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Ministry of Public Health of Ukraine Ukrainian Medical Stomatological Academy Ministry of Public Health of Ukraine Ukrainian Medical Stomatological Academy Approved At the meeting of the department of neurological diseases with neurosurgery and medical genetic "__"__ ____________20___ Protocol №________ Head of department _______________ prof. Delva M.Yu. METHODICAL INSTRUCTIONS FOR THE INDEPENDENT WORK OF STUDENTS FOR PREPARATION TO PRACTICAL CLASSES AND DURING PRACTICAL CLASSES Academic subject Neurology The module № 1 General neurology Topic Syndromes of defeat oculomotor nerves. Pathology of olfactory and visual analyzers. Year of study IV Faculty Foreign Students Training (Medicine) Poltava 20___ 1.Relevance of the topic: the olfactory and visual analyzers play a role in receptor function of the nervous system. With the functions of these disorders analyzers, as well as with oculomotor disturbances faced by doctors of different specialties - neurologists, ophthalmologists, neurosurgeons, pediatricians, phthisiatricians, endocrinologists, internists. Violations of the functions of these analyzers is observed in a variety of inflammatory, demyelinating processes, tumors, trauma, endocrine disorders. The correct methodological approach to the study of functions, pathological changes of the olfactory and visual analyzers, oculomotor nerves makes it possible to deliver topical and clinical diagnosis and treatment in a timely manner. 2. Specific Objectives: To investigate the function of I, II, III, IV, VI pairs of cranial nerves, identify signs of a lesion of the nerve disorder Examine the identification functions I, II, III, IV, VI pairs of cranial nerves and set the topical diagnosis. To treat the symptoms obtained during examination of the patient. 3. Basic knowledge, abilities, skills, necessary for a study themes (interdisciplinary integration) Disciplines To know Able 1. Base level of preparation (previous disciplines) Normal structure of I, II, III, IV, VI pair of On plaster casts and charts to show the anatomy cranial nerves barrel of cerebrum, place of finding of kernels of I, II, III, IV, VI pair of cranial nerves and their counterfoils Histology Histological information about the Microscopically to distinguish motive, structure of kernels, counterfoils and sensible, vegetative kernels, counterfoils nerves of I, II, III, IV, VI pair of I, II, III, IV, VI pair of cranial nerves Normal Functions olfactory, optic analyzers, To draw charts olfactory, optic analyzers, physiology oculomotor nerves reflex arc of pupil reflex 2. Next disciplines Neuro-surgery Pathology of I, II, III, IV, VI pair of To find out the symptoms of defeat of I, II, cranial nerves at by volume III, IV, VI pair of cranial nerves at the processes in an area to the barrel of tumours of barrel of brain, cranial-cerebral brain, cranial-cerebral traumas traumas Infectious Pathology of I, II, III, IV, VI pair of To find out the symptoms of ekso- and diseases cranial nerves, at infectious endophthalmus, myosis and mydriasis, diseases with the defeat of the cross-eye, to conduct perimetriya, nervous system ophthalmoplegia Eye illnesses Pathology of I, II, III, IV, VI pair of To find out pathology IX, X pair of cranial cranial nerves, types of nerves for patients with the tumours of hemianopsia, changes of an eye pharyngx, paresises of larynx, vocal bottom at illnesses of CNS connection 3. Intrasubjects integration Tumours of Simpomi of defeat of I, II, III, IV, To find out the level of defeat of I, II, III, CNS VI pair of cranial nerves for IV, VI pair of cranial nerves at brain- patients with tumours main growths, to define the syndrome of intracranial pressure Infectious Pathology of I, II, III, IV, VI pair of To find out symptoms and level of defeat diseases of the cranial nerves at the infectious of I, II, III, IV, VI pair of cranial nerves at nervous system diseases of the nervous system an encephalitis, meningitis Vascular Signs of defeat of I, II, III, IV, VI To find out symptoms and level of defeat diseases of pair of cranial nerves at of I, II, III, IV, VI pair of cranial nerves cerebrum cerebrovascular pathology for patients with violations of cerebral circulation of blood 4. Tasks for independent work during preparation for the lesson and on the lesson. 4.1 A list of key terms, parameters, characteristics which the student needs to learn while preparing for the class: № Term Definition Anosmia Complete loss of sense of smell Hyposmia Reducing the sense of smell Amaurosis Blindness Amblyopia Reducing the vision Hemianopsia Defect half of the visual field of each eye Scotoma Visual field defect, which does not merge with its peripheral border Photopsia The appearance the field of view of twinkling lightning Ptosis Omission of the upper eyelid Mydriasis Pupil dilation Myosis Pupillary constriction Diplopia Double vision objects Convergence Reduction of both eyes on close objects Accommoda- Changing the curvature of the lens when viewing objects at different tion distances Ophthalmo- Paralysis of the eye muscles plegia 4.2. Theoretical questions to the lesson: 1. Name the location place of olfactory and visual analyzers receptor 2. What are the subcortical centers of smell and sight. 