The aim of the course is to provide a contemporary and thorough grounding in cellular, molecular and systems neuroscience. This knowledge is intended to serve as a basis for understanding the effects of damage to the nervous system as seen in General Clinical Medicine and in specialties such as Neurology, Neurosurgery, Psychiatry and Ophthalmology.

The course further aims to facilitate the awareness and development of professional competencies, which include clinical reasoning, components of clinical skills used in Neurological examinations, basic interpretation of modern imaging techniques, and team-based inter-personal skills, in particular during small group practicals and other interactive settings.

MODULE A: NEURANATOMY

2 & 3 Organization of the Nervous System - Objectives:

After the lecture a student should be able to:

• Describe the components of the nervous system, central nervous system (CNS) and peripheral nervous system (PNS), somatic nervous system (SNS) and autonomic nervous system (ANS).
• Differentiate the components of the CNS and the lobes of the cerebral hemispheres.
• Interpret the structural and functional features of the cerebral cortex and its connections with other parts of the CNS.
• Explain the anatomy of the spinal cord and the distribution of the white and grey matter at the different spinal cord levels.
• Understand the structure of a peripheral nerve.
• Apply the knowledge of the cranial nerves and differentiate, whether they are sensory, motor or both.
• Relate the clinical correlations to the underlying functional and anatomical organization

 

4. Neuroimaging - Objectives

After the lecture a student should be able to:

• Understand the different X-ray techniques in brain imaging, including angiograms and CAT Scan.
• Apply the knowledge about MRI (Magnetic Resonance Imaging).
• Identify and understand brain metabolism and brain diffusion with the use of radionuclear techniques e.g. PET, SPECT.
• Explain the indications for the above techniques diagnosis and research.
• Differentiate cerebral hemorrhages.

 

5. General Morphology – SG 1 - Objectives

After the lecture a student should be able to:

• Apply the knowledge of the different terms that describe the directions and sections in the Central Nervous System.
• Know the 5 parts of the brain and the ventricles.
• Describe the landmarks that separate the different lobes of the cerebral hemispheres.
• Recognize the significant structures of the inferior surface of the brain.
• Find the significant surface structures of the brainstem.
• Differentiate the cranial nerves on the surface of the brainstem.
• Describe the structures of a horizontal section if the spinal cord.

 

5.2 Surface of the Brain – SG 2 - Objectives

After the lecture a student should be able to:

• Apply the knowledge of the topography and the most important Brodmann’s areas of the lateral view of the hemispheres.
• Recognize the significant structures of the inferior surface of the brain and apply the knowledge of the olfactory cortex.
• Explain the anatomical parts of the fornix.
• Describe the surface structures of the medial aspect of the brain.
• Differentiate the different parts of the diencephalon and the ventricular system in a medial view.

 

6. Meninges and Arteries - Objectives

After the lecture a student should be able to:

• Apply the knowledge of the structures of the meninges in the brain and spinal cord.
• Describe the arterial supply to brain, brain stem and spinal cord.
• Explain the territories of the arterial supply to cerebral hemispheres, brain stem and spinal cord.
• Consider the likely functional losses arising from obstructions of the arterial supply to the cerebral hemispheres, brain stem and spinal cord.
• Understand the factors that influence blood flow in the CNS

 

7. Ventricles, CSF, Veins & Sinuses - Objectives

After the lecture a student should be able to:

• Describe the ventricular system of the brain.
• Apply the knowledge about the sites of CSF production and drainage.
• Understand the main chemical and physical characteristics of CSF.
• Interpret the mechanisms of increased intracranial pressure.
• Describe the venous system (veins and sinuses) of the brain.
• Know the veins of the spinal cord
• Localize the circumventricular organs

 

 

8. Brainstem and Cerebellum - Objectives

After the lecture a student should be able to:

• Describe the surface structures of the brain stem. 
• Apply the knowledge of the functions and the symptoms of dysfunction of the cranial nerves.
• Explain the inner structure of the brain stem and the organization of the efferent and afferent columns of the brain stem and some functions of the reticular formation.
• Understand the location of important efferent and afferent pathways between the cerebral cortex and the spinal cord.
• Know the anatomy of the most important nuclear groups in the brain stem and their relationship to the afferent and efferent tracts of the cranial nuclei.
• Name the arteries that supply the brainstem and describe their supply area.
• Recognize the surface structures of the cerebellum

 

MODULE B: CELLULAR NEUROSCIENCE

9. Neurons and Glia - Objectives

After the lecture a student should be able to:

• Describe the structural classification of neurons.
• Identify the differences between afferent neuron, efferent neuron and interneuron and the anatomical locations of their cell bodies and axons.
• List the main structural features of a neuron and understand how these features are related to neuronal function.
• Understand the roles of the microtubules, neurofilaments and microfilaments as components of the neuronal cytoskeleton.
• Understand the fibre classification systems of Erlanger & Gasser and of Lloyd
• Understand the roles of the axonal transport systems
• Understand the electrical signalling mechanisms in neurons.
• Describe the types of glial cell and their functions in the CNS and PNS.
• Understand the clinical correlations listed at the end of the lecture outline.

