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Introduction

• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration
Clinical Neuroanatomy for
Undergraduates
S. Mark Williams, Ph.D.
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates
The course provides an overview of the structure of the
Introduction central nervous system
• Overview
• Rationale  • Topographical anatomy of the brain and spinal cord

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content  • The organization of the major neural systems
underlying sensory, motor and cognitive function.
Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction Keys to the (active) learning process


• Overview
• Rationale
• Hands-on examination of human brain specimens

• Interactive brain atlas and glossary exercises


Course format:
• Lectures
• Solving anatomical puzzles (clinical cases)
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks CLINICAL NEUROANATOMY method of studying
• Lab manual lesions of the human nervous system as a tool to
• Course website reinforce and amplify learning of the structure and
• Sylvius organization of the CNS.
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center not training neurologists ...
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates
Neuroanatomical training is fundamental .... but why
Introduction
teach clinical neuroanatomy to undergraduates?
• Overview
• Rationale

• As part of pre-medical training


Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions * It’s an effective method for providing the necessary
• Content anatomical foundation for further study in the neurosciences

Resources:  • motivational
• Textbooks
• Lab manual  • instructional
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

“Non-clinical”
S. Mark Williams, Ph.D. Neuroanatomy
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy Learning objective: Understand the organization of the
for undergraduates partial crossing of fibers in the optic chiasm.

The nasal (medial) retinal fibers for each eye, which are
Introduction responsible for information in the temporal (lateral)
• Overview hemifields, cross the midline at the optic chiasm. Lesions
• Rationale of the middle portion of the optic chiasm therefore
produce bitemporal visual field defects (bitemporal
hemianopia). Left eye Right eye
visual field visual field
Course format:
(A)
• Lectures
• Labs
• Clinical cases Left Right

• Review sessions (B)

• Content
Optic
nerve
A
Resources: Optic
chiasm (C)
B
• Textbooks
Optic C D
• Lab manual tract

• Course website Lateral


geniculate (D)
• Sylvius nucleus

• Integration Optic
radiation

E
(E)

Striate cortex
S. Mark Williams, Ph.D.
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction
• Overview
• Rationale
PATIENT PRESENTATION
A 50-year-old woman went to an ophthalmologist
because of several months of worsening vision that
Course format:
had begun to interfere with her driving. Past history is
• Lectures
• Labs notable for long-standing menstrual irregularity and
• Clinical cases infertility.
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction PATIENT PRESENTATION


• Overview A 50-year-old woman went to an ophthalmologist because of
• Rationale several months of worsening vision that had begun to interfere
with her driving. Past history is notable for long-standing
menstrual irregularity and infertility.
Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

MENSTRUAL IRREGULARITY AND


S. Mark Williams, Ph.D.
Department of Neurobiology
BITEMPORAL HEMIANOPIA
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
the cases:
• Lab manual
• Course website
richly illustrate our learning objectives (e.g.organization of the partial
• Sylvius
crossing of fibers in the optic chiasm)
• Integration
significantly expands the discussion (e.g. spatial relationship of pituitary
and chiasm, asymmetry of visual field cut)
S. Mark Williams, Ph.D.
Department of Neurobiology
Duke University Medical Center interesting and motivating for students
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction
• Overview examination vs
• Rationale dissection

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration
40 cases presented by
students
S. Mark Williams, Ph.D.
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates

Introduction Drill sessions


• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration
9: lesion
produces ______?
S. Mark Williams, Ph.D.
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy Challenge:
for undergraduates • clinical orientation of material for non-medical students

Introduction
• Overview
Neuroanatomy Through Clinical Cases
• Rationale

Hal Blumenfeld, M.D., Ph.D., Yale


University School of Medicine
Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content The NeuroExam Video

Resources: neuroexam.com
• Textbook
• Lab manual
• Course website
• Sylvius Recommended text
• Integration
Neuroscience 3rd edition
Purves, Augustine, Fitzpatrick, Hall, LaMantia,
McNamara & Williams
S. Mark Williams, Ph.D.
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy Challenge:
for undergraduates • directing and focus brain specimen examination

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
Challenge:
for undergraduates • organizing and distributing course resources

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
Challenge:
for undergraduates • organizing and distributing course resources

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
Challenge:
for undergraduates • organizing and distributing course resources

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
Challenge:
for undergraduates • organizing and distributing course resources

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
Challenge:
for undergraduates • organizing and distributing course resources

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
Challenge:
for undergraduates • organizing and distributing course resources

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy Challenge:
• content management !
for undergraduates

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy Challenge:
for undergraduates • 1985, technological limitations; 2005, pedagogical value

Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D.


Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu
SylviusVG: Visual Glossary of
Human Neuroanatomy
Challenge: S. Mark Williams, Ph.D., Leonard E. White,
Ph.D., and Andrew C. Mace
• 100s of new, unintuitive terms
Sinauer Associates, Inc.
SylviusVG: Visual Glossary of
Human Neuroanatomy

CNS quick reference tool S. Mark Williams, Ph.D., Leonard E. White,


Ph.D., and Andrew C. Mace

Sinauer Associates, Inc.


SylviusVG: Visual Glossary of
Human Neuroanatomy

CNS quick reference tool S. Mark Williams, Ph.D., Leonard E. White,


Ph.D., and Andrew C. Mace

Sinauer Associates, Inc.


Clinical Neuroanatomy Challenge:
for undergraduates • 100s of new, unintuitive terms
... students are mobile
Introduction
• Overview
• Rationale

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

“...after class, we go to breakfast


and quiz each other on brain SylviusVG: Visual Glossary of
Human Neuroanatomy, iPod edition
S. Mark Williams, Ph.D.
Department of Neurobiology structures using the iPod.”
Duke University Medical Center S. Mark Williams, Ph.D., Leonard E. White, Ph.D.,
markw@neuro.duke.edu and Andrew C. Mace
SylviusPRO: 3D Dissector and
Atlas of the Human Central
Nervous System
- SylviusPRO: 3D Dissector and Atlas of the Human
S. Mark Williams, Ph.D., Leonard E. White,
Challenge: Central Nervous System (CD or download) Ph.D., and Andrew C. Mace

• 3D organization of brain is complex Sinauer Associates, Inc.


SylviusPRO: 3D Dissector and
Atlas of the Human Central
Nervous System
- SylviusPRO: 3D Dissector and Atlas of the Human
S. Mark Williams, Ph.D., Leonard E. White,
Central Nervous System (CD or download) Ph.D., and Andrew C. Mace

3D Dissector and Atlas Sinauer Associates, Inc.


- SylviusPRO: 3D Dissector and Atlas of the Human
Central Nervous System (CD or download)
3D Dissector and Atlas
Clinical Neuroanatomy
for undergraduates
Describe the
Introduction effects of the
• Overview lesion shown
• Rationale in red

Course format:
• Lectures
• Labs
• Clinical cases
• Review sessions
• Content

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration

S. Mark Williams, Ph.D. Challenge:


Department of Neurobiology
Duke University Medical Center • integrating the resources to effectively meet learning objectives
markw@neuro.duke.edu
Clinical Neuroanatomy
Problem: Increasing need for neuroanatomical expertise
for undergraduates
Part of the solution ? teach fundamental neuroanatomy
Introduction to undergraduates (and graduate students) using clinical
• Overview cases
• Rationale
Benefits:

Course format: • increase learning efficacy and retention


• Lectures (supposition)
• Labs
• Clinical cases • offers numerous active learning opportunities
• Review sessions
• Content
• wealth of resources, leverage medical school
teaching resources
Resources:
• Textbooks
• Lab manual Challenges:
• Course website
• Sylvius • orientation complexity of clinical material for non-
• Integration medical students
Summary
• new terminology, spatial relationships of brain
S. Mark Williams, Ph.D.
Department of Neurobiology
structures
Duke University Medical Center
markw@neuro.duke.edu
Clinical Neuroanatomy
for undergraduates
No Date Topic Rea

Introduction 01 Wed, August 31 Introduction to the Course


• Overview
02 Fri, September 02 Lecture: Organization of the Nervous System I Blum 2
• Course goals
Blum 2
• Rationale 03 Wed, September 07 Lecture: Organization of the Nervous System II LM 1

Blum 1
04 Fri, September 09 Lecture: Gross anatomy of the Brainstem and Thalamus LM 2

Course format: 05 Wed, September 14 Lab Demo: Gross Anatomy of the Brain and Spinal Cord I LM 1

• Lectures
• Labs 06 Fri, September 16 Lab Demo: Gross Anatomy of the Brain and Spinal Cord II LM 1

• Clinical cases 07 Wed, September 21 Review: Gross Anatomy of the CNS


• Review sessions
08 Fri, September 23 Exam No.1
• Content
09 Wed, September 28 Lecture: Introduction to Clinical Cases Blum C

