Exam preparation
Medical Neuroscience & Neuroanatomy
Lectures and literature
Inhoudsopgave
Lecture 1 & Chapters 1,2 and relevant pages of 10, 12 ..................................................................................... 3
General history and physical exam .................................................................................................................... 3
Hemiparesis vs. paralysis ................................................................................................................................... 3
Hearth arrythmia................................................................................................................................................ 4
Arteries ............................................................................................................................................................... 5
Embryological of the central nervous system ..................................................................................................... 5
White vs. Gray matter ......................................................................................................................................... 9
Anatomical organization: various ways of subdividing the nervous system .................................................... 11
Lesion vs. Hand ................................................................................................................................................ 11
Short Summary ................................................................................................................................................. 11
Stretch reflex .................................................................................................................................................... 12
Lecture 2 & Chapter 6 ........................................................................................................................................ 12
Somatic versus autonomic nervous system ....................................................................................................... 12
Parkingson disease ........................................................................................................................................... 14
Important terms ................................................................................................................................................ 15
Pyramidal or extrapyramidal systems (motor functions) ................................................................................. 16
Ascending motor pathway ................................................................................................................................ 19
Tentorial Herniation ........................................................................................................................................ 20
Coma ................................................................................................................................................................ 21
Primary, secondary and tertiary areas (association cortices) ......................................................................... 21
Lecture 3 & Chapter 7 and 10............................................................................................................................ 22
Motor vs. somatosensory cortical areas ........................................................................................................... 22
Internal capsule ................................................................................................................................................ 22
Blood vessels .................................................................................................................................................... 22
Figures + tables for exam ................................................................................................................................ 25
Neurons ............................................................................................................................................................ 26
Neurotransmitters............................................................................................................................................. 26
Four different basic system sorts of metabolism of neurotransmitters ............................................................. 27
4 types of receptors .......................................................................................................................................... 28
,Lecture 4 & Chapter 7, 12 and 13...................................................................................................................... 30
Neurophysiology............................................................................................................................................... 30
Psychogalvanic response or lie detector test ................................................................................................... 30
Nerve conduction influences ............................................................................................................................ 30
What can go wrong in motor nerve condition? ................................................................................................ 30
Clinical syndromes ........................................................................................................................................... 31
Needle examination .......................................................................................................................................... 31
Summary → Good reasons for an electromyographic test............................................................................... 32
Posturing and triple flexion .............................................................................................................................. 32
Signs of upper motor neurons and lower motor neuron lesions ....................................................................... 32
Functional neurological disorder..................................................................................................................... 33
How does pain work? ....................................................................................................................................... 33
Which fibers are transmitting pain? ................................................................................................................. 34
Pain Lamineas .................................................................................................................................................. 34
Somatosensory pathways .................................................................................................................................. 35
Examples of type of pain .................................................................................................................................. 36
Lecture 5 & Chapter 12, 13 and 14.................................................................................................................... 36
Pain pathways .................................................................................................................................................. 36
Pain suppression: gate control theory (spinal cord level) + music ................................................................. 37
Descending pathways ....................................................................................................................................... 37
Ascending Reticular Activating System (ARAS) ............................................................................................... 38
Locked-in syndrome ......................................................................................................................................... 38
Cranial Nerves ................................................................................................................................................. 39
Sleep ................................................................................................................................................................. 40
Consciousness .................................................................................................................................................. 43
Nice picture to know ........................................................................................................................................... 45
, Lecture 1 & Chapters 1,2 and relevant pages of 10, 12
General history and physical exam
The general history and physical exam (H&P) usually contain the following elements:
• The chief complaint (CC)
• History of the present illness (HPI)
• Past medical history (PMH)
• Review of systems (ROS)
• Family history (FHx)
• Social and environmental history (SocHx/EnvHx)
• Medications and allergies
• Physical exam
• Laboratory data
• Assessment and plan
Hemiparesis vs. paralysis
Patient with stroke (infarction or hemorrhage bleeding): can have both a pure hemiparesis
or an paralysis. The stroke can both be a cortical as well as a subcortical problem
Pure hemiparesis: paralysis of one part of the body. Weakness of muscles (CNS problem)
(NL: verlamming van een kant van je lichaam)
• Pure hemiparesis with no sensory loss?