 

 

10. Resting Excitable Cells - Objectives

After the lecture a student should be able to:

• List typical values of the intracellular and extracellular concentrations of sodium, chloride and potassium ions for skeletal muscle fibres and neurons.
• Understand the mechanisms that maintain the ionic distributions across the cell membrane.
• Understand that ion channels are conductances and know their roles in determining the ionic currents flowing across the cell membrane.
• Understand the relation between the Nernst equation and the concept of ion equilibrium potential.
• Understand the concept of the electrochemical gradient for ionic diffusion across the cell membrane.
• List the typical values of the equilibrium potentials for sodium, chloride, calcium and potassium ions in skeletal muscle fibres and neurons.
• Understand the concept of the electrical equivalent circuit model of the cell membrane potential.
• Describe the ionic basis of the resting membrane potential.

 

 

11. Stimulated Cellular Neuroscience - Objectives

After the lecture a student should be able to:

• Understand the concept of linking the stimulus delivered to an excitable cell with the associated graded response generated by the cell
• Explain how excitable cells convert stimuli into responses consisting of changes of conductance and membrane potential
• Understand the concept of electrical signals spreading with decrement (length constant ) from their sites of origin
• Relate the properties of cable-like structures to their length constants
• Understand the signaling mechanisms giving graded responses in Ia afferent fibres in muscle spindles, rods in the retina and olfactory neurons in the nasal cavity
• Understand the concepts of the all-or-none response to depolarization, the threshold for excitation and the physical features determining the trigger (spike-initiating) zone in neurons

 

 

12. Action Potential - Objectives

After the lecture a student should be able to:

• Describe the basic features of the myotatic reflex.
• Understand that the muscle spindle monitors changes in muscle length.
• Understand the concept of receptor potential and how it is produced in the endings of Ia afferents in muscle spindles.
• Describe the factors influencing action potential propagation.
• Understand the concept of length constant.
• Understand the roles of myelin and ion channel distributions in saltatory conduction in myelinated axons.
• Relate conduction velocities and fibre diameters for myelinated and unmyelinated axons.
• Locate the sites of action and actions of TTX, STX, local anesthetics and 4-aminopyridine on voltage-gated ion channels.
• Understand how demyelination influences impulse conduction.
• Understand the clinical correlations.

 

 

13. Synaptic Transmission - Objectives

After the lecture a student should be able to:

• Understand how Ia afferents excite motor neurons and local interneurons in the spinal cord by releasing glutamate.
• Understand the excitatory transmitter evokes an EPSP by activation of ionotropic receptors which are cation channels.
• Explain why most excitatory synapses in the CNS have the same ionic basis.
• describe how the local inhibitory interneurons, excited by glutamate released by Ia afferents, release glycine.

• Understand why the ionic basis of IPSP evoked by glycine (or GABA) reflects the activation of ionotropic receptors which are chloride channels.
• Understand the processes of spatial and temporal summation.
• Understand the general features of synaptic transmission (chemical & electrical transmission, location and roles of synapses, ionotropic and metabotropic receptors, mechanisms for removal of transmitter from synaptic cleft).

 

14.  Neuromuscular & Ganglionic Transmission - Objectives

After the lecture a student should be able to:

• Understand that ACh is the excitatory transmitter released by all efferent neurons
• Understand that all postsynaptic cells innervated by efferent neurons have nicotinic receptors (nAChRs) for Ach
• understand that the nicotinic receptor (nAChR) is an ionotropic receptor with a typical ligand-gated structure mediating fast responses and that it operates as a cation channel
• understand the mechanism of activation of nAChRs
• Describe what a motor unit is.
• Locate the distribution of channels in the motor nerve ending, the muscle end plate and the rest of the muscle membrane.
• Understand the ionic basis of the end plate potential (EPP) and that the EPP normally it exceeds the threshold of the muscle.
• Describe the fate of ACh in the synaptic cleft.
• Locate the sites of action and understand the mechanisms of action of drugs and toxins at the NMJ.
• Understand the list of clinical correlations at the end of the lecture outline.

 

 

15.  Transmitter Release - Objectives

After the lecture the student should be able to:

• Understand the role of extracellular calcium ions in transmitter release.
• Understand the role of intracellular calcium ions in transmitter release.
• Understand the quantal hypothesis of transmitter release.  Understand the difference between quantum content and quantum size.
• Understand the concepts of co-existence and co-release of transmitters.
• Understand the roles of cytoskeketon in exocytosis, endocytosis, axonal transport and retrieval and recycling of vesicular membrane.
• Understand the cellular mechanisms of botulism, tetanus and the effect of alpha latrotoxin
• Understand the mechanisms of presynaptic inhibition.
• Understand the list of clinical correlations.

 

 

16.  Neurotransmitter Systems - Objectives

After the lecture the student should be able to:

• Describe the chemical nature of transmitters, their precursors and their removal mechanisms
• Describe the similarities and differences between the efferent pathways of the somatic nervous system ( SNS) and those of the autonomic nervous system (ANS)
• Understand that muscarinic  receptors and adrenoceptors are metabotropic receptors interacting with G-proteins to mediate relatively slow excitatory or inhibitory responses
• List the differences between nAChRs and muscarinic receptors and the main sites of the cellular distribution of these receptors
• Understand the basis of adrenoceptor classification
• Locate the cellular distribution of the receptors for ACh and catecholamines and describe the nature of the responses they mediate in heart, glands and smooth muscle.
• List the main agonists and antagonists for nicotinic, muscarinic and adrenoceptors.
• Understand that inhibition in the central nervous system is mediated by glycine and GABA acting on ionotropic glycine and GABAA  receptors and also by GABA on metabotropic GABAB receptors
• Describe the mechanism of action of benzodiazepines and barbiturates on the ionotropic GABAA receptor
• Describe the use of re-uptake blockers to improve serontonergic and noradrenergic transmission in treatment of mood disorders
• Describe the use of dopamine agonists and antagonists in the treatment of movement and psychosis respectively
• Understand the clinical correlations listed at the end of the lecture outline.

