introduction to neurosciences to 4 th year medical students
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04/08/23 FOURTH YEAR LECTURE 1
AN INTRODUCTIONTO CLINICAL NEUROSIENCES
WALID MAANIPROFESSOR OF NEUROSURGERY
04/08/23 FOURTH YEAR LECTURE 2
IT IS VERY DIFFICULT TO DO
THIS IN ONE HOUR
04/08/23 FOURTH YEAR LECTURE 3
PRESENTATON OF CENTRAL NERVOUS
SYSTEM PROBLEMS
• HOW DO CRANIAL LESIONS PRESENT?
• HOW DO SPINAL PROBLEMS PRESENT?
04/08/23 FOURTH YEAR LECTURE 4
PRESENTATION OF CRANIAL LESIONS
THIS IS HOW THE INTRACRANIALCONTENTS ARE ARRANGED AS
SEEN ON MAGNETICRESONANCE
IMAGING (MRI)
T1 WEIGHTED MRI
VENTRICLE
SULCI
MIDLINE
CHOROID PLEXUS
04/08/23 FOURTH YEAR LECTURE 5
PRESENTATION OF CRANIAL LESIONS SUDDEN:
CEREBRO-VASCULAR ACCIDENTS INTRACEREBRAL HEMORRHAGE SUBARACHNOID HEMORRHAGE INFARCTION
TRAUMA RAPID:
INFECTION GRADUAL:
NEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 6
PRESENTATION OF CRANIAL LESIONSSUDDEN:
CEREBRO-VASCULAR ACCIDENTSINTRACEREBRAL HEMORRHAGESUBARACHNOID HEMORRHAGEINFARCTION
TRAUMARAPID:
INFECTIONGRADUAL
NEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 7
INTRACEREBRAL HEMORRHAGE
04/08/23 FOURTH YEAR LECTURE 8
INTRACEREBRAL HEMORRHAGE
MAY CAUSE DEATH MAY CAUSE LOC DESTRUCTION OF BRAIN
AREA
PRESENTS WITH: SUDDEN HEADACHE SUDDEN PARALYSIS SPEECH PROBLEMS SENSORY DISTURBANCES VISUAL DISTURBANCES
04/08/23 FOURTH YEAR LECTURE 9
PRESENTATION OF CRANIAL LESIONSSUDDEN:
CEREBRO-VASCULAR ACCIDENTSINTRACEREBRAL HEMORRHAGESUBARACHNOID HEMORRHAGEINFARCTION
TRAUMARAPID:
INFECTIONGRADUAL
NEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 10
SUBARACHNOID HEMORRHAGE
04/08/23 FOURTH YEAR LECTURE 11
SUBARACHNOID HEMORRHAGE
MAY CAUSE DEATH SUDDEN HEADACHE LOC EPILEPSY NECK RIGIDITY MAY BE ASSOCITAED
WITH PARALYSIS IF
ACCOMPANIED BYINTRACEREBRAL HEMORRHAGE
04/08/23 FOURTH YEAR LECTURE 12
PRESENTATION OF CRANIAL LESIONSSUDDEN:
CEREBRO-VASCULAR ACCIDENTSINTRACEREBRAL HEMORRHAGESUBARACHNOID HEMORRHAGEINFARCTION
TRAUMARAPID:
INFECTIONGRADUAL
NEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 13
INFARCTION
04/08/23 FOURTH YEAR LECTURE 14
INFARCTION
MAY BE ISCHAEMIC MAY BE HEMORRHAGIC MAY BE UN-NOTICED LOC EPILEPSY DESTRUCTION OF
BRAIN: PARALYSIS SPEECH PROBLEMS VISUAL PROBLEMS SENSORY PROBLEMS
04/08/23 FOURTH YEAR LECTURE 15
PRESENTATION OF CRANIAL LESIONSSUDDEN:
CEREBRO-VASCULAR ACCIDENTSINTRACEREBRAL HEMORRHAGESUBARACHNOID HEMORRHAGEINFARCTION
TRAUMARAPID:
INFECTIONGRADUAL
NEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 16
TRAUMA
EXTRADURAL HEMATOMA BRAIN CONTUSION
04/08/23 FOURTH YEAR LECTURE 17
TRAUMA
