Neurology (in General) Lin Yin, MD Chief, Professor,Teaching/research Section of Neurology and Psychiatry The 2nd Clinical College of Dalian Medical University,Chapter 1 Introduction,Definition Neurology means clinical neurology, which is a branch of internal medicine. Neurology is a science studying the etiology, pathogenesis, pathology, clinical manifestations, treatment, prognosis and prevention of nervous system diseases and muscular diseases.,Chapter 1 Introduction,Neurology and Psychiatry Neurological diseases are close to but different from Psychiatric diseases. Psychiatric diseases refer to disturbance of the normal function of the brain esp. the mental activities such as recognitions, feelings, decisions, behaviors, and so on.,Chapter 1 Introduction,Working protocol Similar to internal medicine. First take the medical history, then do physical exam, and then do some medical exams. So we get the correct diagnosis and begin to treat the patient. Some differences to Internal Medicine Need to master the thorough and systemic examination skills of the nervous system, Focus on the localization diagnosis and etiological diagnosis of the disease. Selectively choose some medical examinations from so many available today, such as lumbar puncture (LP), CT, CTA, MRI, MRA, DSA, ECT, EEG, EMG, etc.,第一章 绪 论,工作思维方法 与内科大体相同，通过病史、体格检查、辅助检查，来进行诊断、治疗和预防。与内科不同之处在于： 1、需要掌握神经系统检查方法。 2、强调疾病的定位诊断与定性诊断。 3、辅助检查发展的很快，有腰穿、CT、MRI、PET（正电子发射断层扫描）、DSA（脑血管造影）等，要有针对性地选择。 4治疗原则：治愈（脑炎、脑膜炎、GBS）、缓解（EPI,PD,MS）、对症(AD,OPCA,PMD,ALS),CT- Computerized Tomography,Chapter 1 Introduction,Importance of Neurology,CTA- Computerized Tomography Angiography,MRI-Magnetic Resonance Imaging,MRA- Magnetic Resonance Angiography,DSA-Digital Substration Angiography,ECT Emission Computerized Tomography : PET (Positron Emission Tomography) SPECT (Single Photon Emission CT),Neurophysiolgy: EEG-Electroencephlography EMG-Electromyography MEG-Magnetoencephlography CEP-Cerebral Evoked Potentials,第一章 绪 论,神经系统疾病的种类 感染、血管病、肿瘤、外伤、免疫、变性、遗传、中毒、先天、营养代谢、等。,第一章 绪 论,神经症状的分类 缺损症状（脑血管病） 刺激症状（肿瘤、腰凸） 释放症状（锥体束征、强笑强哭） 休克症状（脑休克、脊髓休克）,第一章 绪 论,神经病学的特点及重要性 大脑是人体的“司令部”，支配和调节全身各系统的功能。中枢神经一旦发生损害难于治疗，原因是中枢神经元不能再生。 神经解剖复杂、难学、难懂，但是它非常有条理、逻辑性强，只要入门，有兴趣，就不难。 神经病学大有前途，随着社会的发展，寿命的延长，发病率明显增加，脑血管病已成为三大死亡疾病之一，我们将来无论干那一科都用得上神经科的知识。,Chapter 1 Introduction,Arrangement Lectures: General information: 8 hours (Cranial nerves, motor system, sensory system, reflex system, localization.) Individual information: 20 hrs (CVD, spinal diseases, Epilepsy, muscular disease) Internship: 2 times,8 hours,Chapter 2 FUNDAMENTAL NEUROANATOMY AND LOCALIZATION,Section 1 Cranial nerves,Do you remember what are the 12 pairs of cranial nerves? ，Olfactory nerve,Temporal,nasal,Optic N.,chiasm,Optic tract,Optic radiation,Lateral Geniculate body,Visual cortex,Lesion sites and clinical,Section 1 Cranial nerves ，Optic nerve,Anatomy and pathway Retina(rods,cones)ganglion cellsoptic nerveoptic chiasm(nasal half fibers cross, temporal half fibers uncross)optic tractlateral geniculate bodyposterior limb of the internal capsuleoptic radiationoccipital (calcarine)cortex (visual center),Section 1 Cranial nerves ，Optic nerve,Clinical Findings: Vision and Visual Field Defects(Visual loss) a. Optic nerve: total blindness (visual loss) of the ipsilateral eye. b. Optic chiasm(such as pituitary tumor) : bitemporal hemianopsia. c. Perichiasmal area(such as calcified ICA): ipsilateral nasal hemianopsia. d. Optic tract: contralateral total homonymous hemianopsia. *. Optic radiation: e. complete lesion can cause contralateral total homonymous hemianopia. f. lower portion cause contralateral sup. quadrantanopsia; g. upper portion cause contralateral inf. quadrantanopsia; h. Occipital lobe: often produces contralateral homonymous hemianopia with macular sparing.,8,Temporal,nasal,Optic N.,chiasm,Optic tract,Optic radiation,Lat.eral Geniculate body,Visual cortex,Lesion sites and clinical,Section 1 Cranial nerves ，Optic nerve,“macular sparing”: the visual field in the central portion of the hemianopia side is preserved and the light reflex in the same side still exists. Macular sparing is a characteristic of central hemianopsia.,Section 1 Cranial nerves ，Optic nerve,Optic disk changes (with ophthalmoscope) Papilledema Bleeding of retina Fundus change of blood hypertention Optic atrophy,Section 1 Cranial nerves ,(Oculomotor N,Trochlear N,Abducens N),Anatomy and Physiology group of nuclei (midbrain) : muscle function levator palpebrae m. open the eye superior rectus m. move the eye upward medial rectus m. move the eye medially inferior rectus m. move the eye downward inferior oblique m. move the eye upward and outward sphincter m. of iris(虹膜) constrict the pupil ciliary muscle thicken the lens nucleus (midbrain) superior oblique m. rotates the eye downward and outward nucleus (pons) lateral rectus m. rotates the eye out