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LESSON 1. MOVEMENT SYSTEM.

QUESTIONS

1) How many neurons are included into the corticospinal tract?

2) What is the other name of the corticospinal tract?

3) Why is the corticospinal tract called as the pyramidal?

(2 variants).

4) Where is a cortex centre of the movement system located?

5) What anatomical features are there in the cortex exposition of the body and limbs in the precentral gyres?

6) Describe the anatomical way of the upper motoneuron.

7) Describe the pathways of the lower motoneuron.

8) Where is a crossing of both corticospinal tracts located?

9) Which structures of the lower motoneuron lead the nerve roots to the segments of the spinal cord?

10) Which structures of the lower motoneuron lead the nerve roots to the limbs and body?

11) Which segments of the spinal cord lead the nerve roots to the muscles of the head and neck? Which segments of the spinal cord lead the nerve roots to the muscles of the shoulder girdle and upper extremities?

12) Which segments of the spinal cord lead the nerve roots to the muscles of the body?

13) Which segments of the spinal cord lead the nerve roots to the muscles of the pelvis girdle and lower extremities?

14) Where is the centre of an autonomic innervation?s of a bladder and bowel located?

15) Which pathological sings are positive?

16) Which pathological sings are negative?

17) What complex of signs and symptoms include a clinical picture of the upper motoneuron paralysis?

18) What complex of signs and symptoms include a clinical picture of the lower motoneuron paralysis?

19) Describe the precentral gyres syndrome.

20) What signs of damage are present in subcortical structures? Describe the difference between the damage of corona radiate and internal capsule of the damage of the brainstem.

21) Describe the characteristic signs of disturbances on the level C1-C4.

22) Describe the characteristic signs of disturbances on the level C5-C8.

23) Describe the characteristic signs of disturbances on the level Th1-Th12.

24) Describe the characteristic signs of disturbances on the level L1-L4.

25) Describe the characteristic signs of disturbances on the level L5-S2.

26) What are the types of epileptic seizures, which are present in precentral gyres syndrome? What kinds of seizures develop in this syndrome?

27) Describe the epicones syndrome.

28) Describe the cones syndrome.

29) What is the difference between central and peripheral types of the bladder and bowel dysfunctions?

Task 1.

Two hours prior to admission to the emergency ward a 52 year- old man developed right arm, hand and leg weakness. At the time of examination, dysphasia and right face drooping were noted. Over the ensuing hour the patient became obtunded, areflexic on the right side, and completely unable to lift the right arm against gravity. The physical exam added no new information.

● What syndrome is revealed in the patient?

● What structures are involved?

● Where is the focus of the lesion?

Task 2.

A 65 year-old man complained of weakness in the right arm. For 3 months he had been dropping objects, and it was gradually getting worse. There were no sensory symptoms. On exam, the patient was mildly confused and speech was slow and slurred. The right nasolabial fold was flat. Muscle bulk was normal. No fasciculations were seen. Rapid passive movements of the right arm or leg met with resistance which would give way ("clasp-knife"). Strength was minimally diminished in the right intrinsic hand muscles, the wrist dorsiflexors, triceps, deltoids, iliopsoas, hamstrings and tibialis anterior. A right pronator drift was observed. Finger movements were slow on the right. The right leg circumducted while walking. Reflexes were hyperactive on the right. The right plantar response was extensor. Sensation to touch, pin, cool, vibration was normal. Two-point discrimination, point localization and graphesthesia were poorly done on the right in comparison with the left.

● List features of the clinical upper motoneuron and low motoneuron syndrome.

● What are possible sites of weakness in this case?

● Give a few etiological possibilities.

Task 2.

? 62 year old man complains of tremor of the right hand for six months. It began with an occasional tremor of the right thumb but has gradually spread to all fingers and is now continuous. He has also noticed that his handwriting has become smaller and more difficult to read. It is harder for him to use a toothbrush with the right hand and his wife must help him button the left shirt sleeve. She has observed that her husband occasionally drools and that his voice is softer. On examination, the patient is mentally normal but often responds slowly. The voice is soft and monotone. Facial expression and blink rate are diminished. He pushes off with his hands when arising from a chair and the gait is slowed with short steps and decreased arm swing on the right. There is a slow, resting tremor of the right hand which suppresses with maintenance of a posture. There is an occasional, asymptomatic tremor of the right foot. There is cogwheel rigidity in both upper extremities, the right more than left, with slowed repetitive movements of the right hand and foot.

-What is the diagnosis?

-Distinguish the following tremors: Parkinson's, Essential, Cerebellar.

-What is meant by "tone?" Distinguish flaccidity, spasticity, cogwheel rigidity, and paratonic ("lead-pipe") rigidity.

-What are the classical symptoms and signs of Parkinson's Disease?

Task 3.