Then we can exclude some hypothesis, like:
o Cortical lesion: unlikely because a cortical lesion would involve the entire
motor strip (nearby sensory strip), therefore there is a high risk for sensory
involvement
(NL: hersenschors bedenkt veel kwabben, waaronder de hele motorstrip)
o Peripheral lesion: unlikely because the olfactory nerve and the opticus nerves
are peripheral, therefore the whole face would be affected as well as the
entire half of the body
(NL: hierbij zou het gezicht dus aangedaan moeten zijn)
o Medulla and the spinal cord are affected: unlikely because the face would be
spared and with pure hemiparesis half of the face is affected (only the lower
part of the face) The upper part of the face is controlled by the ipsilateral and
contralateral side. So, one side can take over the functions of the other side
(NL: als de medulla en ruggengraat geraakt zijn, is het gezicht ook vaak
aangetast)
o No sensory loss with pure hemiplegia is not very common
We can also include some areas:
o More likely to have sensory problems if you have a stroke near the motor
cortex, because the somatosensory cortex is nearby
So it could be in the following areas: this region motor systems come close together,
face also has bilateral branch so upper half will be ok
o Corticospinal/pyramidal tract (large motor systems) and corticobulbar
o Contralateral: on the other side
, Paralysis: paralysis of the whole body. Complete loss of muscle strength (CNS problem)
(NL: complete verlamming)
NOTE: if paresis or paralysis would be a PNS problem, alle the nerves would have to be
affected individually. It is a CNS problem because all nerves are affected at once!
Hearth arrythmia
Middle cerebral artery: if the blood clot arrives in the middle arteria, it will affect the arm
more then the leg because the middle arteria also receives blood from the anterior arteria
Anterior cerebral artery: if the blood clot arrives in the anterior arteria, it will close it up,
therefore the area behind it will fall out and produce an edema (pressure on the brain), in
the first 24u people try to eliminate/remove as much as possible from the edema. When this
doesn’t exceed it causes an infarct (NL: afsterven van weefsel). Here the leg is more affected
then the arm
Medical Neuroscience & Neuroanatomy
Lectures and literature
Inhoudsopgave
Lecture 1 & Chapters 1,2 and relevant pages of 10, 12 ..................................................................................... 3
General history and physical exam .................................................................................................................... 3
Hemiparesis vs. paralysis ................................................................................................................................... 3
Hearth arrythmia................................................................................................................................................ 4
Arteries ............................................................................................................................................................... 5
Embryological of the central nervous system ..................................................................................................... 5
White vs. Gray matter ......................................................................................................................................... 9
Anatomical organization: various ways of subdividing the nervous system .................................................... 11
Lesion vs. Hand ................................................................................................................................................ 11
Short Summary ................................................................................................................................................. 11
Stretch reflex .................................................................................................................................................... 12
Lecture 2 & Chapter 6 ........................................................................................................................................ 12
Somatic versus autonomic nervous system ....................................................................................................... 12
Parkingson disease ........................................................................................................................................... 14
Important terms ................................................................................................................................................ 15
Pyramidal or extrapyramidal systems (motor functions) ................................................................................. 16
Ascending motor pathway ................................................................................................................................ 19
Tentorial Herniation ........................................................................................................................................ 20
Coma ................................................................................................................................................................ 21
Primary, secondary and tertiary areas (association cortices) ......................................................................... 21
Lecture 3 & Chapter 7 and 10............................................................................................................................ 22
Motor vs. somatosensory cortical areas ........................................................................................................... 22
Internal capsule ................................................................................................................................................ 22
Blood vessels .................................................................................................................................................... 22
Figures + tables for exam ................................................................................................................................ 25
Neurons ............................................................................................................................................................ 26
Neurotransmitters............................................................................................................................................. 26
Four different basic system sorts of metabolism of neurotransmitters ............................................................. 27
4 types of receptors .......................................................................................................................................... 28
,Lecture 4 & Chapter 7, 12 and 13...................................................................................................................... 30
