A 25-year-old man injured his neck in an MVA 2 years ago. He has proprioception loss in his right foot, paralysis of the right lower extremity, and pain sensation loss on part of his left bodyPart of the C4 in his spinal cord broke off, his spinal cord was getting larger as it was going up, causing his symptomsMaking a Neurologic Diagnosis:The neurologic clinician attempts, with each patient, to answer:1) -Where is the lesion?2) -What is the lesion?Lesions of the nervous system can beAnatomic - with dysfunction resulting from structural damage (stroke, trauma, and brain tumors)Physiologic - reflecting neuronal dysfunction in the absence of demonstrable anatomic abnormalitiesSymptoms are subjective experiences from the disorder ("I have a headache"; "The vision in my right eye became blurry a month ago")Signs are objective abnormalities detected on examination or via laboratory tests (a hyperactive reflex or abnormal CSF protein level)sometimes patients can have both symptoms and signsManifestations of Neurologic Disease May Be Negative or PositiveNegative manifestations reflect damage to neurons-result from loss of function (hemiparesis, impaired sensation, loss of memory)-Parkinson disease-multiple sclerosisPositive abnormalities result from inappropriate excitation of neurons-These include seizures (caused by abnormal cortical discharge) and spasticity (from the loss of inhibition of motor neurons)NSC 4366 1st Edition Lecture 1Outline of Last Lecture I. No last lecture. This is the first lecture of the semesterOutline of Current Lecture II. DirectionsIII. Making a neurologic diagnosisIV. Clinical CasesV. Intro to anatomy of nervous systemCurrent Lecture:Directions: make sure to know the directions•Dorsal - back•Ventral - front•Rostral - headward•Caudal - buttward•Ipsilateral - same side•Contralateral - other side•To describe the flow of information:•Afferent - carries information into a region•Efferent - carries information away from a region• look over the horizontal plane, sagittal plane, and coronal plane•Coronal - slices the brain from front to back. Resembles a butterfly in most slices•Sagittal (midsagittal) - slices the brain down the midline so you can see what’s on each half•Horizontal - separates top from bottom•Processes Causing Neurologic Disease•Physicians ask, “Is there a single lesion that accounts for a patient’s signs and symptoms?” and in some cases, a single, critically places lesion injures several fiber tracts and/ or nuclei•Focal Process: Focal pathology from a single lesion. Most common example is astroke, when ischemia in the territory of an artery kills brain in a defined area.•Multifocal process: Multifocal pathology at separate sites. In multiple scleroses,lesions are disseminated throughout the CNS and over time (the lesions do not develop at once or in one place)•Diffuse Process: Diffuse dysfunction of the nervous system is produced by toxins and metabolic abnormalities, causing dysfunction throughout the nervous system, as in alcohol intoxication. •White vs. Gray matter•White matter - axon bundles - white because of myelin sheaths that cover the axons. •cholesterol is the main component of myelin•Gray matter - clusters of cell bodies - dark gray appearing•gray matter is mostly at the top and deep nuclei - basal ganglia and thalamus•Anatomy•know the basic anatomy on ppt. 1 starting from slide 15•central sulcus - nothing is in it. Sulcus means valley - space between two parts•Precentral gyrus is involved in motor function•Post central gyrus is involved in sensory function•The medulla, pons, and midbrain make up the brain stem•Thalamus controls attention•Reticular Activating System is involved in waking you up•Clinical Case:•A 25-year-old man injured his neck in an MVA 2 years ago. He has proprioception loss in his right foot, paralysis of the right lower extremity, and pain sensation loss on part of his left body• Part of the C4 in his spinal cord broke off, his spinal cord was getting larger as it was going up, causing his symptoms• Making a Neurologic Diagnosis:•The neurologic clinician attempts, with each patient, to answer:1) -Where is the lesion?2) -What is the lesion?3)•Lesions of the nervous system can be • Anatomic - with dysfunction resulting from structural damage (stroke, trauma, and brain tumors)• Physiologic - reflecting neuronal dysfunction in the absence of demonstrable anatomic abnormalities•Symptoms are subjective experiences from the disorder ("I have a headache"; "The vision in my right eye became blurry a month ago")•Signs are objective abnormalities detected on examination or via laboratory tests (a hyperactive reflex or abnormal CSF protein level)•sometimes patients can have both symptoms and signs•Manifestations of Neurologic Disease May Be Negative or Positive•Negative manifestations reflect damage to neurons-result from loss of function (hemiparesis, impaired sensation, loss of memory)-Parkinson disease-multiple sclerosis•Positive abnormalities result from inappropriate excitation of neurons-These include seizures (caused by abnormal cortical discharge) and spasticity (from the loss of inhibition of motor