You are asked to consult on a 35 year old woman hospitalized on the psychiatry service for evaluation of "muscle twitches." The patient is currently hospitalized for depression and anxiety. Further history reveals that the patient's work performance has declined over the past year associated with changes in personality and occasional poor judgment. The patient's family history reveals that her father died at age 50 in a nursing home of "Alzheimer's disease." The patient's paternal grandmother died in a mental institution of unclear cause. The patient's brother is described as being "restless." The patient's children are healthy. On examination, the patient is dysarthric and shows impaired memory and concentration on mental status testing. She has irregular "jerky movements," of the hands, feet, and trunk. These are rapid and non-stereotyped. The patient's saccades are slow but with full eye movements. There is a milkmaid's grip. The patient has an unusual gait disorder, placing the feet irregularly with a tendency to trip and demonstrate

"dancing like" movements.

● What type of hyperkinesia is in the patient?

● What is chorea? Be able to differentiate it from tremor, myoclonus, and dystonia.

● What neuroimaging finding is seen in Huntington's disease?

Lesson 2: Sensory system

QUESTIONS

1. Give the classification of receptors.
2. What does analysator mean?
3. Can you give the classification of sensation types?
4. What type of receptors is the first neuron of the tactile sensation?
5. What type of receptors is the first neuron of the pain sensation?
6. What type of receptors is the first neuron of the temperature sensation?
7. What type of receptors is the first neuron of the touch sensation?
8. What type of receptors is the first neuron of the proprioception?
9. How many neurons do the pathways of superficial sensation (pain- and temperature) have?
10. How many neurons do the pathways of deep sensation and tactile type of superficial sensation have?
11. Where is the crossing of the pathways for pain and temperature sensation located? What peculiarity does the way of pathways in this crossing have?
12. Describe the peculiarities of the presentation of the limbs and body in the spinothalamical tract. How can help this knowledge in differential diagnosis between pathological processes in spinal cord?
13. Where is the cortex centre of the different types of sensation located?
14. Describe the presentation of the limbs and body in precentral gyres.
15. Describe the methods of examination of different kinds of superficial sensations?
16. Describe the methods of examination of different kinds of deep sensations?
17. What does the complete sensation mean?
18. Give the classification of the types of sensations disorders?
19. What types of sensations disorders include the peripheral type?
20. What types of sensations disorders include the spinal type?
21. What types of sensations disorders include the central type?

22. What view does the area of presentation of hypo- or anesthesia in neural type of sensations disorder have?

23. What view does the area of presentation of hypo- or anesthesia in polyneural type of sensations disorder have?

24. What view does the area of presentation of hypo- or anesthesia in spinal conductive type of sensations disorder have?

25. What view does the area of presentation of hypo- or anesthesia in segmental spinal type of sensations disorder have?

Task 1.

A 55 year old right-handed man presented with a 4 hour history of weakness and tingling of his right hand and numbness of the right side of his mouth. Mild difficulty was experienced with word finding. Symptoms had improved since onset, but had not fully resolved. There was no significant past symptomatology.

Vital signs and general physical exam were normal. Mental status and speech were normal. Right nasolabial fold was flat relative to the left, but all other cranial nerve functions were intact. Subjective numbness was noted over the right distal hand, with errors exhibited in tests for two-point discrimination and graphesthesia. A mild right arm pronator drift and clumsiness of finger tapping in the right hand were observed. Reflexes were slightly more active on the right. The right toe was upgoing.

● What syndromes are revealed in the patient?

● Where is the likely focus of the lesion?

Task 2.

? 47 year-old right-handed man developed progressive numbness of both feet over a 6 month period. Recently, his fingertips started feeling numb. He described an unpleasant burning sensation. Weakness was denied.

On exam, mentation and cranial nerves were normal. There were no palpably enlarged nerves, nor high arches. Position and vibration sense were grossly diminished in the feet. Cool stimuli and pin were perceived, but there was a subjective stocking distribution of numbness to mid-calf bilaterally. Reflexes were absent at the ankles and diminished elsewhere. Strength was close to normal, except that he could not walk on his heels.

● What type of sensory disorder is there?

● Is there evidence for autonomic involvement? What points in the history and exam might be explored to test this?

Lesson 3 : Cranial nerves

Questions

1. How many portions have the facial nerve? Describe them.
2. How many knees have the facial nerve? Where are they located?
3. Where is the first neuron of the facial nerve located? Describe the presentation of the facial, tongue, swallowing and chewing muscles in the cortex centre of the facial nerve.
4. Describe the way of the secondary neuron of the facial nerve? Where are the many nucleus of the 7 par located?
5. What particularity have clinical picture of the damage of facial nerve on the difference anatomical levels?
6. Describe the basis points into the difference between central and peripheral facial paralyses.
7. Describe the clinical picture of the peripheral idiopathic paralysis of the facial nerve. What name has this type of plegia?
8. Present the methods of examination of the facial nerve.
9. What does the alternative paralysis mean? What kinds of alternative paralysis will be after damage in the pons develops?
10. How many portions have the vestibulocochlear nerve? Give they names.
11. What functional role has the cochlear portion of the vestibulocochlear nerve? Where are the receptors of this portion located?
12. What functional role has the vestibular portion of the vestibulocochlear nerve? Where are the receptors of this portion located?
13. Where is the cortex centrum of the vestibulocochlear nerve located? Describe the way of they pathways in thalamus and subcortical structures.
14. What type of dizziness will be after damage of the 8 par develop? Describe the other sings, which are after damage of the cochlear portion of the vestibulocochlear nerve develops.
15. What anatomical structures are the primer auditory centre derives?
16. Describe the basic function of the gloss pharyngeal and vague nerves.
17. Where are the nucleuses for bulbar group of nerves located?
18. What function has the vague nerve?
19. What signs are after damage of the vague nerve develops?
20. What signs can we see after damage of the gloss pharyngeal nerve?
21. What function has the accessories nerve?
22. When the bulbar paralyses are developing?
23. When the pseudo bulbar paralyses are developing? Describe the difference signs between bulbar and pseudo bulbar kinds of paralysis.
24. What group of the muscles is from accessories nerve innervated?
25. Describe the clinical picture after one siding damage of the accessories nerve.