HISTORY OF TRAUMA DEATH LOC EPILEPSY PARALYSIS SPEECH PROBLEMS VISUAL PROBLEMS
04/08/23 FOURTH YEAR LECTURE 18
PRESENTATION OF CRANIAL LESIONSSUDDEN:
CEREBRO-VASCULAR ACCIDENTSINTRACEREBRAL HEMORRHAGESUBARACHNOID HEMORRHAGEINFARCTION
RAPID:INFECTION
GRADUALNEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 19
INFECTION
THE UNDERSURFACE OF THE BRAIN IN MENINGITIS
04/08/23 FOURTH YEAR LECTURE 20
INFECTION
GRADUAL FEVER LETHARGY NECK RIGIDITY LOC EPILEPSY PARALYSIS DEATH
04/08/23 FOURTH YEAR LECTURE 21
PRESENTATION OF CRANIAL LESIONSSUDDEN:
CEREBRO-VASCULAR ACCIDENTSINTRACEREBRAL HEMORRHAGESUBARACHNOID HEMORRHAGEINFARCTION
RAPID:INFECTION
GRADUALNEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 22
NEOPLASTIC LESIONS
BRAIN METASTASES BRAIN GLIOMA
04/08/23 FOURTH YEAR LECTURE 23
NEOPLASTIC LESIONS
GRADUAL EPILEPSY PARALYSIS SENSORY
PROBLEMS SPEECH PROBLEMS VISUAL PROBLEMS BALANCE
PROBLEMS BEHAVIOUR
CHANGES
04/08/23 FOURTH YEAR LECTURE 24
THE NORMAL PICTURE
T1 WEIGHTED MRI T2 WEIGHTED MRI
04/08/23 FOURTH YEAR LECTURE 25
NOW IMAGINE IF WE ADD SOMETHING ELSE TO THE CONTENTS
MENINGIOMA ON MRI T2 MULTIPLE LESIONS ON CT
BRAIN OEDEMA
TUMOR MASS TUMORS
BRAIN OEDEMADISPLACED
MIDLINE
THE ORIGINAL MIDLINE
DEFORMEDVENTRICLE
04/08/23 FOURTH YEAR LECTURE 26
ADDITION OF NEW CONTENTS
• INCREASE IN THE INTRACRANIAL PRESSURE
• IRRITATION OF THE AREA• PRESSURE ON THE AFFECTED AREA• DESTRUCTION OF THE AFFECTED AREA• OBSTRUCTION OF THE CSF PATHWAYS• HORMONAL PROBLEMS
04/08/23 FOURTH YEAR LECTURE 27
INCREASE IN THE INTRACRANIAL PRESSURE
• SYMPTOMS:• HEADACHE• VOMITING• VISUAL PROBLEMS• INCREASE IN THE SIZE OF THE HEAD
04/08/23 FOURTH YEAR LECTURE 28
INCREASE IN THE INTRACRANIAL PRESSURE
• SYMPTOMS:• HEADACHE• VOMITING• VISUAL PROBLEMS• INCREASE IN THE
SIZE OF THE HEAD
IS A MORNING HEADACHE WHICH
RESPONDS TO SIMPLE ANALGESIA. ITDOES NOT INDICATETYPE OF PROBLEM
04/08/23 FOURTH YEAR LECTURE 29
INCREASE IN THE INTRACRANIAL PRESSURE
• SYMPTOMS:• HEADACHE• VOMITING• VISUAL PROBLEMS• INCREASE IN THE
SIZE OF THE HEAD
IS A MORNING VOMITING AND IS PROJECTILE IN
NATURE. IT RESEMBLES
MIGRAINE VOMITINGOR THE VOMITINGASSOCIATED WITH
PREGNANCY
04/08/23 FOURTH YEAR LECTURE 30
INCREASE IN THE INTRACRANIAL PRESSURE
• SYMPTOMS:• HEADACHE• VOMITING• VISUAL PROBLEMS• INCREASE IN THE
SIZE OF THE HEAD
COULD BE IN THEFORM OF BLURRED
VISION OR DECREASED
ACUITY OR FIELD DEFECT IN ONE OR
BOTH EYES. DEFECTSCAN INDICATE SITE
OFPATHOLOGY
04/08/23 FOURTH YEAR LECTURE 31
INCREASE IN THE INTRACRANIAL PRESSURE
• SYMPTOMS:• HEADACHE• VOMITING• INCREASE IN THE
SIZE OF THE HEAD
THIS OCCURSONLY IN CHILDREN
BECAUSE THECRANIAL SUTURESHAVE NOT UNITED
YET.
04/08/23 FOURTH YEAR LECTURE 32
INCREASE IN THE INTRACRANIAL PRESSURE
• SIGNS• PAPILLOEDEMA
IS SWELLING OF THE
OPTIC DISC ANDIS SEEN BY
OPHTHALMOSCOPY
NORMAL FUNDUS PAPILLOEDEMA
04/08/23 FOURTH YEAR LECTURE 33
IRRITATION OF THE AREA
THIS LEADS TO EPILEPSY IF THE LESION IS ON THESURFACE OF THECEREBRUM. THE
CORTEXMUST BE IRRITATED
TO PRODUCE EPILEPSY
THERE ARE MANY FORMS OF EPILEPSY:
GRAND MALPETIT MALPARTIAL COMPLEXETC.
EPILEPSY MAY LEAD TO: SUFFOCATIONTEMPORARY PARALYSIS
(TODD’S) ORPERMANENT BRAIN
DAMAGE
04/08/23 FOURTH YEAR LECTURE 34
PRESSURE ON THE AFFECTED AREA
• DEPENDS ON WHETHER:• SUPRATENTORIAL• INFRATENTORIAL
Site of tu
mor
after re
moval
04/08/23 FOURTH YEAR LECTURE 35
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA• SUPRATENTORIAL:
• FRONTAL• TEMPORAL• PARIETAL• OCCIPITAL
• INFRATENTORIAL:• LATERAL • MIDLINE
04/08/23 FOURTH YEAR LECTURE 36
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA
SUPRA TENTORIAL LESIONS:
FRONTAL LOBE AFFECTION:DISTURBANCE OF ORIENTATIONBEHAVIORAL CHANGESSPHINCTER PROBLEMSMOTOR SYMPTOMS ON THE OPPOSITE
SIDE
04/08/23 FOURTH YEAR LECTURE 37
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA
TEMPORAL LOBE AFFECTION:EXPRESSIVE DYSPHASIA OR APHASIAVISUAL FIELD DEFECTS SENSORY SYMPTOMS ON THE OPPOSITE
SIDEMOTOR SYMPTOMS ON THE OPPOSITE
SIDE
04/08/23 FOURTH YEAR LECTURE 38
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA
PARIETAL LOBE AFFECTION:RECEPTIVE DYSPHASIA OR APHASIASENSORY SYMPTOMS ON THE OPPOSITE
SIDEMOTOR SYMPTOMS ON THE OPPOSITE SIDEASTEREOGNOSISLACK OF TWO POINT DISCRIMINATIONSPATIAL DISORIENTATIONFINGER AGNOSIA
04/08/23 FOURTH YEAR LECTURE 39
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA
OCCIPITAL LOBE AFFECTION:VISUAL FIELD DEFECTS
(HOMONYMOUS HEMIANOPIA)
04/08/23 FOURTH YEAR LECTURE 40
PRESSURE ON THE AFFECTED AREADESTRUCTION OF THE AFFECTED AREA
INFRATENTORIAL TUMORSATAXIANYSTAGMUSOBSTRUCTION OF
CSF FLOW
TOP: MEDULLOBLASTOABOTTOM: ASTROCYTOMA
04/08/23 FOURTH YEAR LECTURE 41
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY
INTERNAL CAROTID ARTERYANTERIOR CEREBRALMIDDLE CEREBRAL
BASILAR ARTERYPOSTERIOR CEREBRAL
04/08/23 FOURTH YEAR LECTURE 42
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY
INTERNAL CAROTID ARTERYANTERIOR CEREBRALMIDDLE CEREBRAL
BASILAR ARTERYPOSTERIOR CEREBRAL
