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NEUROLOGY
Zheng Xiao
Dept. Neurology ,1st Hospital , CQUMS
Outline
v Brief Introduction
v Localization of Neurologic Diaease
Cranial Nerve
Localization of Sensory System Deficits
Localization of Motor System Deficits
Reflex
v Summary
Brief Introduction
v About Clinical Neurology
v Investigative Examinations
v Etiology
v Tumor
v Head trauma
v Intoxication
v Degenerative diseases
v Autoimmune disease
v Nutritional disorders
Diagnosis of Neurologic Disease
Is it Neurologic Disease?
Detailed history
History of present illness,
Mode of onset
Course of the illness
Associated symptoms
Previous medical history,
Family history
Neurological Examinations
What is the Location of the Lesion?
Neurological Examinations
Conscious State
Cranial Nerves
Motor System
Sensory System
Reflexes
The location of symptoms/signs may provide a
clue to their origin.
What is the Underlying Etiology?
Medical History; Neurologic Examinations; Investigative Examinations
v Anterior horn
(Anterior roots-motor)
v Posterior horn
(Posterior roots-
sensory)
v Ascending tract:
spinothalamic tract,
dorsal column
(fasciculus gracilis,
fascilulus cuneatus)
v Descending tract:
corticalspinal tract
Cranial Nerves
• 12 pairs, exiting skull
through foramina
I OLFACTORY-
II OPTIC-
III OCULOMOTOR-
IV TROCHLEAR
V TRIGEMINAL;
VI ABDUCENS
VII FACIAL
VIII ACOUSTIC
IXGLOSSOPHARYNGEALL
X VAGAL
XI ACCESSORY
XII HYPOGLOSSAL
Spinal Nerves
• 31 pairs
• Each connected to spinal
cord by 2 roots (anterior
root—cell bodies in the
anterior horn; posterior
root—cell bodies in the
spinal ganglion)
localization of Sensory System
Deficits
v About sensation
v Sensory pathways
Posterior Horn
Anterior Commissure
Spinothalamic Tract
Medial Lemniscus
LHS
dorsal column spinal cord injury
pathway
medial lateral
Superficil s.
C T L S
deep s.
S L T C
C-cervical T-thoracic
L-lumbar S-sacral
Segmental and peripheral
distribution
Phenomena of Sensory
Disturbances
v Loss of sensation:
Dissociated sensory loss and complete sensory loss
anesthesia,hypesthesia//analgesia,hypalgesia
v Abnormal sensation
Parethesia,hyperesthesia,hyperpathia
v pain
Localization of Sensory System
Deficits(1)
Terminal Type
§Symmetric
§Distally Dominant
Localization of Sensory System
Deficits(2)
Nerve Trunk Type
Ulnar nerve, radial nerve,median nerve, superficial peroneal nerve, tibial nerve
Localization of Sensory System
Deficits(3)
Posterior Horns
or
Root type
Segmental pattern
Localization of Sensory System
Deficits(4)
Central Cord
Or
Anterior Combining type
§ Segment
§ Symmetric
§ Bilateral
Localization of Sensory System
Deficits(5)
transection type
3H Syndrome
Hemiparesis
Hemianopia
Hemiparesthesia
Localization of Sensory System
Deficits(11)
Cortical Sensory disturbances
impairs
Discriminative
sensory
function on the
opposite side of
the body.
involved the
single arm or
leg.
Summary
Figure 12.17b
Figure 12.17b
Thank you!
Figure 12.16c