Task 1.

A 50 year-old woman complained of dizziness when she moved her head when turning over in bed. She was otherwise well and without antecedent illness or medical history of note. Exam demonstrated transient torsional-vertical nystagmus after the patient quickly moved her head back with the right ear down.

● Give a general approach to the "dizzy patient". Begin with likely causes of dizziness.

● When is dizziness "vertigo". What are some important etiologies of vertigo?

● What studies can be done to clarify the etiology of vertigo?

● What is the most likely diagnosis in this case? How would you advise and treat the patient?

Task 2.

A 33 year-old woman slowly developed tinnitus and lost hearing in her left ear over a 2 year period. There were no other reported symptoms. Exam confirmed decreased acuity on the left, with air conduction greater than bone conduction bilaterally, and Weber lateralizing to the right ear. The left corneal reflex was diminished. A mild clumsiness and intention tremor was noted in the left hand.

● What is the differential diagnosis of hearing loss in one ear?

● What neural systems are impaired in this woman? What is the likely diagnosis?

Task 3.

A 63 year-old man presented to the emergency room because he was unable to see objects to his left. This came to his attention when he was sideswiped by a garbage truck in cross-traffic. On examination he had a left homonymous hemianopsia. Saccades could be made in all directions but smooth eye movements were interrupted by frequent saccadic eye movements. The remaining neurological exam was negative.

● What is the course of fibers from retina to occipital lobe?

● What is the significance of:

Homonymous hemianopia?

Heteronymous hemianopia?

3. Homonymous superior quadrantinopia?

● What is the significance of congruity in a field defect?

● What is the significance of the smooth pursuit defect in this case?

Task 4.

A 25 year-old R.N. suddenly notices that her left pupil is larger than her right (5 vs 3 mm).

● What is the pathway mediating the pupillary light reflex?

● What is the differential diagnosis of anisocoria?

● What is a "IIIrd nerve palsy"? A "Homer's Syndrome"? What do each signify?

Lesson 4: HIGHER PSYCHICAL FUNCTIONS.

QUESTIONS

1. Describe the cortex centre of the speech function. Give the definition of the expressive and impressive speech.
2. Give the definition of different central speech disorders.
3. Where is the motor speech centre located?
4. Where is the sensory speech center located?
5. What names do the different speech centers have?
6. Describe the methods of the examination of speech disturbances.
7. What signs develop after damage of the motor speech centre?
8. Give the definition of the motor aphasia.
9. What signs develop after damage of the sensory speech centre?
10. Give the definition of the sensory aphasia.
11. What does the conductive aphasia mean?
12. Where is the pathological process in conductive type of aphasia located?
13. What does the Brocas aphasia mean?
14. What does the Wernices aphasia mean?
15. Describe different types of apraxies.
16. Describe different types of agnosies.
17. Where is the cortex centre of the gnosis located? Describe the visual and auditory types of agnosies.
18. Describe the methods of examination of different types of apraxies.
19. Give the definition of praxis.
20. What lobe of the brain is dominant in righthanded people?
21. What complex of sign will develop after damage into the left frontal lobe?
22. What kinds of the paresis of the gaze will be after damage into frontal lobe develops?
23. Give the definition of the psychical disorder, which will develop after damage into the frontal lobe?
24. What complex of signs will develop after damage into the left temporal lobe?
25. Describe the special signs of the temporal epilepsy.
26. Describe the clinical picture that will develop after damage of the parietal lobe.
27. Give the description on the damage in occipital lobe.
28. Give the localization of the damage process in presentation of the astereognosis.
29. What complex of signs is develops after damage on the border between parietal, temporal and occipital lobes?

Task 1.

A 59 y/o right-handed man was brought to the emergency room because of sudden onset of disturbance of speech. On examination, he spoke spontaneously and excessively but conveyed little meaning. He used paraphrasias and neologisms. He could carry out only simple instructions. Naming, repetition, and reading were all impaired.

● Define "aphasia", "apraxia", "agnosia", "alexia", "agraphia".

● Describe Broca's vs. Wernicke's aphasia & usual lesion site.

● Give a description and pathophysiological explanation of a "disconnection syndrome".

Lesson 5 : VASCULAR DISEASE . STROKE. INFARCTION OF THE

Date: 2016-06-12; view: 51