Neurology Neurology is the branch of medicine, the science of the causes, mechanism, the diagnosis and the treatment of the nervous system diseases. Neurology is based on neuroanatomy, neurophysiology, neurochemistry, neuropathology and genetics. The curriculum of the medical studies in neurology provides the opportunity to gain both theoretical and practical skills: the neurological examination, diagnosis and the treatment of the most common diseases of the nervous system and life-threatening cases. The realisation of the curriculum of neurology is one of the conditions essential to obtain the medical doctor certificate and is the basis of opening a specialisation in neurology. Teachers Dr n.med Beata Kukulska-Pawluczuk Dr n.med Magdalena Nowaczewska Lek. med. Wiktoria Rajczyk Dr n.med Piotr Rajewski Lek. med Adam Wiśniewski Syllabus I. Department of Neurology II. Head of the unit: dr hab. n. med. Barbara Książkiewicz, prof. UMK III. Faculty of Medicine, 5th year, 80 hours IV. Form of the classes: seminars 40h, classes 40h V. Form of crediting - exam VI. Principles course objective: credit, 5 p. ECTS VII. Topics of the course (detailed plan): 1. Physical examination, anamnesis, examination of the head and cranial nerves – examination technique and results interpretation. 2. Motor and coordinating system - Examination of upper and lower limbs - examination technique and results interpretation . - Defect of the motor system: spastic and flaccid syndrome. - Location of the injury and the size as well as character of the paresis. - General motility of the body within the scope of physiology and pathology. - Examination of the motor coordination - examination technique and results interpretation. - Role of the coordinating system. - Injury of the coordinating system and its reasons. - Parkinson disease and other disease of extrapyramidal system 3. Syndrome of increased intracranial pressure and consciousness disorders. - Syndrome of increased intracranial pressure and mechanism regulating the intracranial pressure. - Symptoms reflecting the syndrome of increased intracranial pressure and symptoms of cerebral shift. - Treating the syndrome of increased intracranial pressure. - Qualitative and quantitative consciousness disorders. Primary and secondary cerebral comas. Determining the degree of consciousness disorders. - Life threatening symptoms. Evaluation of circulatory system, respiratory system and renal disorders. - General examination. Neurological examination: character and location of the injury within the central nervous system. 4. Syndromes revealing injury of the spinal cord and caudal equine. - Syndrome of hemilateral and transverse core interval. - Extra-spinal and intra-spinal syndrome. - Conus medullaris and caudal equine syndrome. - Posterior-cordal syndrome. 5. Peripheral nervous syndrome. - Plexuses: brachial, lumbosacral. - Scope of innervation and symptoms of medial nerve, ulnar nerve, radial nerve, femoral nerve, sciatic nerve, common peroneal and tibial nerve damage. 6. Meningeal syndrome. - Symptoms of meningeal syndrome, mechanism underlying the above. - Technique used to examine meningeal symptoms. - cerebrospinal fluis examination – technique and results 7. Intracranial and spinal canal tumours. - Intracranial tumours: definition of intracranial tumour, division of tumours, general symptoms related with intracranial tumours, focal symptoms of intracranial tumours, histopathological forms. - Clinical symptoms and histopathological forms of spinal canal tumours. - Diagnostic tests, treatment. 8. Epilepsy, other paroxysmal conditions. - Epilepsy: classification of epilepsy, reasons of epilepsy, morphology of epileptic attacks. - Differentiating epilepsy from other conditions related with losing consciousness, EEG in epilepsy. - Status epilepticus - Treating epilepsy. 9. Cerebral stroke. - Definition of stroke, epidemiology, risk factors - Causes of ischemic and hemorrhagic strokes, subarachnoid haemorrhages. - Pathophysiology and pathomorphology of strokes. - Clinical symptoms concerning ischaemic strokes, hemorrhagic strokes and subarachnoid haemorrhages, additional tests, treatment. 10. Neuroinfections. - Clinical symptoms of meningitis and encephalitis. - Diagnostics and clinical differentiation of inflammation with viral, bacterial and tubercular aetiology. - Guillain-Barre syndrome. - Treatment of neuroinfections. 11. Spinal disorders. Neurological rehabilitation. - Sciatica syndrome, irritation and loss sciatica, high and low sciatica. - Etiology and clinical symptoms of sciatica and shoulder pain. - Sciatica of disc aetiology – clinical symptoms, location, differentiation. - Examining the patient with sciatica: subjective and objective symptoms. - Additional tests in patients with sciatica: radiological examinations, examination of the cerebrospinal fluid. 12. Multiple sclerosis, syringomyelia, sclerotic lateral atrophy. - Aetiology, clinical symptoms, diagnosis, treatment. 13. Headaches as an interdisciplinary problem. - Division of headaches. - Reasons and pathomechanisms of headaches. - Migraine, cluster headache, tension-type headache – aetiology, pathogenesis and treatment. - Neuralgia within the head with particular consideration of V nerve. 14. Dementia and disorders within higher activities of the nervous system. - Dementia: definition, aetiology, clinical symptoms, treatment. - Aphasia: definition, division, diagnostics. - Disorders related with other higher functions of the CNS. - Dysarthria. 15. Head injury - Commotio cerebri - concussion, cerebral contusion, extradural and subdural hematoma - Clinical symptoms , diagnostics and treatment. VII. Literature 1. Main book – Neurology and Neurosurgery Illustrated 5e Kenneth W. Lindsay Churchill Livingstone 01/10/2010 2. Additional book – neurological examination Neurological Examination Made Easy Geraint Fuller Churchill Livingstone 01/05/2008 3.Complementary book Netter's Neurology H.Royden Jones W.B. Saunders Company 01/10/2011 Rules and regulations The student has to be present on seminars and exercises in order to pass. During exercises assistant shall verify student’s preparation to classes on a regular basis by means of oral questions, whereas during the practical the student shall be obliged to show his skills to perform neurological examination. It is also required to write a medical history. The practical and theoretical (test) examination shall verify the effects of students’ learning efforts. The practical part of the test shall take part during the last block of the exercises. The assisting physician, a specialist in neurology shall indicate a patient for each student, and the student has to examine the patient, indicate deviations concerning the examination, propose local, etiologic, syndrome diagnosis, as well as differentiation and recommended treatment. The student elaborates medical history that is to be approved by the assistant. The assistant evaluates the ability to perform neurological examination, proper naming of abnormalities observed during the examination, accuracy of the initial diagnosis, perception concerning differentiation with other ailments of the nervous system. The theoretical part has a form of a test – 100 questions The first 45 questions are statements with 5 possible answers – the student has to indicate the most appropriate answer (a test of choice – 1 proper answer). The following 45 questions are statements with 4 possible answers – the student selects the answers he considers right (multiple choice test). The last 10 questions contain description of cases basing on which the student determines the most probable reason of the described ailment (a test of choice – 1 proper answer).