 

 

17.  Transport within the CNS - Objectives

After this lecture a student should be able to:

• List the fluid compartments in the CNS
• Describe the site of the blood brain barrier (BBB) and the blood CSF barrier
• Understand the mechanisms of solute transport across the BBB
• Know that the endothelial cells of the blood capillaries have transporter proteins for glucose and some amino acids
• Understand the role of the choroid plexus in CSF formation and the arachnoid villi in CSF drainage
• Understand the differences between solute (and water) transfer across the BBB and blood CSF barrier and across the ependymal cells lining the ventricles
• List the main components of the CSF and the normal value of the intracranial pressure.  Be aware of changes in the composition of the CSF in the examples of disorders cited in the lecture
• Understand the causes of brain edema and hydrocephalus

MODULE C: SENSORY SYSTEMS

18. Sensory Systems - Objectives

After this lecture a student should be able to:

• Describe the common plan of sensory systems and its components
• Name the four basic sensory receptor classes, indicate which receptor classes are used in which of the six sensory systems, and know the adequate stimulus for each of the receptor classes
• Draw and label the different components of a pseudounipolar neuron as an example of a sensory receptor and explain where each of the three basic processes takes place
• Describe the morphological and functional differences between sensory receptor neurons and sensory receptor cells
• Explain the difference between graded receptor potentials and action potentials
• Explain how the four attributes of a stimulus, modality, intensity, duration and location are encoded in sensory systems
• Outline the three basic wiring mechanisms of sensory systems and explain their functional consequences

 

19.  Somatosensory System - Objectives

After this lecture a student should be able to:

• describe the morphology, location and functional characteristics of somatosensory receptors of the skin and of the skeleto-muscular system
• name the four different classes of afferent fibers, appropriately use each of the two classification schemes for skin afferents and muscle afferents, describe the morphological and functional characteristics of these fibers and indicate which sensory modalities are carried in the different fiber types
• explain the segmental organization of the somatic sensory system in the spinal cord and the dermatomal innervation of the body surface, using the appropriate names and classifications of the spinal nerves, and to describe the anatomical relation between spinal nerves and the vertebral column
• apply the knowledge of dermatomal landmarks in clinical case scenarios and extrapolate for regions in between if necessary
• describe the two pathways of the somatosensory system, the Dorsal Column / Medial Lemniscus System and the Anterolateral System from the dermatomes of the skin to the spinal cord, including their passage within the spinal cord, and the topographical organization of the fibers
• describe the anatomical details of Lissauer’s Tract and explain its relevance in clinical case scenarios
• relate the clinical correlations Shingles (herpes zoster), Brown Sequard Syndrome and Syringomyelia to the underlying functional and anatomical organization of the somatic sensory system, and elaborate their diagnostic value in the identification and localization of the disease processes

 

20.  Touch - Objectives

After this lecture a student should be able to:

• Describe the complete pathways for touch, vibration and proprioception, including the localization in different sections of the central nervous system
• Apply the knowledge of touch, vibration and proprioception pathways in a clinical scenario with respect to potential lesions in the pathways
• Identify the primary somatosensory cortex and localize the areas involved anatomically, as well as in Brodmann’s system
• Describe the three features of sensory cortex areas in general, and specifically of the somatosensory cortex
• Apply the knowledge of the organization of the primary somatosensory cortex, specifically the somatotopic organization, in a clinical scenario with respect to potential cortical lesions
• Explain two point discrimination, the variation in different areas of the body’s surface, and its underlying mechanisms
• Relate the clinical correlations of Neurological Examinations, Tabes dorsalis and Phantom limb sensations  to the underlying functional and anatomical organization of the somatic sensory system, and elaborate their diagnostic value in the identification and localization of the disease processes

 

 

21.  Pain - Objectives

After the lecture a student should be able to:

• describe the different types of pain and explain the underlying mechanisms
• describe the complete pathways for pain and temperature, including the localization in different sections of the central nervous system
• apply the knowledge of pain and temperature pathways in a clinical scenario with respect to potential lesions in the pathways
• explain the difference between activation and sensitization of nociceptors and know the relevant chemical components and their origin
• describe the gate control theory, the afferent and descending pain regulation pathways and explain the transmitters and mechanisms involved
• relate the clinical correlations of Neurological Examinations, Headache, Aspirin, Surgical Management of Pain and Acupuncture to the underlying functional and anatomical principles

 

 

22.  Visual System - Objectives

After this lecture a student should be able to:

• Describe the major structures of the eye and where they are located, their functional relevance, including the blind spot, and to interpret the fundus of the eye as it is seen through an ophthalmoscope
• Explain how refraction contributes to the formation of an image, recognize the refractive power of cornea and lens
• Explain the mechanism of near and far vision, define refractive power for the different structures of the eye, and describe the change of refractive plasticity during aging
• Define visual acuity and explain the major factors contributing to visual acuity
• describe the mechanism of change of pupil diameter and the neuronal pathways involved in its control
• Relate the clinical correlations of Emmetropia, Myopia, Hyperopia, Papilledema, Macular Degeneration and Diabetic Retinopathy to the underlying functional and anatomical principles, describe the Neurological Examination of Visual Acuity and interpret the associated distance equivalent values