Resources: 10 Fri, September 30 Lecture: Corticospinal Tract and Other Motor Pathways Blum C

• Textbooks
11 Wed, October 05 Cases: Corticospinal Tract and Other Motor Pathways Blum C
• Lab manual
• Course website 12 Fri, October 07 Lecture: Somatosensory pathways Blum C

Block 1
• Sylvius 13 Wed, October 12 Cases: Somatosensory pathways Blum C

• Integration
14• Background
Fri, October 14 Lecture: Visual System Blum C

• Surface features and internal anatomy of brain and spinal cord


15 Wed, October 19 Cases: Visual System Blum C

S. Mark Williams, Ph.D. 16 Fri, October 21 Lecture: Brainstem I (Cranial Nerves) Blum C
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu 17 Wed, October 26 Lecture: Brainstem II (Cranial Nerve Nuclei) Blum C
07 Wed, September 21 Review: Gross Anatomy of the CNS
Clinical Neuroanatomy
08 Fri, September 23 Exam No.1
for undergraduates
09 Wed, September 28 Lecture: Introduction to Clinical Cases Blum C

10 Fri, September 30 Lecture: Corticospinal Tract and Other Motor Pathways Blum C
Introduction
• Overview 11 Wed, October 05 Cases: Corticospinal Tract and Other Motor Pathways Blum C

• Course goals
12 Fri, October 07 Lecture: Somatosensory pathways Blum C

• Rationale
13 Wed, October 12 Cases: Somatosensory pathways Blum C

Course format: 14 Fri, October 14 Lecture: Visual System Blum C

• Lectures 15 Wed, October 19 Cases: Visual System Blum C

• Labs
16 Fri, October 21 Lecture: Brainstem I (Cranial Nerves) Blum C
• Clinical cases
• Review sessions 17 Wed, October 26 Lecture: Brainstem II (Cranial Nerve Nuclei) Blum C

• Content 18 Fri, October 28 Cases: Brainstem/Cranial Nerves Blum C

19 Wed, November 02 Review: Long Tract Pathways and Brainstem


Resources:
• Textbooks 20 Fri, November 04 Exam No.2
• Lab manual 21 Wed, November 09 Lecture: Motor modulation I (Cerebellum) Blum C

• Course website
• Sylvius 22 Fri, November 11 Lecture: Motor modulation II (Basal Ganglia) Blum C

• Integration 23Block
Wed, 2
November 16 Cases: Basal Ganglia and Cerebellum Blum C

24 Fri, November 18 Lecture: Limbic System and Cerebral Cortex I Blum C

• Introduction to clinical cases


25 Wed, November 23 THANKSGIVING BREAK
S. Mark Williams, Ph.D. • Long tracts, visual pathways, cranial nerves, cranial nerve nuclei
Department of Neurobiology
Duke University Medical Center 26 Fri, November 25 THANKSGIVING BREAK
markw@neuro.duke.edu
19 Wed, November 02 Review: Long Tract Pathways and Brainstem
Clinical Neuroanatomy
20 Fri, November 04 Exam No.2
for undergraduates
21 Wed, November 09 Lecture: Motor modulation I (Cerebellum) Blum C

22 Fri, November 11 Lecture: Motor modulation II (Basal Ganglia) Blum C


Introduction
• Overview 23 Wed, November 16 Cases: Basal Ganglia and Cerebellum Blum C

• Course goals
24 Fri, November 18 Lecture: Limbic System and Cerebral Cortex I Blum C
• Rationale
25 Wed, November 23 THANKSGIVING BREAK

Course format: 26 Fri, November 25 THANKSGIVING BREAK

• Lectures 27 Wed, November 30 Lecture: Cerebral Cortex II Blum C

• Labs
28 Fri, December 02 Cases: Limbic System and Cerebral Cortex II Blum C
• Clinical cases
• Review sessions 29 Wed, December 07 Cases: Cerebral Cortex II and Review Blum C

• Content
30 Fri, December 09 Exam Review and Final Discussion

Resources:
• Textbooks
• Lab manual
• Course website
• Sylvius
• Integration Block 3

• Motor modulation (cerebellum and basal ganglia)


S. Mark Williams, Ph.D. • Limbic system and cerebral cortex
Department of Neurobiology
Duke University Medical Center
markw@neuro.duke.edu