NEUROLOGY I Lex Lycurgus N.

Castillo

INTRODUCTION TO MD, FPNA

Assistant Professor
THE COURSE Department of Clinical
Neurosciences
COURSE REQUIREMENTS
OBJECTIVES
At the end of the semester, the student should be able to:

• Review neuroanatomy
• Understand the concepts of localization
• Apply the principles of localization in the approach to
neurological diseases
• Perform a complete neurological examination
• Undergo OSCE satisfactorily
 Date Day Section Lecture Lecturer
January 6, 2021 M ABC Start of Second Semester  

January 11 M B Introduction to the Course; Approach to the  

January 11 M C Patient with Neurologic Disease; Overview of Dr. Castillo
January 11 M A the Neurological Examination
January 18 M B
January 18 M C Review of Neuroanatomy Dr. M. Punsalan
January 18 M A
January 25 M B
The Examination of Cerebral Function
January 25 M C Dr. Badillo
January 25 M A
February 1 M B
February 1 M C The Examination of Vision Dr. Guillermo
February 1 M A
February 9-11;
1st Long Test
15-16
 Date Day Section Lecture Lecturer
February 19 F A
February 19 F C The Examination of the Sensory Function Dr. Nepomuceno
February 26 F B
February 22 M B  
M The Examination of Smell, Taste and Hearing
February 22 C Dr. Tiongson
February 22 M A
March 1 M B The Examination of Motor Function and Deep
March 1 M C Tendon Reflexes Dr. Zialcita
March 1 M A
March 8 M B The Examination of Ocular Movement and
March 8 M C Pupillary Function Dr. Fandialan
March 8 M A
March 16-18; 2nd Long Exam
22-23
 Date Day Section Lecture Lecturer
March 29 M A
March 29 M C The Examination of Cerebellar Dysfunction Dr. Soto
March 29 M B
April 5 M B  
M The Examination of Stance and Gait
April 5 C Dr. Chua
April 5 M A
April 12 M B
April 12 The Examination of the Comatose Patient
M C Dr. R. Punsalan
April 12 M A
April 19 M B
Approach to Localization
April 19 M C Dr. Olaivar
April 19 M A
April 26 M B
April 26 M C Clinicopathologic Conference
April 26 M A
April 29 OSCE
March 10-12; Semestral Exam
17-18
July 29-30 Second Year Comprehensive Exam
 REFERENCES
 Localization in Neurology
(Brazis)
 Adam’s Principles of Neurology,
11th edition
Techniques of Neurological
Examination (DeMyer)
Neurology Manual
APPROACH
TO THE
PATIENT
WITH
NEUROLO
GIC
DISEASE
Lex Lycurgus N. Castillo MD
Assistant Professor
Department of Clinical Neurosciences
 “ We treat our patients and
not their Cranial CT/MRI
scan plates.”
 THE CLINICAL METHOD
1) Symptoms and signs obtained in history and
physical examination
2) Relevant symptoms and physical signs are
interpreted in terms of anatomy and physiology.
3) Localization of the disease process through these
analyses. (anatomic diagnosis; syndromic diagnosis)
4) Deduction of pathologic and etiologic diagnosis
5) Assess the degree of disability (functional diagnosis); prognostication
IMPORTANT DATA IN
ESTABLISHING DIAGNOSIS

Symptom Medical
Demographic
onset and History and
s
development PE

Incidence and
Family
Social History Prevalence of
History
diseases
MAJOR CATEGORIES OF
NEUROLOGIC DISEASE

Genetic-
Infectious Traumatic Degenerative
Congenital

Metabolic
Vascular Toxic • Inherited Neoplastic
• Acquired

Inflammatory
Psychogenic Iatrogenic
-Immune
CATEGORIES OF
COMMON COGNITIVE
MISTAKES IN ARRIVING
AT A DIAGNOSIS
- Framing Effect
 Excessive weight put on a specific initial data of the presentation of the problem

-Anchoring Heuristic
 Initial impression can not be adjusted to accommodate new data

- Availability Heuristic
 Recent Experience influences the diagnosis of the present case