3. Name the cortical centers of smell and sight. 4. What is anosmia, hyposphresia, dysosmia, scents agnosia? At what level of destruction of the olfactory analyzer they are observed? 5. What is the structure of visual analyzer? 6. What methods of investigation functions of the visual analyzer? 7. What are amaurosis, amaurosis, hemianopsia, visual agnosia? 8. Name the cranial nerves, which take part in the innervation of the eyeball. 9. Describe the symptoms of lesions of the oculomotor, and diverter block nerves. 10. Describe the symptoms of defeat the sympathetic and parasympathetic innervation eyes. 11. What are the signs of alternating syndroms Weber, Fovilya. 12. What syndromes violation of pupillary reactions. When they meet? 13. Describe the clinical picture of lesions of the cortical and brainstem centers sight. 4.3. Practical work (tasks) that are executed on lesson: 1. Study Group functions oculomotor nerve (ptosis, strabismus, anisocoria, convergence). 2. The study attributes the defeat of the sympathetic innervation of the eye (ptosis, miosis, enophthalmos). 3. Investigation of smell. 4. Investigation of visual acuity. 5. The study of color perception. 6. The study of visual fields. Topics content Chart 1 Vegetative innervation of eye and symptoms of its violation Department of the Even defeats Symptoms vegetative nervous system Likable - ciliospinal center (lateral horns of Syndrome of Bernara-gornera: S8-D1) - ptosis - neck likable knots - myosis - likable interlacement of internal - enophthalmus sleepy, eye arteries - violation of innervation of m.dalatator pupillae, tarsalis superior, m.orbitalis Parasimpatic - kernels of Yakubovicha - paralysis of accommodation - parasympathetic fibres of - midriasis oculomotor nerve - absence reaction of pupil on - innervation of m.sphincter pupilae, light m.ciliaris Count of logical structure Groups oculomotor cranial nerves I. Nerves Oculomotor Trochlearis Abducens Sympathetic II. - Muscles which Lifting eyelip innervation Overhead slanting Superior obliqus External direct Orbital Extending Tarsalis Overhead directpupil Constrictor of pupil Lower direct Internal direct Lower slanting Narrowing a pupil Akomodation III. - Signs Ptosis Cross-eye Cross-eye Enophthalmus defeat Cross-eye Diplopiya Ptosis Diplopiya Miosis Paresis of convergence Midriasis Absence pupilar reflex IV. – Methods of Width of eye cracks research Pupils, reactions of pupils Motions of eyeballs Convergence Cross-eye Eno- ,exophthalmus V. - Clinical syndromes Complete ophthalmoplegy Internal ophthalmoplegy External ophthalmoplegy Syndrome of Ardzhil-Robertsona Syndrome of overhead orbital crack Syndrome of Gornera Alternative syndromes: Vebera, Fovilya Paralysis of look Count of logical structure Visual and olfactory analyzers І. Nerves Opticus Olfactory II. Symptoms of defeat Amavrosis Anosmia Nasal gemianopsiya Homonimus gemianopsiya Olfactory Gemianopsiya quadrant hallucinations Fotopsiya Visual agnozia Disk atrophy n. opticus Stagnant disk Neuritis n. opticus ІІІ. Methods Sharpness of vision Recognition of research colours smells Eyeshots Eye bottom Chart 2 Innervation of vision and its disorders Centers of A crust center of turn of chairman and eyes Bridge center of vision vision is in an opposite side Pathology Impossibility of turn of eyes in an opposite Paresis of vision in the side of cell, side (paresis of vision) eyes, look in an opposite from a cell Eyes «vision at a pathological hearth» side, on the paralysed extremities Cranial Nerves Olfactory System (CN I) The olfactory pathway(4.7 and 4.8) is composed of the olfactory epithelium of the nose, the fila olfactoria (olfactory nerve = CN I), the olfactory bulb and tract, and a cortical area (the paleocortex) extending from the uncus of the temporal lobe across the anterior perforated substance to the medial surface of the frontal lobe under the genu of the corpus callosum. The olfactory epithelium occupies an area of about 2 cm2 in the roof of each nasal cavity, overlying portions of the superior nasal concha and of the nasal septum. It contains receptor cells, supportive cells, and glands (Bowman’s glands) that secrete a serous fluid, the so-called olfactory mucus, in which aromatic substances are probably dissolved. The sensory cells (olfactory cells) are bipolar cells whose peripheral processes terminate in the olfactory hairs of the olfactory epithelium.
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