E – ER) Outpatient clinics Wards

Private clinics

The first encounterThe first encounter

In the health centre In the A & E in the outpatient clinic In the ward In the private clinic

The clinical workupThe clinical workup

History taking (interviewing) Physical examination Investigations Management

Diagnosis Intervention (therapeutic & non-therapeutic)

Important ConceptsImportant Concepts

The patient-doctor relationship

The patient-centered approach

The illness-centered approach

The Patient-centred/illness-centredThe Patient-centred/illness-centred

Focuses on: Their ideas about what is wrong with them Their feelings, especially fears about being ill The impact of their problems on functioning Their expectations about what should be done

About the EncountersAbout the Encounters

The content (what you should do)

The process (how to do) The rationale (why) The skills & the protocols

The frameworkThe framework

Initiating the session Gathering Information Physical examination Explanation & planning Closing the session

The frameworkThe framework

Providing structure Building the relationship

The Communication SkillsThe Communication Skills

The Communication SkillsThe Communication Skills

IssuesIssues

Introduction Background knowledge Imaging Anatomy Interviewing Physical examination

The balanceThe balance

Neurological examination by the internist1

General examination by the neurologist2

Neurological ExaminationNeurological Examination

Mental status Sensory examination Motor examination Examination of the cranial nerves