Neurophysiology............................................................................................................................................... 30
Psychogalvanic response or lie detector test ................................................................................................... 30
Nerve conduction influences ............................................................................................................................ 30
What can go wrong in motor nerve condition? ................................................................................................ 30
Clinical syndromes ........................................................................................................................................... 31
Needle examination .......................................................................................................................................... 31
Summary → Good reasons for an electromyographic test............................................................................... 32
Posturing and triple flexion .............................................................................................................................. 32
Signs of upper motor neurons and lower motor neuron lesions ....................................................................... 32
Functional neurological disorder..................................................................................................................... 33
How does pain work? ....................................................................................................................................... 33
Which fibers are transmitting pain? ................................................................................................................. 34
Pain Lamineas .................................................................................................................................................. 34
Somatosensory pathways .................................................................................................................................. 35
Examples of type of pain .................................................................................................................................. 36
Lecture 5 & Chapter 12, 13 and 14.................................................................................................................... 36
Pain pathways .................................................................................................................................................. 36
Pain suppression: gate control theory (spinal cord level) + music ................................................................. 37
Descending pathways ....................................................................................................................................... 37
Ascending Reticular Activating System (ARAS) ............................................................................................... 38
Locked-in syndrome ......................................................................................................................................... 38
Cranial Nerves ................................................................................................................................................. 39
Sleep ................................................................................................................................................................. 40
Consciousness .................................................................................................................................................. 43
Nice picture to know ........................................................................................................................................... 45
, Lecture 1 & Chapters 1,2 and relevant pages of 10, 12
General history and physical exam
The general history and physical exam (H&P) usually contain the following elements:
• The chief complaint (CC)
• History of the present illness (HPI)
• Past medical history (PMH)
• Review of systems (ROS)
• Family history (FHx)
• Social and environmental history (SocHx/EnvHx)
• Medications and allergies
• Physical exam
• Laboratory data
• Assessment and plan
Hemiparesis vs. paralysis
Patient with stroke (infarction or hemorrhage bleeding): can have both a pure hemiparesis
or an paralysis. The stroke can both be a cortical as well as a subcortical problem
Pure hemiparesis: paralysis of one part of the body. Weakness of muscles (CNS problem)
(NL: verlamming van een kant van je lichaam)
• Pure hemiparesis with no sensory loss?
Then we can exclude some hypothesis, like:
o Cortical lesion: unlikely because a cortical lesion would involve the entire
motor strip (nearby sensory strip), therefore there is a high risk for sensory
involvement
(NL: hersenschors bedenkt veel kwabben, waaronder de hele motorstrip)
o Peripheral lesion: unlikely because the olfactory nerve and the opticus nerves
are peripheral, therefore the whole face would be affected as well as the
entire half of the body
(NL: hierbij zou het gezicht dus aangedaan moeten zijn)
o Medulla and the spinal cord are affected: unlikely because the face would be
spared and with pure hemiparesis half of the face is affected (only the lower
part of the face) The upper part of the face is controlled by the ipsilateral and
contralateral side. So, one side can take over the functions of the other side
(NL: als de medulla en ruggengraat geraakt zijn, is het gezicht ook vaak
aangetast)
o No sensory loss with pure hemiplegia is not very common
We can also include some areas:
o More likely to have sensory problems if you have a stroke near the motor
cortex, because the somatosensory cortex is nearby
So it could be in the following areas: this region motor systems come close together,
face also has bilateral branch so upper half will be ok
o Corticospinal/pyramidal tract (large motor systems) and corticobulbar
o Contralateral: on the other side
, Paralysis: paralysis of the whole body. Complete loss of muscle strength (CNS problem)
(NL: complete verlamming)
NOTE: if paresis or paralysis would be a PNS problem, alle the nerves would have to be
affected individually. It is a CNS problem because all nerves are affected at once!
Hearth arrythmia
Middle cerebral artery: if the blood clot arrives in the middle arteria, it will affect the arm
more then the leg because the middle arteria also receives blood from the anterior arteria
Anterior cerebral artery: if the blood clot arrives in the anterior arteria, it will close it up,
therefore the area behind it will fall out and produce an edema (pressure on the brain), in
the first 24u people try to eliminate/remove as much as possible from the edema. When this
doesn’t exceed it causes an infarct (NL: afsterven van weefsel). Here the leg is more affected
then the arm