- Representative Heuristic
 Lack of appreciation of the frequency of the disease

- Blind Obedience
 Undue deference to authority or to the results of a laboratory test
“Unusual Presentation of
Common diseases are more
frequently encountered than Usual
Presentation of Rare Diseases.”
NEUROLOGIC HISTORY

1) Avoid suggesting to the patient the

symptom that one seeks
2) Learn precisely how each
symptom began and progressed
3) Estimate the mental capacities of
patients
4) Patient’s own Interpretation of the
symptom/s
 Mental Status Exam
OVERVIE Cranial Nerves
W OF Motor Exam
THE Sensory Exam
NEUROL
Reflexes
OGIC
EXAMIN Cerebellar Exam
ATION Gait
Meninges
“The neurological examination
is the means by which we are
able to examine the nervous
system.”
DIVISIONS OF THE
NEURAXIS
Cortical Brain
Subcortical Brain
Brainstem
Cerebellum
Spinal Cord
Nerve Root
Peripheral Nerve
Neuromuscular Junction
Muscle
LOCALIZE THE PARTS OF THE
NEURO EXAM
a. Cortical Brain
b. Subcortical Brain
c. Brainstem 1. Mental status

d. Cerebellum 2. Cranial nerves

e. Spinal Cord 3. Motor
f. Nerve Root 4. Reflexes
g. Peripheral Nerve 5. Sensory
h. Neuromuscular Junction 6. Cerebellum
i. Muscle 7. Coordination and Gait
j. Meninges 8. Meninges
HOW TO ENSURE AN ORDERLY,
COMPLETE EXAMINATION

Perform an orderly, sequential neuro exam

Avoid shortcuts
Lay out your instruments in the order of use.
 Replace each instrument in your bag as you finish with it.
 When you have replaced every instrument, you will have done a
complete examination
S
THE PARTS OF THE NEURO EXAM

Cortic
Mental al
Status brain
THE PARTS OF THE NEURO EXAM

Cranial
Cranial nerves/
nerves brainste
m
THE PARTS OF THE NEURO EXAM

CN I

CN II

Cranial CN III &

midbrain
nerves IV
CN V, VI,
pons
VII, VIII
CN IX, X,
medulla
XI, XII
THE PARTS OF THE
Motor Exam & Reflexes
NEURO EXAM
Corticospinal tract

UMN LMN

Cortical – motor
Anterior horn cell
cortex BA 4

Subcortical –corona Nerve root / Peripheral

radiata nerve

Neuromuscular
Subcortical – IC/BG
junction

Subcortical -
brainstem
muscle

Spinal cord – above

anterior horn cell
THE PARTS OF THE Sensory exam
NEURO EXAM
Spinothalamic Dorsal column

Joint position,
touch, temperature,
vibratory ,tactile
pain receptors discrimination

1st order neurons:

1 order neurons:
st
DRG; FG-LE, FC-
DRG
UE

2nd order: dorsal 2nd order : GN-LE;

horn – decussate in CN-UE, caudal
VWC medulla - ML

3rd order VPL 3rd order VPL nucleus

nucleus thalamus thalamus

Somatosensory Somatosensory cortex

cortex (BA 312) (BA 312)
THE PARTS OF THE
NEURO EXAM

Station, walking,
Vestibulocerebellum
tandem gait
and spinocerebellum
cerebellum

dorsal Rapid alternating

column cerebrocerebellum
Gait and movements, finger-to-
coordination nose, heel-to-shin,
rebound and check
motor reflex, speech

cortical
THE PARTS OF THE NEURO
EXAM
QUESTIONS TO BE
ANSWERED

Where is What is
Is there a
the the
lesion?
lesion? lesion?
READING
ASSIGNMENT

Approach to the Patient with

Neurological Disease Chapter 1 pp.
3-12
READING
ASSIGNMENT

Outline of the Standard

Neurological Examination pp. xv-
xxi
REMINDERS:

Study your reference textbooks

 Transcriptions are not considered textbooks
Cramming never works
 Cramming = negligible synapses, memory not stored
 Studying repeatedly = more synapses formed, memory stored = stock knowledge!

Enjoy neurology!!!