Introduction to Clinical Skills: Lumbar Puncture Gregory Gruener, M.D. Department of Neurology.
Introduction to neurology
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Transcript of Introduction to neurology
Introduction toIntroduction to
Neurology Neurology
Prof. Mamun SarhanProf. Mamun SarhanHead of NeurologyHead of Neurology DepartmentDepartment
WHAT IS NEUROLOGY?
Neurology is the branch of medicine that deals with diseases of the nervous system.
Major divisionsMajor divisions
NervousNervousSystemSystem
CentralCentral nervousnervous systemsystem
PeripheralPeripheralnervousnervoussystemsystem
1.Cerebrum 2. Brain stem 3. Cerebellum
Intracranial part
Intracranial part
Spinal part
Spinal part
Spinal cord &
Cauda equina
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 part
Equilibrim Caloric and rotational chair
Cochlear part
Hearing Watch test, weber test
Motor cranial nervesN. Name Function Assessment
Ⅲ Oculomotor Motor to superior, inferior and medial recti; inferior oblique & levator palpebrae superioris
Ptosis, pupil, eye movements & 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 and trapezius
Elevaton of shoulders and neck rotation
Ⅻ Hypoglossal Motor to muscles of tongue Tongue movements
Mixed cranial nervesN. Name Function Assessment
V Trigeminal Muscles of mastication & sensations of face
Face sensations & power of muscles of mastication
VII Facial Muscles of facial expression & taste sensation in ant. 1/3 of tongue
Muscles of facial expression & taste sensation in ant. 1/3 of tongue
X Vagus Sensation and movements of Larynx, pharynx, thoracic and abdominal organs
Palatal and pharyngeal reflexes & movements of uvula
XII Glossopharyng-eal
Taste in post 2/3 of tongue & gen. sensation
Taste & general sensation and pharyngeal reflex
Cerebellum
• Behind the brain stem
• Formed of : medline vermis
two cerebellar hemispheres
• Composed of :
outer grey matter and inner
White matter
MBMB
PonsPons CC
MOMO
Superior peduncle connects cerebellum with midbrain. Middle peduncle connects cerebellum with pons. Inferior peduncle connects cerebellum with medulla oblongata
Cerebellar peduncles
lefthemisphere
righthemisphere
Hemispheres and vermis
Cerebellar hemispheres are the two bilateral structures.Vermis is the unpaired midline structure between
the two hemispheres.
vermis
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 equinaBrachial plexusLumbosacral plexusCervical enlargementLumbosacral enlargement
Peripheral nervous system
• A.H.Cs
• Roots
• Plexuses
• Peripheral nerves
Medulla
motor cortex
internal capsule
Uppermotorneuron
Lowermotorneuron
anterior horn cell
Motor pathway
UMNL LMNL
Tone Increased, with ‘clasp knife’ quality
Decreased
Clonus Present Absent Fasciculations Absent Present Muscle Wasting Absent, but disuse
atrophy eventually results
Present (within 2-3 weeks)
Tendon Reflexes Increased. Extensor plantar reflexes.
Decreased or absent. Flexor plantar reflexes.
Distribution Whole limbs, with more weakness in the upper limb extensors and lower limb flexors
Specific muscle groups affected (e.g. in the distribution of a spinal segment, or just the proximal muscles, etc.)
Thank You!!!