 

 

23.  The Retina - Objectives

After the lecture a student should be able to:

• Describe the structure of retinal photoreceptors, their functional properties, and the turnover process of their outer segments
• Name and classify the two components of the visual pigment rhodopsin, and describe the phototransduction process, including the dark current
• Describe the functional characteristics of the three different cone types and explain how they contribute to color vision
• Describe the structure of the retina, including cell types, the direct and indirect information flow
• Explain the generation of ON and OFF signals in retinal bipolar cells, the mechanisms involved in the center surround organization of retinal cells, and the firing patterns of ON and OFF center ganglion cells
• Relate the clinical correlations of Retinitis Pigmentosa, Night Blindness, and Color Blindness to the underlying functional and anatomical principles, and describe the Testing procedure for Color Blindness

 

24.  Visual Pathways - Objectives

After the lecture a student should be able to:

• Describe the organization of the visual field including the point of fixation, the blind spot, and their anatomical correlates, using the appropriate terminology
• Describe how the visual field is represented on the retina
• Describe the retinal projections to the different areas of the brain
• Draw and explain the different neuronal pathways for all quadrants of the visual field
• Identify and describe the location of the primary visual cortex in the occipital lobe
• Explain the organization of the primary visual cortex, with special reference to the columnar organization, and describe the experiments that revealed this organization
• Describe the organization of parallel functional pathways for depth, motion, form and color
• Describe the Neurological Examination of the Visual Fields, and relate the clinical correlations of Visual Pathway Lesions including Cortical Color Blindness to the underlying functional and anatomical principles

 

 

25.  Eye Movements - Objectives

After the lecture a student should be able to:

• Briefly describe the different types of eye movements
• Name the extraocular muscles, list their innervation, and the major function of each muscle, and interpret graphical sketches of extraocular function
• Localize the ocular motor nuclei and other control units of extraocular movements in the brain stem and in the cerebral cortex
• Describe the function and characteristic parameters of saccadic eye movements and lateral gaze
• Draw and describe the neuronal circuitry of saccades
• Explain the Neurological Examination of Eye Movements and the Red Glass Test, and relate the clinical correlations of Trochlear Nerve Palsy, Oculomotor Nerve Palsy, Abducens Nerve Palsy, Diplopia, Internuclear Ophthalmoplegia, PPRF Lesion and One-and-a-half Syndrome to the underlying functional and anatomical principles

 

 

26.  Vestibular System - Objectives

After the lecture a student should be able to:

• Describe the functional anatomy of the two receptor organs of the vestibular system, the otolithic organs and the semicircular canals
• Explain the cellular and molecular elements of the signal transduction process in the inner ear
• Explain how linear acceleration is detected in utricle and saccule, and angular acceleration in the semicircular canals
• Point out the essence of the vestibular pathways, including the input and output of the vestibular nuclei
• Describe and explain the Vestibulo-Ocular Reflex, including the afferent and efferent limbs, the underlying mechanisms, in particular the activation mechanism in the horizontal semicircular canals and the circuitry of the horizontal VOR
• Define nystagmus in general, distinguish a physiological nystagmus from a pathological nystagmus and describe the elements and mechanisms of the physiological Vestibulo-Ocular Nystagmus
• Explain the Neurological Examination procedures of Brainstem Functions including the Vestibulo-Ocular Reflex, and relate the clinical correlations of Meniere’s Disease, Motion Sickness, Alcohol Intoxication, Antibiotics, and the Pathological Vestibular Nystagmus to the underlying functional and anatomical principles

 

 

27.  Ocular Reflexes - Objectives

After the lecture a student should be able to:

• Outline the diagnostic value of the visual system in Clinical Medicine
• Describe and explain the Optokinetic Reflex, its function, circuitry, and the afferent and efferent limbs, including the adequate stimulus
• Explain how an Optokinetic Nystagmus is induced and describe its different elements and their direction
• Explain the three different phases of the Rotating Chair Experiment and use it as a tool to study the Vestibulo-Ocular Nystagmus and the Optokinetic Nystagmus
• Describe and explain the Corneal Reflex, its function, circuitry, and the afferent and efferent limbs, including the adequate stimulus, and summarize the innervation of the eye lid
• Describe and explain the Optokinetic Reflex, its function, circuitry, and the afferent and efferent limbs, including the adequate stimulus
• Explain the Neurological Examination of the Optokinetic Nystagmus, the Pupillary Light Reflex, and the Corneal Reflex and use them as means of identifying the localization of lesions, by relating the findings to the underlying anatomical and functional principles
• Explain Bell’s palsy and the deficits it causes in relation to the Corneal Reflex and the facial expressions of the mimic musculature

 

 

28.  Auditory System - Objectives

After the lecture a student should be able to:

• Describe the nature of sound and its characteristics
• Describe the functional anatomy of the outer, middle and inner ear, explain the mechanisms of pressure amplification in the middle ear
• Describe the different fluid compartments of the cochlea, their chemical and electrical properties, and their relation to the hair cells
• Explain the mechanisms for the encoding of sound frequency
• Identify the two different types of hair cells and describe their different functions
• Explain the mechanisms of sound transduction in the inner ear and their underlying structures, including traveling waves and the mechanism of mechanically gated potassium channels

 

 

29.  Chemical Senses - Objectives

After the lecture a student should be able to:

