Medical college lectures 5th year neurology

1. 5 th year neurology lectures: Around 30 Lectures: 1. Dr. Mohammad Shaikhani: 8. 2. Dr. Mohammad Tahir: 7. 3. Dr. Rasul M.Hasan: 7. 4. Dr. Akram Mahdawi: 7.

3. 5 th year neurology lectures: Introduction: ANATOMY / PHYSIOLOGY: Dr. Mohammad Shaikhani. Assistant professor. M. B. Ch. B/ C.A.B.M

9. Neurotransmission / neurotransmitters. (1) An action potential arriving at the nerve terminal depolarises the membrane & opens voltage-gated calcium channels. (2) Entry of calcium causes the fusion of synaptic vesicles containing neurotransmitters with the pre-synaptic membrane & release of the neurotransmitter across the synaptic cleft. (3) The neurotransmitter binds to receptors on the post-synaptic membrane to either (A) open ligand-gated ion channels which, by allowing ion entry, depolarise the membrane& initiate an action potential (4), or (B) bind to metabotrophic receptors, which activate an effector enzyme (e.g. adenylyl cyclase)& thus via the intracellular second messenger system modulate gene transcription, leading to changes in synthesis of ion channels or modulating enzymes. (5) Neurotransmitters are taken up at the pre-synaptic membrane &/or metabolised.

10. NEUROTRANSMITTERS

11. Pesticide toxicity injections Botulinum toxicity Cataplexy Anticholinergics, e.g. oxybutinin Bladder control Anticholinergics, e.g. hyoscine Motion sickness Huntington's chorea Anticholinergics, e.g. benztropine, orphenadrine, procyclidine Parkinson's disease Peripheral acetylcholinesterase inhibitors, e.g. edrophonium, pyridostigmine Myasthenia gravis Central acetylcholinesterase inhibitors, e.g. donepezil, rivastigmine Alzheimer's disease Excitatory Acetylcholine Pharmacology Clinical relevance Effect Neurotransmitter

12. Used therapeutically as i.m. botulinum toxin Metoclopramide Vomiting Antipsychotics Schizophrenia Alzheimer's disease dopamine agonists Parkinson's disease Excitatory Dopamine Motor neuron disease Memantine Alzheimer's disease Memory Epilepsy Aspartate Cerebral ischaemia Excitatory Glutamate Dexamfetamine Sleep disorders Tizanidine Spasticity Multi-system atrophy Amphetamines, sibutramine Appetite (α-blockers) Bladder control (β-blockers), (α-blockers) Cardiovascular control Antidepressants Mood disorders β-blockers Migraine Excitatory Noradrenaline/adrenaline

13. Uncertain Inhibitory Histamine Startle syndromes Inhibitory Benzodiazepines Spasticity Benzodiazepines Anxiety vigabatrin Epilepsy Inhibitory GABA Sleep Ondansetron Vomiting Pain SSRI antidepressants Depression Pizotifen, triptans Migraine Excitatory (5-HT, serotonin)

14. Dynorphins Morphine Enkephalins Morphine Endorphins Morphine Opioid peptides (> 20) Pain Substance P Melanocyte-stimulating hormone (MSH) Adrenocorticotrophic hormone (ACTH) Memory Uncertain Excitatory/ inhibitory Neuropeptides Vasopressin

15. FUNCTIONAL ANATOMY OF THE NERVOUS SYSTEM

27. The major anatomical components of the nervous system

28. The anatomy of the cerebral cortex.

29. CORTICAL LOBAR FUNCTIONS Focal sensory seizures Contralateral hemisensory loss Dysphasia Language Calculation Parietal: dominant Versive seizures Focal motor seizures (Jacksonian march) Continuous partial seizures (epilepsia partialis continua) Impaired smell Contralateral hemiparesis Frontal release signs Disinhibition Lack of initiation Antisocial behaviour Impaired memory Expressive dysphasia Incontinence Personality Emotional control Social behaviour Contralateral motor control Language Micturition Frontal Positive phenomena Associated physical signs Cognitive/behavioural Function Lobe Effects of damage

30. CORTICAL LOBAR FUNCTIONS lower quadrantanopia Dressing apraxia Contralateral homonymous Constructional apraxia Agraphaesthesia Spatial disorientation Focal sensory seizures Contralateral hemisensory loss Astereognosis Neglect of contralateral side Spatial orientation Constructional skills Parietal: non-dominant

31. CORTICAL LOBAR FUNCTIONS Complex hallucinations (smell, sound, vision, memory) Contralateral homonymous upper quadrantanopia Receptive aphasia Dyslexia Impaired verbal memory Auditory perception Language Verbal memory Smell Balance Temporal: dominant

32. CORTICAL LOBAR FUNCTIONS Complex hallucinations (smell, sound, vision, memory) Contralateral homonymous upper quadrantanopia Impaired non-verbal memory Impaired musical skills (tonal perception) Auditory perception Melody/pitch perception Non-verbal memory Smell Balance Temporal: non-dominant

33. CORTICAL LOBAR FUNCTIONS Simple visual hallucinations (e.g. phosphenes, zigzag lines) Homonymous hemianopia (macular sparing) Visual inattention Visual loss Visual agnosia Visual processing Occipital

34. NS Exam: