1. Cerebral hemisphere Diencephalon Brain stem Spinal cord

3. Neurology deals with the diagnosis and treatment of all categories of disease involving the nervous system which comprises 3 parts : 1) Central nervous systems Central nervous systems 2) peripheral nervous systemsperipheralnervous systems 3) autonomic nervous systems3) autonomic nervous systems,

4. Anatomy What are the basic anatomical components of the nervous system ?

5. Upper motor neuron sign == above ant. horn and cranial nuclei No wasting Weakness [UMN] No Fasculation Hypereflexia Hypertonia [clasp knife spasticity ] Wasting Weakness [LMN] Fasculation Hyporeflexia Hypotonia lower motor neuron sign == anterior horn or cranial nerve nuclei and below Clinical features differences between UMN and LMN lesion ?

6. FUNCTIONAL ANATOMY Types of cells includes: 1.Neurons 2.glial cells--- of 3 types I.Astrocytes I. structural framework II. control the biochemical environment around the neuron III. with the blood vessels forms the blood-brain barrier II.Oligodendrocytes I.formation and maintenance of the myelin sheath] inside the CNS III.Microglia[blood-derived mononuclear macrophages] 3.ependymal cells lining the cerebral ventricles Schwann cells : Peripheral neurons have axons invested in myelin made by Schwann cells which line the nerve axon [ OUTSIDE PNS

7. Cerebral hemispheres has four functionally specialised lobes 1. Frontal 2. parietal 3. Temporal 4. Occipital

8.  The brain stem 1. midbrain 2. pons 3. medulla oblengata

9. Brain stem 1-An important link between spinal cord and higher brain levels 2-relays motor and sensory impulses between other “higher” parts of the brain and spinal cord 3-Midbrain – eye movement control 4-Pons/Medulla Signal relay Involuntary functions Many cranial nerves

10.  Spinal cord : 31 different segments 1. cervical 2.Thoracic [dorsal] 3. lumber 4.Sacral 5. coccygeal The terminal portion of the spinal cord is called the conus medullarisconus medullaris The cauda equina (“horse’s tail”) the collection of nerves root at the end of the spinal cordcauda equina

11. Gray Matter –masses of neurons + Absence of myelin accounts for the gray matter of the brain – Cerebral Cortex White Matter - Myelinated neurons gives neurons a white appearance – inner layer of cerebrum

12. Physiology Who does the nerve impulse take place ?

13. THE GENERATION AND TRANSMISSION OF THE NERVOUS IMPULSE Synapse and synaptic terminal Nerve terminal AXON CELL BODY MYLEINE AXON 1.conduction through the nerve followed by 2.synaptic transmission Transmissions of information between different part of nervous system take place in 2 physiological steps

14. conduction [Nerve impulse] : E lectrical wave conducted along the nerve leading to transmission of information between neurons through generation and propagation of an action potential this is initiated by series of chemical transport of Na+ and K+ across the neuronal cell

15. Synaptic transmission : Entry of calcium causes release of the neurotransmitter across the synaptic cleft which binds to receptors on the post-synaptic membrane which depolarize the membrane and initiate an action potential in the postsynaptic structure. Neurotransmitter :are of 2 types Excitatory 1-Acetylcholine 2-Noradrenaline/ 3- adrenaline 4-Glutamate 5-Aspartate 6- 5-hydroxytryptamine Inhibitory 1)Gamma-aminobutyric acid (GABA 2)Glycine

16. Terms Agnosia: faulty identification of recognition of an object which cannot be explained by primary sensory deficit. Finger agnosia: :inability to identify and differentiate between his fingers

17. Astereognosia :inability to identify an object by palpation Bilateral astereognosia = tactile agnosia Visual agnosia :inability to identify an object by vision  Apraxia : loss of ability to execute previously learned skills; in patients with normal sensory, motor,cerebellar and extra pyramidal systems

18. Frontal lobe PersonalityDisinhibition Emotional controlLack of initiation Social behavior Antisocial behaviour Contra lateral motor controlhemiplagia Language[dominant lobe]Expressive dysphasia[dominant lobe] Micturition Incontinence OlfactionImpaired smell[anosmia] Apraxia of the left handDominant

19. Parietal lobe : non dominant Spatial orientation and Constructional skills 1.Apraxia[bilateral] 2.Tactile agnosia 3. Agraphaesthesia 4.Gerstman syndrom [Acalculia + agraphia+ Rt-Lt disorintation + finger agnosia ] 1) Constructional apraxia 2)Dressing apraxia 3)Neglect of contra lateral side [anasognosia] 4)Spatial disorientation 1.Focal sensory seizures 2.Contra lateral hemi sensory loss 3.Contra lateral homonymous 4.lower quadrantanopia 5.Asymmetry of OKN Dominant lobe Non dominant

20. Parietal: dominant: - Language - Calculation Dysphasia Contralateral hemisensory loss Focal sensory seizures Dyscalculia Astereognosis Dyslexia Agraphaesthesia Apraxia Contralateral homonymous Agnosia lower quadrantanopia Asymmetry of optokinetic nystagmus

21. Temporal: dominant = Auditory perception =Language = Verbal memory = Smell = Balance Receptive aphasia Dyslexia Amusia :non recognition of music Impaired verbal memory Contralateral homonymous upper quadrantanopia Temporal: non-dominant Auditory perception = Melody/pitch perception = Non-verbal memory = Smell = Balance Lesion leads to Impaired non-verbal memory Impaired musical skills (tonal perception) Contralateral homonymous upper quadrantanopia

22. Occipital Visual processing Visual inattention Visual loss Visual agnosia [dominant] Homonymous hemianopia (macular sparing)

23. Investigations : Electrophysiological EEG[electroencephalogram] EMG [electromyography ] NCS [nerve conduction study] evoked potential [visual, somatosensory,brainstem audatory ]  IMAGING CT [computerized tomography] MRI [magmatic resonant tomography] SPECT or PET ultrasound (Doppler or duplex scanning) MR angiography MR venography CT angiography  Laboratory CSF Oligoclonal band IgG index antibodies