• Describe the basic taste qualities, and explain the functional anatomy of the gustatory system, focusing on taste buds and receptor cells, and the different signal transduction processes
• Describe different smell qualities and explain the functional anatomy of the olfactory system, focusing on olfactory receptor neurons, the signal transduction process, the olfactory bulb and its circuits
• Describe the olfactory pathways, the location of cortical olfactory areas, and their relation to our emotional system
• Describe the basic anatomical and functional characteristics of the Vomeronasal Organ and explain the identification process of human pheromones
• Rate the clinical correlations of Loss of Taste Functions, Loss of Smell Function and Olfactory Hallucinations in epileptic seizures to the underlying functional and anatomical principles

 

MODULE D: NEURODEVELOPMENT

Objectives

After the lectures, as student should be able to:

Neuroembryology

• Learn the structures in the nervous system which develop from the neural tube and neural crest
• Know the role of Bone Morphogenetic Protein (BMP) in ectoderm differentiation
• Realize the clinical consequences of failed neural tube closure (rostral and caudal)

Segmentation

• Define homeotic (homeobox) genes (Hox family). Learn the source and role of retinoic acid in the differential expression of these genes
• Learn the mechanism of the highly segmented rhombencephalon
• Understand the source of Sonic Hedgehog protein, the influence of this protein on the neural tube, and the significance of its interaction with BMP
• Appreciate the implications of experiments which over express the “Eyeless” gene in Drosophila
• Learn cerebral cortex anomalies associated with defects in the genes emx and otx
• Define primary and secondary vesicles and associated nervous system structures

Cell Proliferation

• Identify neuronal cellular activity at the ventricular and pial surfaces during development.
• Define the marginal and ventricular zones in the telencephalic vesicle

Cell Migration

• Define and understand the role of radial glial cells
• Understand what is meant by the layers of cortex developing in an “inside-out” fashion
• Appreciate the importance of the Cajal-Retzius cells and the reeler gene with regard to cellular migration
• Understand how GnRH producing cells provide one exception to the general principle that radial glial cells provide guidance for migration

Cell Maturation and Commitment

• Understand how the neuron’s environment influences its commitment to function
• Appreciate the role of neuronal location in determining the specific neurotransmitter released by specific cells
• Learn the role of Leukemia Inhibitory Factor as an example of local peptide influences on neuronal cell phenotypes
• Understand the role of PMP-22 protein in myelination of peripheral nerves
• Explain the relevance of Schwann Cell – Neuron interactions to the appropriate expression of PMP-22
• Learn how experiments with the “Trembler” mouse (with genetic myelination deficiencies) illustrate the importance of the Schwann cell’s role
• Associate knowledge of PMP-22 protein with Charcot Marie Tooth disease
• Learn the role of laminin in axonal outgrowth
• Be aware of the diffusible substance “netrin”, and its influence on axon growth, with specific regard to motor versus sensory nerves

Cell Survival and Death

• Understand the basic mechanisms that explain the actions of Nerve Growth Factor, including tyrosine receptor kinase activity
• Explain the role of NGF for Sympathetic and Dorsal Root Ganglion structures
• Identify the importance of the Neurotrophin family of growth factors
• Define apoptosis and its importance in neurodevelopment
• Appreciate how cell death appears to be crucial for appropriate matching of motor neurons and skeletal muscle targets

Specificity of Synaptic Connections

• Understand the specificity example elucidated in the frog’s retina to tectum connections
  
• Learn the role of the Eph (ephrin) family of receptor tyrosine kinases
  
• Appreciate how ligands for ephrin receptors (Ephrin A2 and A5) are expressed differentially with regard to time and location (tectum concentration gradient)
  
• Realize the limitations of knowledge regarding synaptic specificity
  
• Understand how a skeletal muscle motor end plate starts off by being innervated by 5or 6 motor axons, all of which retract subsequently leaving just one
• Define the critical period in relation to visual projections from the Lateral Geniculate Nucleus to the Visual (Striate) Cortex
• Learn the difference in changes to ocular dominance columns after monocular deprivation, before and after the critical periods
• Interpret histograms demonstrating shifts in ocular dominance during monocular deprivation in the critical period
• Understand how geniculate axon retraction occurs, and know the effect on this process when monocular blindness occurs during the critical period
            

 

MODULE E: MOTOR SYSTEMS

38. Organization of the Motor Pathways - Objectives

After the lecture a student should be able to:

• Understand how sequences of movements are initiated and controlled.
• Describe how the motor neurons are distributed in the spinal cord (axial, proximal and distal muscles; flexor and extensor muscles).
• Explain that some motor pathways are biased to produce excitation of the motor neurons innervating flexor muscles whereas other pathways are biased to activate extensor motor neurons.
• Know the locations of the flexor and extensor biased pathways in the spinal cord
• Understand the topographical relationships between locations of motor neurons in the cortex and their activating pathways in the spinal cord.
• Understand the symptoms of lesions in different locations (levels) of the motor pathways (i.e. anterior horn, spinal cord).

 

39. Corticospinal – and Corticobulbar Fibers - Objectives

After the lecture a student should be able to:

• Apply the knowledge of the features of the corticospinal pathway.
• Describe the somatotopic organization of motor cortex.
• Understand how different parts (i.e. premotor cortex, somatosensory cortex) act together to initiate and control the sequences of movements.
• Understand the symptoms of lesions in different locations (levels) of the motor pathways (spinal cord, motor cortex).
• Explain the concept of the corticobulbar fibres.
• Describe hypoglossal and facial innervation.