04/08/23 FOURTH YEAR LECTURE 43
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY
INTERNAL CAROTID ARTERYANTERIOR
CEREBRALMIDDLE CEREBRAL
BASILAR ARTERYPOSTERIOR
CEREBRAL
• CONTRALATERAL HEMIPLEGIA
• MILD SENSORY DEFICIT
• MENTAL CONFUSION• CLOUDING OF THE
CONSCIOUSNESS
04/08/23 FOURTH YEAR LECTURE 44
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY
INTERNAL CAROTID ARTERYANTERIOR
CEREBRALMIDDLE CEREBRAL
BASILAR ARTERYPOSTERIOR
CEREBRAL
• COMA• CONTRALATERAL
FLACCID HEMIPLEGIA
• HEMIANESTHESIA• HEMIANOPIA• MOTOR APHASIA• SENSORY APHASIA
04/08/23 FOURTH YEAR LECTURE 45
DESTRUCTION COULD RESULT FROM OCCLUSION OF A MAJOR ARTERY
INTERNAL CAROTID ARTERYANTERIOR
CEREBRALMIDDLE CEREBRAL
BASILAR ARTERYPOSTERIOR
CEREBRAL
• CONTRALATERAL HEMIANESTHESIA
• CONTRALATERAL HOMONYMOUS HEMIANOPIA
• SENSORY APHASIA
04/08/23 FOURTH YEAR LECTURE 46
OBSTRUCTION OF CSF PATHWAYS
WILL LEAD TO DILATATION OF THE VENTRICULAR SYSTEM AND SIGNS AND
SYMPTOMS OF INCREASED INTRACRANIAL PRESSURE.
NORMAL
ABNORMAL
DILATED VENTRICLES
SEEPAGE OF CSF
04/08/23 FOURTH YEAR LECTURE 47
OBSTRUCTION OF CSF PATHWAYS
IN INFANTS AND LITTLE CHILDERN IT WILL
LEAD TO ENLARGMENT OF
THE HEAD DUE TO THE FACT THAT SUTURES
ARE NOT CLOSED.
HYDROCEPHALUS COULD BE OBSTRUCTIVE OR
COMMUNICATING
04/08/23 FOURTH YEAR LECTURE 48
OBSTRUCTION OF CSF PATHWAYS
BESIDE ENLARGMENT OF THE HEAD,DILATATION OF THE VENTRICULAR
SYSTEMWILL LEAD TO DETERIORATION OF THE
LEVEL OF CONSCIOUSNESS.
ASSESSMENT OF THE LOC IS DONE GENERALLY
BY THE USE OF THE GLASGOW COMA SCALE(GCS)
04/08/23 FOURTH YEAR LECTURE 49
OBSTRUCTION OF CSF PATHWAYS
THE GLASGOW COMA SCALE
Points Eye Opening Best Verbal Response Best Motor Response
6 Follows command
5 Appropriate Localizes pain
4 Spontaneous Inappropriate Withdraws
3 To voice Moaning Flexion
2 To pain Incomprehensible Extension
1 None None None
04/08/23 FOURTH YEAR LECTURE 50
THE GLASGOW COMA SCALE• A NORMAL PERSON WOULD SCORE
15• 6 FROM FOLLOWING COMMAND• 5 FROM APPROPRIATE VERBAL
RESPONSE• 4 FROM SPONTANEOUS EYE OPENING
• A DEAD PERSON SCORES 3• 1 FROM NO MOTOR RESPONSE• 1 FROM NO VERBAL REPONSE• 1 FROM NO EYE OPENING
04/08/23 FOURTH YEAR LECTURE 51
HORMONAL PROBLEMS
USUALLY IN PROBLEMS OF THE PITUITARY
GLAND OR THE PINEAL BODY.INCREASE PITUITARY SECRETION LEADS
TO: ACROMEGALLY
GIGANTISM GALACTORRHOEA AMENORRHOEA
