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NEUROLOGY in Lectures (Selected Lectures)

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NEUROLOGY in Lectures (Selected Lectures) MINISTRY OF UKRAINE PUBLIC HEALTH I.Y. HORBACHEVSKYY TERNOPIL STATE MEDICAL UNIVERSITY Department of Neurology, Psychiatry, Science of Narcotics and Medical Psychology NEUROLOGY in lectures (Selected lectures) Ternopil TSMU Ukrmedknyha 2006 1 The redaction of Head of Department of Neurology, Psychia- try, Science of Narcotics and Medical Psychology Honoured Science and Technic Worker, d.m.s. prof. Shkrobot S.I. The authors of lectures: d.m.s. prof. Shkrobot S.I. , k.m.s. assoc. prof. Hara I.I. Literature redaction: Milevska L.S. It was approved by CMC (the report ¹ 4 28.05.2003) Reviewers: The Head of Department of Neurology, Lviv National Medical University d.m.s. prof. Pshyk S.S. The Head of Department of Neurology, Psychiatry and Medical Psychology Bukovinskyy State Medical University d.m.n. prof. Pashkovskyy V.M. Responsibility for this edition is on the Rector of I.Y. Horbachevskyy Ternopil State Medical University the Member of Ukrainian Academy of Medical Science prof. Kovalchuk L.Y. 2 CONTENS Introduction ..................................................................................... 4 Functions of nervous system. Conditioned and unconditioned reflexes. Motor system (symptomatic and topical diagnostics of movement disturbances) ................................................................................... 5 Sensation. Signs of sensation disturbances ...................................... 25 Extrapyramidal system and Cerebellum. The main anatomic and physiological data. Physiological functions and pathologic syndromes at lesion of cerebellum .................................................................... 51 Brain cortex. Localization of functions. Syndromes of brain lesion ... 68 The autonomic nervous system. Anatomy. Functions. The symptoms of lesion ........................................................................................ 84 Cerebrovascular diseases. Dynamic cerebral blood circulation disturbances .................................................................................. 94 Strokes ....................................................................................... 109 Meningitis .................................................................................... 131 Encephalitis ................................................................................. 151 Neurosyphilis ............................................................................... 170 Neurological signs of lumbar and cervical osteochondrosis. ........... 181 Peripheral neuropathies. Neuritis. Neuralgia. Polyneuritis. ............. 197 Demyelinating diseases ................................................................. 209 Amyotrophic Lateral Sclerosis. Syringomyelia. ............................. 220 Brain tumors and spinal tumors ..................................................... 232 Epilepsy and convulsion syndromes .............................................. 253 Hereditary diseases of nervous system .......................................... 262 Additionals....................................................................................302 References .................................................................................. 316 3 Introduction Nowadays one of the main conditions of higher medical establishments activity is teaching of English speaking foreign students. As there is a problem of this process methodical equip- ment, such as English Neurology textbook according to the study- ing program, the staff of I.Y. Horbachevskyy Ternopil State Medi- cal University Neurology Department has prepared English sylla- bus Neurology in lectures under the editorship of prof. Shkrobot S.I. It reckons in the existing differences between studying programs in English speaking countries and Ukraine, some differences in the names of diseases and classification. The syllabus includes certain lectures of propaedeutics and special neurology for the students of medical faculty. All the data of anatomy, physiology of nervous system and propaedeutics of neurological pathology should be studied by the fourth year students of medical faculty for better understanding of topical diagnostics and neurological syndromes. All the diseases are described according to the X th international classification (1997). There are described different forms of the diseases, the peculiari- ties of the course of disease, diagnosis, modern methods of treat- ment, social and working rehabilitation and prevention of the dis- eases. In lectures of special neurology one can find the questions of etiology, pathogenesis and diagnosis of vascular, inflammatory and demyelinating diseases, brain tumors, peripheral diseases of ner- vous system, autonomic disorders, hereditary diseases, intoxica- tions and so on. A great attention is paid to urgent treatment of dynamic cerebral circulation disorders, strokes, inflammatory and demyelinating diseases of nervous system. The syllabus is printed according to the demands of Central methodical cabinet of higher medical education in Ukraine. 