 

40. Other Motor Pathways - Objectives

After the lecture a student should be able to:

• Know that some motor pathways are biased to produce excitation of the motor neurons innervating flexor muscles whereas other pathways are biased to activate extensor motor neurons.
• Know the start, end, route and function of the flexor biased pathways:lateral corticospinal, rubrospinal and medullary (lateral) reticulospinal

• Know the start, end, route and function of the extensor biased pathways: pontine (medial) reticulospinal, lateral and medial vestibulospinal tract.

• Understand the functions of the flexor and extensor biased pathways and know what factors influence activity in these pathways.
• Be able to describe the locations of the flexor and extensor biased pathways in the spinal cord.
• Differentiate which pathways synapse with alpha and /or gamma neurons.
• Know which pathways synapse with interneurons and distinguish which pathways have excitatory input versus inhibitory input.
• Be able to describe the concept of the gamma loop.
• Understand that certain motor tracts modify the modulation the gamma loop

 

41.   Muscle Innervation & Motor Unit - Objectives

Prior to the lecture a student should:

Review the classification of muscle afferent fibers related to fiber diameters and myelination.

After the lecture a student should be able to:

• Describe the types of intrafusal fibers within the muscle spindles and their sensory and motor innervations.
• Explain the roles of dynamic and static intrafusal fibers in monitoring muscle length changes.
• Apply the knowledge of the anatomy and physiology of the Golgi tendon organ.
• Understand the general features of the motor control system.
• Indicate the important characteristics about the location of motor neurons in the spinal cord.
• Apply the concept of the physiological roles of the muscle spindle in the stretch reflex, in sustained contraction, and during co-activation of alpha and gamma motor neurons.
• Define the motor unit and know the types of motor units within the muscle.
• Understand the mechanisms whereby contraction of a muscle can be increased.

 

42.  Diseases of NMJ & Motor Unit - Objectives

After the lecture a student should be able to:

• Know the sites of possible lesions in the motor unit.
• Be aware of toxins that can influence ACh release.
• Apply the knowledge of the pathomechanisms of Lambert Eaton Syndrome, the different forms of myasthenia, and myotonias.
• Describe different forms of myasthenia (auto-immune effects on number of voltage-gated calcium channels or nAChRs, deficiency of ACh-esterase, slow channel syndrome).
• Understand the differences between the myopathies, myotonia congenita and muscular dystrophy.
• Understand the terms 'lower motor neuron' and 'upper motor neuron'.
• Explain the difference between fibrillation and fasciculation.
• Describe the changes taking place in de-nervated muscle and the mechanisms of re–innervation.

 

43.  PNS Disorders - Objectives

After the lecture a student should be able to:

• Explain the basic features of nerve conduction velocity measurement and what theses measurements may reveal about the sites of the lesion in the peripheral nervous system.
• Understand the process involved in the neuron's response to trauma and know that the death of a neuron can lead to death of its presynaptic and postsynaptic neighbors.
• Apply knowledge about the processes involved in regeneration and re-myelination in the peripheral nervous system.
• Describe the features of guidance of a regenerating motor axon to its end plate target on a de-nervated muscle fiber.
• Interpret the basis of neuropathy in the examples cited, namely Guillain-Barré syndrome, leprosy, diabetic and alcoholic neuropathy.

 

44. Spinal Reflexes - Objectives

After the lecture a student should be able to:

• Explain the circuit of the stretch reflex, its function, and the reflex testing in a neurological examination including landmarks.
• Apply the knowledge about the pathological findings of the reflex testing in an UMS and LMS.
• Describe the functional role of the Golgi tendon organ and its reflex circuit.
• Know and understand the circuit of the flexion crossed extension reflex and its function.
• Describe the basic components of the plantar response, its normal and pathological version, functional changes during development, and the basics of its neurological examination.

 

45.   Movement Disorders:  Introduction - Objectives

After the lecture and watching the video a student should be able to:

• understand the terms stance, gait and posture
• describe the clinical features of  some motor disorders
• list the clinical terms describing the movement disorders shown in the video

 

46.  Movement Disorders:  Basal Ganglia - Objectives

After the lecture a student should be able to:

• list the nuclei of the basal ganglia
• describe the functional connections between the nuclei of the basal ganglia
• define the inputs into the striatum and the output pathway to the thalamus
• describe the anatomical relations of the direct and indirect pathways
• understand the functional significance of the direct and indirect pathways
• understand the role of the indirect pathway in Parkinson disease and the drug and surgical procedures used to treat the disease
• understand the different roles of lesions in the basal ganglia that cause Huntington’s chorea and hemiballismus
• understand the bases of therapies for disorders of the basal ganglia

 

 

47. Movement Disorders:  Cerebellum - Objectives

After the lecture a student should be able to

• describe the gross structure  of the cerebellum and its three functionally important divisions.
• understand the functions of the cerebellum in relation to its control of movement.
• describe the signs of cerebellar disease.
• state that the Purkinje cells in cerebellar cortex are the only output cells of the cortex and that they are inhibitory.
• relate the main input and output connections between the cerebellum and the body’s motor systems.
• understand why lesions of particular divisions of the cerebellum will cause the specified disorders of posture, stance and gait.