DECREASED SECRETION LEADS TO:HYPOPITUITRISM
04/08/23 FOURTH YEAR LECTURE 52
HORMONAL PROBLEMS
USUALLY IN PROBLEMS OF THE PITUITARY
GLAND OR THE PINEAL BODY.INCREASE PITUITARY SECRETION LEADS
TO: ACROMEGALLY
GIGANTISM GALACTORRHOEA AMENORRHOEA
DECREASED SECRETION LEADS TO:HYPOPITUITRISM
04/08/23 FOURTH YEAR LECTURE 53
HORMONAL PROBLEMS
DUE TO THE OVER SECRETION OF THEGROWTH HORMONE
AFTER THE EPIPHYSIS HAD UNITED:
INCREASE NOSE SIZE INCREASE HAND SIZE INCREASE FEET SIZE INCREASE JAW SIZE
04/08/23 FOURTH YEAR LECTURE 54
HORMONAL PROBLEMS
USUALLY IN PROBLEMS OF THE PITUITARY
GLAND OR THE PINEAL BODY.INCREASE PITUITARY SECRETION LEADS
TO: ACROMEGALLY
GIGANTISM GALACTORRHOEA AMENORRHOEA
DECREASED SECRETION LEADS TO:HYPOPITUITRISM
04/08/23 FOURTH YEAR LECTURE 55
HORMONAL PROBLEMS
DUE TO THE OVER SECRETION OF THEGROWTH HORMONE
BEFORE THE EPIPHYSIS
HAD UNITED.
04/08/23 FOURTH YEAR LECTURE 56
HORMONAL PROBLEMS
USUALLY IN PROBLEMS OF THE PITUITARY
GLAND OR THE PINEAL BODY.INCREASE PITUITARY SECRETION LEADS
TO: ACROMEGALLY
GIGANTISM GALACTORRHOEA AMENORRHOEA
DECREASED SECRETION LEADS TO:HYPOPITUITRISM
04/08/23 FOURTH YEAR LECTURE 57
EXAMPLES OF PITUITARY LESIONS
04/08/23 FOURTH YEAR LECTURE 58
PRESENTATION OF SPINAL LESIONS
• SUDDEN:• VASCULAR ACCIDENTS
• INTRASPINAL HEMORRHAGE• INFARCTION
• RAPID:• INFECTION• DEMYLINATION
• GRADUAL:• NEOPLASTIC LESIONS
04/08/23 FOURTH YEAR LECTURE 59
PRESENTATION OF SPINAL LESIONS
SPINAL CORD LESIONSLOSS OF POWER BELOW THE LEVELLOSS OF SENSATION BELOW THE LEVELLOSS OF SPHINCTERIC CONTROL
ROOT LESIONSPAIN ALONG A ROOTLOSS OF POWER IN A MUSCLE OR
GROUPLOSS OF SENSATION IN A DERMATOMELOSS OF A REFLEX OR REFLEXESLOSS OF SPHINCTERIC CONTROL
04/08/23 FOURTH YEAR LECTURE 60
PRESENTATION OF SPINAL LESIONS
ACUTE PRESENTATIONLOSS OF POWERLOSS OF SENSATIONHYPOTONIADECREASED
REFLEXESMUTE PLANTER
REFLEX
CHRONIC PRESENTATIONLOSS OF POWERLOSS OF SENSATIONHYPERTONIA INCREASED
REFLEXESEXTENSOR PLANTER REFLES ( BABINISKI)
04/08/23 FOURTH YEAR LECTURE 61
PRESENTATION OF CORD LESIONS
EXAMPLE OF A SPINAL CORD
LESION(TUMOUR)
INTRADURAL SPINAL CORD TUMOR ON T2
WEIGHTED MRI
04/08/23 FOURTH YEAR LECTURE 62
PRESENTATION OF ROOT LESIONS
EXAMPLE OF A SPINAL ROOT
LESION(PROLAPSED DISC)
PROLAPSED DISC ON T1
WEIGHTED MRI
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