4 Functions of nervous system. Conditioned and uncon- ditioned reflexes. Motor system (symptomatic and topi- cal diagnostics of movement disturbances) Neurology as science Neuropathology (from Greek neuro nerve, pathos disease, logos science) is a part of clinical medicine, which is involved in nervous diseases and its role in pathology of other organs and sys- tems of human body. The main structural, functional, genetic and anatomic unit of nervous system is neuron nervous cell. Its main function is to ac- cept and carry out impulse. The main function of nervous system is unification and regu- lation of different physiological processes. That means that nervous system unites, integrates and subordinates all the 4 parts of human body and provides its connection with environment. The base of nervous system activity is reflex 5 principle. Reflex is a re- action of our organism to 2 various outside and inside effects. It is provided by nervous system. The reflex consists L 1 2-4 of afferent part (which ac- cepts information), central part (that keeps informa- 3 tion), and efferent part (that creates response). As a result we have a circle like structure receptor (primary informa- tion center) programme center executive appa- Fig. 1 Scheme of knee jerk reflex arch: 1. Receptors of nervous muscular cords ratus (fig. 1, 2). 2. Dorsal root ganglion of spinal cord All the reflexes can 3. Alfamotorneuron be divided into different 4. 5. The central neuron of Pyramidal tract 5 Fig. 2 Spinal effector mechanism (Frank H. Netter, M.D.) groups simple and complex, inborn and trained, conditioned and unconditioned. Unconditioned reflexes: 1. They are inborn ones. 2. They are phylogenetically old, that means they were formed in course of phylogenesis. 3. They are based on certain anatomic structures (segments of spinal cord or brain stem). 4. They exist even without brain cortex control. 5. They are inherited. 6 6. They can be regulated by brain cortex. 7. They are basis for the conditioned reflexes. Conditioned reflexes: 1. They are the result of the individual experience and are formed during ontogenesis. 2. They are unstable, that means they need constant support. 3. They arent based on certain anatomic structures. 4. They are fixed in brain cortex. There are such conditioned reflexes as speaking, writing, reading, calculation, practice. Neurology studies unconditioned reflexes. That helps evaluate the state of nervous system. Conditioned reflexes are studied by psy- chiatrists. Unconditioned reflexes are divided into such groups: • Superficial and deep. • Simple and complex. • Proprioceptive (stretch, periosteal, joint). • Exteroceptive (dermal, from mucose membrane). • Interoceptive (from mucose membrane of internal organs for ex- ample urination in case of internal sphincter irritation). In clinical practice we evaluate the following reflexes (fig. 3-8): The group of Reflex Muscles Nerves Segments reflex 1 2 3 4 5 Deep, M. orbicularis Trigeminal N (V) – Medulla Subeyesbrow periostal oculi Facial N (VII) oblongata and pons Superficial, M. orbicularis Trigeminal N (V) – Medulla Corneal (lid) from mucose oculi Facial N (VII) oblongata membrane and pons Jaw Jerk Trigeminal N (V) – (mandibular, Deep, M. masseter Mandibular N Medulla chin masseter) periosteal (sensory and oblongata (Bechterev’s) motor ) and pons Mm. Glossopharingeal Pharyngeal Superficial, constrictores N (IX) and Vagus Medulla from mucose pharyngis N (X) (sensory and oblongata membrane and others motor) 7 Ïðîäîâæåííÿ òàáë. 1 2 3 4 5 Glossopharingeal Palatal Superficial, Mm. N (IX) and Vagus Medulla (palatine) from mucose levatores N (X) (sensory and oblongata membrane velli palatini motor) Biceps Deep, M. Biceps Musculocutaneous C5-C6 stretch brachii N Triceps Deep, M. Triceps Radial N C7-C8 stretch brachii Mm. Radial Deep, pronatores Median N, (carporadial, periosteal flexores, Radial N, C5-C8 brachioradial) digitorum, Musculocutaneous brachiora- N dialis, biceps Scapulo- Mm. teres humeral Deep, major, (scapuloperios periosteal subscapu- Subscapular N C5-C6 teal) laris Upper Mm. trans- superficial Superficial, versus, obli- Intercostals Nn Th7-Th8 abdominal dermal quus, rectus abdominis Middle Mm. trans- superficial Superficial, versus, obli- Intercostals Nn Th9-Th10 abdominal dermal quus, rectus abdominis Lower Mm. trans- superficial Superficial, versus, obli- Intercostals Nn Th11-Th12 abdominal dermal quus, rectus abdominis Cremasteric Superficial, M.cremaster Genitofemoral
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