 

MODULE F: AUTONOMIC CONTROL SYSTEMS

 

48.  Autonomic Nervous System - Objectives

After the lecture a student should be able to:

• explain the basic concept of autonomic functions, describe the model of negative feedback regulation, and demonstrate its contribution to homeostasis
• compare and contrast the neuroanatomical and functional characteristics of the three Divisions of the Autonomic Nervous System
• outline the morphology, cellular organization, transmitter systems, receptors, and target cells of the sympathetic and parasympathetic efferents
• describe the Pharmacology of Autonomic Function, including the pre- and postsynaptic transmitter and receptor types and subtypes (see Appendix), with a special emphasis on autonomic control of pupil and accommodation, of cardiac function, of the airways, and of the urinary bladder
• relate the Clinical Correlations of Pharmacological Influence on Autonomic Function to the anatomical and functional characteristics of the systems involved and your knowledge of autonomic transmitter and receptor systems

 

 

49. Hypothalamus - Objectives

After the lecture a student should be able to:

• describe hypothalamic function as the central control unit of life, including the integration of autonomic function, endocrine function and behavior
• explain the concept of homeostasis
• describe the neuroendocrine function in the context of chemical signaling in general and compare it with other modes of chemical signaling
• identify and describe the structure of the hypothalamus and pituitary in coronal, sagittal (and horizontal) imaging sections
• explain the pathways connecting the hypothalamus with the anterior and posterior pituitary, the neuroendocrine substances involved, and their function
• explain how the hypothalamus controls feeding behavior, water balance and body temperature
• relate the clinical correlations of Fröhlich syndrome, Diabetes insipidus, Hypo- and Hyperthermia, to the underlying functional and anatomical principles

 

 

50. Autonomic Control Circuits - Objectives

After the lecture a student should be able to:

• present a review the autonomic control of visual functions, including autonomic control of the pupil
• describe the control circuits of the urinary bladder, including the different levels of bladder control, and the control mechanisms and circuits of its filling and emptying
• explain and define circadian rhythms, describe some of the physiological parameters following a circadian pattern
• outline the innervation and autonomic control of reproductive organs
• explain the basics of an activity chart, the experimental setting for studying  circadian rhythms, and the concept of a free running rhythm versus a rhythm controlled by external parameters
• describe the Biological clock system of the Suprachiasmatic nucleus, including its re-setting mechanisms, its link to the Pineal gland, and its humoral output
• relate the Clinical Correlations of Horner's syndrome, Automatic and Atonic bladder, Jet Lag, Sleep-Wake Disorders in Blind Individuals and Seasonal Affective Disorder (SAD) to the underlying functional and anatomical principles

 

MODULE G: COMPLEX BRAIN FUNCTIONS AND DISEASES

Sexual Differentiation of the Brain - Objectives

After the lecture a student should be able to:

• describe the evidence for sexual dimorphism of the brain, including frequencies of disease processes, sexual and non-sexual behavior and the hormonal environments of males and females
• name some of the sexually dimorphic areas of the brain and explain their general location and the nature of the differences described
• explain the findings linking morphological differences of brain structures with gender identity and sexual orientation
• explain the steps and mechanisms of sexual differentiation in general, and specifically of the brain, including the genetics of sex, the role of sex hormones, the critical period of sexual differentiation, and the molecular mechanism of testosterone action
• relate the clinical correlation of Fetal Exposure to Diethylstilbestrol (DES) to the underlying mechanisms of sexual differentiation of the brain

 

Emotions - Objectives

After the lecture a student should be able to:

• describe the basic principles of the James-Lange Theory and the Cannon-bard Theory of Emotions
• outline the historical steps in the Development of the Concept of the Limbic System, from Broca's Limbic Lobe and Papez Circuit to MacLean's Limbic System
• explain how lesions can help to identify brain structures involved in emotions by describing the Case of Phineas Gage, Frontal Lobotomy, the Klüver-Bucy Syndrome
• explain how the involvement of the Amygdala in Fear, Anxiety, Anger and Aggression has been analyzed, including the Fear Conditioning Experiment and functional MRI Studies in Humans
• describe the neural circuit for learned fear derived from these experiments
• relate the clinical correlations of Anxiety Disorders, Tumors and Psychomotor Epilepsy to the underlying functional and anatomical principles

 

53. Vascular Brainstem Syndromes - Objectives

After the lecture a student should be able to:

• Describe the structure of the brain stem.
• Interpret the functions and the symptoms of dysfunction of the cranial nerves.
• Describe the inner structure of the brain stem and understand the organization of the efferent and afferent columns of the brain stem and functions of the reticular formation.
• Locate efferent and afferent pathways.
• Explain the ways through which stereotyped behaviors (e.g. eye-movements, postural control) are controlled by the brain stem.
• Understand the clinical correlations presented.

 

54. Consciousness - Objectives

After the lecture a student should be able to:
 

• Explain the Ascending Reticular Activating System.
• Interpret the role, the brain stem and the thalamus plays in regulating consciousness and wake - sleep - cycles.
• Describe the different levels of consciousness and the Glasgow – Coma – Scale.
• Differentiate coma from brain death, locked-in-syndrome and vegetative state.
• Know possible causes for coma.
• Examine an unconscious patient.
• Describe how certain pupillary light responses, oculomotor responses, and respiratory patterns may enable the examiner to locate the lesion which causes a coma in the brain or brain stem and the possible cause for coma

 

55. Language & Aphasias - Objectives

After the lecture a student should be able to:

• Describe the basic construction principles of language.
• Explain the development of language (in evolution and in children)
• Understand how language is processed in the brain:
• Speaking
• Hearing
• Reading
• Writing
• Know about the role of left and right hemisphere in processing language.
• Distinguish different aphasias and know the associated cerebral area(s) that’s damaged.
• Explain Alexia and Dyslexia.

