Neurology Undergraduate Teaching and Learning

A suggested

Neurology Curriculum for

Undergraduate Students

Prince Salman Bin Abdel Aziz University Medical School

clinic 2

Neurology for Undergraduate Students

Provide the student with necessary knowledge to:

1. Recognize a patient with a neurological problem. 2. Evaluate the common neurological presenting symptoms and signs. 3. Recognize the common neurological disorders. 4. Manage the common neurological disorders using medical therapy, referral to neurosurgery or physiotherapy as appropriate. 5. Recognize neurological emergencies and initiate treatment. 6. Be familiar with care of neurological disability.

OBJECTIVES

By the end of the course each student should have learned the basis of the following:

Skills

1. Take a neurological history. 2. Examine the nervous system appropriate to the clinical problem. 3. Describe the likely site of the neurological problem. 4. Formulate a differential diagnosis. 5. Plan a logical sequence of investigations to confirm a final diagnosis. 6. Interpret the results of investigations ordered. 7. Develop a management plan. 8. Follow-up of patient.

Knowledge

1. Have a broad knowledge of the common neurological disorders, their prognosis, and their treatment. 2. Be able to recognize neurological emergencies and their management.

Methods of teaching

Combination of didactic material and clinical training

The didactic component composed of: 1. Lectures 2. Case discussions 3. Practice questions 4. Small discussion groups 1 2

The clinical training component includes obtaining clinical skills for diagnosis and management of neurologic disorders. . Students are expected to develop practical skills including: clinical history, neurological examination, diagnostic procedures and management in outpatient and inpatient settings.

Topics

1. Lecture 1  Introduction to Neurology;  Components of the nervous system, brain and spinal cord anatomy and physiology, neurons, peripheral nervous system, autonomic nervous system, meninges and cerebrospinal fluid (CSF)  Neurological History: Common neurologic symptoms, interpretation of symptoms.

2. Lecture 2: Neurological Examination:  General  Cranial nerves  Motor examination  Sensory examination 4. Lecture3: Diagnostic procedures for neurologic disorders  lumbar punctures (LP’s)  Neuroimaging, including CT, MRI  Angiography  Neurophysiology: EEG’s  Myography  Nerve conduction testing

3. Lecture 4:  Blood Supply to the nervous system  Cerebro-vascular disorders

4. Lecture 5: Meninges and ventricular system:  Meninges & Cerebrospinal Fluid (CSF)  Meningitis  The Ventricular System  Raised intra-cranial pressure  Hydrocephalus

5. Lecture 6: Cranial nerves:  Anatomy and functions of cranial nerves  Cranial nerves disorders

6. Lecture 7 :  Anatomy of the spinal Cord & its nerves  Ascending somatosensory Pathways 2 3

 Disorders of the Ascending Pathways: Syringomyelia; Herpes Zoster  Multiple sclerosis

7. Lecture 8:  The Descending Motor Pathways  Symptoms of LMN and UMN Damage  UMN and LMN disorders  Spinal cord compression  Paraplegia, hemiplegia

8. Lecture9:  Basal ganglia  Extrapyramidal motor system disorders  Parkinsonism  9. Lecture 10  The cerebellum or corpus striatum  Cerebellar disorders  Huntington's Disease  The autonomic nervous system  10. Lecture 11  Peripheral nerve disorders  Neuropathies  Radiculopathies  Guillain-Barre Syndrome  11. Lecture 12  Muscle disorders and myopathies  Motor neurone disease  Myasthenia gravis

12. Lecture 13:  Neurology of Pain Perception  Headache syndromes

13. Lecture 14  Frontal lobe  Parietal lobe  Temporal Lobes & Limbic System  Dementias including Alzheimer’s disease  Memory disorders

14. Lecture 15: 3 4

 Seizures Disorders  Epilepsy  Focal lesions of the nervous system  CNS tumors

Examination skills

Students should be able to examine all aspects of the nervous system and can approach the clinical problem. They should have learned to provide differential diagnosis and plan logical sequence of investigations to arrive at a final diagnosis.

Objectives

1 Examination of gait To be able to analyze the gait so as to identify abnormalities due to Parkinson’s disease, hemiparesis, spastic paraparesis, myopathy and peripheral neuropathy.

2 Cranial nerve examination To be able to describe the basic anatomy and function of each cranial nerve and be able to examine them in a logical sequence including:  visual acuity and fields  ophthalmoscopy of the optic disc and retina  eye movements and pupillary reflexes  corneal reflex  facial strength  gag reflex

3 Examination of the limbs

To be able to describe the basis of the anatomy of the major afferent and efferent pathways in the spinal cord, the spinal roots and peripheral nerves. To be able to identify patterns of impairment due to common brain, cord, spinal root, nerve or muscle disorders. To be able to inspect the limbs and examine power, tone, reflexes, co-ordination and sensation in a logical fashion to identify  Abnormal posture, involuntary movements, wasting and fasciculation  Spastic or rigid increase in tone  Exaggerated or diminished deep tendon reflexes  An extensor plantar response  Abnormalities in the two major somatic sensory systems

4 Higher cortical function

To be able to describe the anatomical site of specific brain activities regulated in the frontal, parietal, temporal and occipital lobes and the clinical presentation of regional deficits. 4