 

56.  Mental Illness - Objectives

• Know the symptoms and anatomical abnormalities of schizophrenia.
• Understand the mechanisms, how antipsychotic drugs are effective in the neurotransmitter pathways.
• Know the symptoms and anatomical abnormalities of affective disorders.
• Understand how antidepressant drugs work.

 

57. Addiction - Objectives

After the lecture a student should be able to:

• Describe the criteria for the ‘Dependence Syndrome” according to ICD 10
• Discuss biological, psychological, and social causes for addiction.
• Explain the brain reward system.
• Know the effects and the symptoms of intoxication of the most important legal and illegal addictive drugs
• Understand psychic and physical dependence
• Describe the withdrawal syndrome in alcohol and opiate dependant patients
• Know the basic concepts of the treatment of the withdrawal syndrome of sedative drugs.

 

 

58. EEG and Epilepsy - Objectives

After the lecture a student should be able to:

• Understand the physiology of an electroencephalography:
• Normal wave
• Pathological wave
• Explain the indications for an EEG.
• Describe the different kinds of seizures.
• Understand the basic principles of epilepsy - treatment
• Know the complications of an epileptic status‘.

 

59.  Sleep - Objectives

After this lecture a student should be able to:

• understand the basis of EEG recording of sleep stages.
• describe the stages of sleep and the differences between NREM (stage 4) and REM sleep.

• list the major differences in sleep stages at different ages.
• understand the basis of the hypnogram used to represent the stage of sleep.
• understand the influences of the thalamus and brain stem on the sleep-wake cycle.
• describe the different forms of sleep disorder.

 

 

60.   Memory Systems - Objectives

After the lecture a student should be able to:

• understand the difference between declarative memory and nondeclarative (procedural) memory

• understand the basis for the terms: intermediate memory, short term memory, long term memory, working memory, retrograde amnesia , anterograde amnesia and transient global amnesia

• understand the concept of engram

• list the parts of the brain involved in declarative memory storage and those involved in processing prior to storage

• understand the role of the hippocampus in new memory formation
• describe the circuitry of the hippocampal formation

• understand the intracellular signalling mechanisms responsible for long term potentiation (LTP) and long term depression (LTD) observed at synapses in the hippocampal formation
• understand the intracellular signaling mechanisms responsible for LTD observed at synapses in the Purkinje cells of the cerebellum.

 

61.   Aging & Alzheimer’s disease - Objectives

After this lecture a student should be able to:

• understand the meaning of life expectancy and healthy life expectancy
  
• understand the factors that influence life expectancy
  
• understand the changes occurring in the nervous system during aging.
  
• describe the pathological signs of Alzheimer’s disease and understand
  their origin.
  
• list the stages of Alzheimer’s disease.
  
• understand the origins of other age-specific degenerating conditions in the
  nervous system

62. Integrating Neuroscience through Imaging - Objectives

After the lecture a student should be able to better:

• Integrate neuro-anatomic and  functional aspects like the significance of cortical-, brainstem-,spinal cord areas and of somatosensory and motor tracts
• Match certain neurological symptoms with the possible site(s) of lesions.

 

BUZZ DISCUSSIONS: CLINICAL CASES

Objectives

The major goal of Clinical Case Discussions is the introduction of students to the process of critical clinical thinking and reasoning. Students should be guided to learn to apply knowledge gained during the preceding basic science lectures. Focus will be on the diagnosis and differential diagnosis, where applicable, far less on treatment of disease processes.

 

At the end of a Clinical Case Discussion, a student should be able to:

• name, define and distinguish the two fundamental questions asked during the diagnosis of a disease process
• classify and differentiate physician-patient interactions into processes of history taking, and general and neurological examinations
• explain and demonstrate the contributions of history and examination to the diagnostic process
• list major categories of disease processes and illustrate what characteristics distinguish these categories from each other
• apply an abbreviated standardized checklist used for taking notes on history and examination by transfering the information derived from a written case description into this checklist
• analyze the notes on the checklist of an individual case and differentiate between normal and pathological findings
• dissect each of the pathological findings and interpret their implications for both, the categories of disease processes, as well as their locations
• explain the thought processes leading to the category and type of disease
• elaborate the relation between proposed structural damages and their functional consequences
• evaluate and rank the different findings with respect to their probability regarding the category of the disease process as well as its location
• integrate the different findings, make a diagnostic proposal and defend the proposal of the most likely category and location of the disease process

Objectives for the Identification of Anatomical Structures – Practical Sessions

The overall goal of the anatomical part of the Small Group Practical Sessions is to facilitate the acquisition of comprehensive knowledge of structures of the central nervous system, as used in basic functional neuroanatomy as well as in clinical settings.

After the Small Group Practical session a student should be able to:

using a model to identify all surface structures listed in this section and describe its neighbouring structures and their 3-dimensional arrangements

discuss the location of underlying structures listed in this section, using the 3-dimensional models

predict the arrangements of structures as seen in hypothetical sections through the models and match these structures with the relevant sections of anatomical specimen, MRIs, or angiograms

apply the anatomical knowledge gained in analyzing models, sections, or angiograms in the clinical case discussions