The Curriculum Outlineof Neurology

The Curriculum Outline of Neurology
For Nepalese Medical Students
Department of Neurology
Weifang Medical College
Outline of neurology
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 General teaching aims
Through theoretical teaching and clinical practice let students grasp or know well the basic theory,
basic technique and establish foundation for further study of clinical neurology.
 General requirement
1. mastering the neurological history taking and neurological examination.
2. mastering the topical diagnosis and qualitative diagnosis of neurological disease.
3. mastering the treatment principle of neurological diseases that is common and serious.
4. mastering the basic operation technique such as lumbar puncture.
 Teaching contents and time distribution (to see table 1)
Table 1 teaching contents and time distribution (1 class hour = 40 minutes)

Content Theoretical Practice Questions and
teaching
teaching answers
Chapter 1 Introduction 0.5
Chapter2 Symptomatology of the 8.5 4 10
neurological diseases
Chapter3 The clinical methods 5 4 6
of neurology
Chapter4 The special techniques for 2 2 4
neurological diagnosis
Chapter 5 The diagnostic principles of the 2 2 4
neurological diseases
2 trigeminal neuralgia
Chapter 6 Diseases of peripheral nerves 4 6
Bell palsy
GBS
Chapter7 Diseases of the spinal cord 2 2 acute myelitis 3
2
Chapter 8 Cerebrovascular diseases 10 6 　TIA 、CI、 CH、 SAH
14
Chapter 9 Infections of the central nervous 2 2　HSE 3
system
Chapter 10 Demyelinating diseases of the 2 2 MS 3
C.N.S
Chapter 11 Movement disorders 3 2 　PD 4
Chorea minor
Chapter12 Neurological degenerative 2 2　 MND 3
diseases
Chapter 13 Epilepsy 5 2　EP 6
Chapter 14 Headache 2 2 2
migraine
Chapter16 Diseases of neuromuscular 4 2 4

junction and muscle MG
periodic paralysis
Total 54 36 72
Chapter 1 Introduction
【Objective and demand】 to comprehend the concepts studying purpose, method and
the relationship between neurology and psychiatry.
【Content of lecture】
1.the concept of the neurology .
2.the methods of studying the neurology.
3.the new progress of the neurology.
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Chapter 2 Symptomatology of the Neurological Diseases
Segment 1 Consciousness Disorders
【Objective and demand】 to master the concept and clinical situations of various
kinds of consciousness disorders.
1.somnolence.
2.stupor.
3.coma.
4.decorticate syndrome.
5.locked-in syndrome.
6.brain death.
Segment 2 Aphasia
【Objective and demand】 to grasp the classification and features of aphasia.
1.the concept of the aphasia
2.Broca aphasia
3.Wernicke aphasia
4.Nominal aphasia
Segment 3 Intelligence Disorders and Amnestic Syndrome
4
【Objective and demand】 to know the classifications and the clinical features of
intelligence disorders and amnestic syndrome.
1. intelligence disorder (1) inherent; (2)secondary.
2. acute amnetic syndrome.
3. chronic amnetic syndrome.
Segment 4 Optic Nerve
【Objective and demand】 to grasp the clinical features of optic nerve lesion.
【Content of leature】
1. anatomy and physiology
2. symptoms and signs
 a defect of visual acuity
 complete blindness.
 visual field defect, partial defect, bitemporal hemianpsia.
 changes in pupil, fundus oculit and light reflex.
3. Tests
 fundoscopic examination.
 light reflex examination (direct and indirect )
Segment 5 Oculomotor , Trochlear and Abducent Nerves
【Objective and demand】
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to grasp the clinical features of lesion of Ⅲ ,Ⅳ ,Ⅵ cranial nerves.
1. anatomy and physiology of cranial nerves (Ⅲ 、Ⅳ、 Ⅵ )
(1) double vision
(2) lid drop
(3) eyeball movement disorders
(4) changes in pupil and light reflexes
(5) distinguish between nuclear ophthalmoplegia and internuclear ophthalmoplegia.
(6) one and a half syndrome.
Segment 6 Facial Nerve
1. to master the situation of bell’s palsy
2. to familiarize the differentiations between peripheral facial palsy and central facial palsy .
1. anatomy and physiology of facial nerve.
2. peripheral facial palsy (including entire half of the face ).
3. central facial palsy.
4. facial spasm.
Segment 7 Acoustic Nerve
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【Objective and demand】 To master the clinical manifestations of acoustic nerve lesions.
1. anatomy and physiology of cochlear and vestibular nerves.
2. signs and symptoms
(1)cochlear nerve a. tinnitus b. deafness c.hyperacusis
(2)vestibular nerve a. vertigo
b. nystagmus
c. general symptoms: nausea ,vomiting, etc.
3. Tests
Weber Test: normally, the closed ear hears sound best by bone conduction .
if no sound is heard in the closed ear, nerves deafness is suspected.
Rinne test: normally, air conduction is greater than bone conduction.
Segment 8 Bulbar Palsy
【Objective and demand】 to grasp the symptoms and signs of bulbar palsy.
1. anatomy and physiology of glossopharyngeal and vagus nerves.
(1) aphonia or dysphonia
(2) paralysis of soft palate will lead to the loss of gag reflex.
(3) loss of sensation in pharynx, tonsils, fauces and back of tongue.
(4) loss of taste in posterior one third of tongue .
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(5) cough while drinking water
(6) differential diagnosis: Pseudobulbar palsy
Segment 9 Syncope and Seizure
【Objective and demand】 to grasp the concept, classifications, clinical features and
differential diagnosis of syncope and seizure.
1. syncope the concept , classifications, clinical features.
2. seizure the concept, classifications, clinical features.
Segment 10 Sensational Disorders
1. to grasp the classifications of sense.
2. to grasp the clinical features and the topical diagnosis of sensational disorders.
1. classifications of sense.
2. classifications of sensory disorders.
(1) hypersthesia
(2) hyperpathia
(3) dysesthesia
(4) paresthesia
(5) pain a. local pain b. radiating pain c. spreading pain d. referred pain
3. Topical diagnosis of sensory disorder.
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(1) terminal type
(2) peripheral nerve type
(3) segment type
(4) spinal cord type (brown-sequard syndrome , transverse lesion)
(5) crossed type
(6) thalamus type
(7)internal capsule type
(8) single limb type
（9）hysterical type
Segment 11 Paralysis
1. to master the concept of paralysis.
2. to master the clinical features of upper motor neuron and lower motor neuron lesion.
3. to master the topical diagnosis of .upper motor neuron and lower motor neuron lesion.
1.the clinical features of upper motor neuron paralysis.
2. the clinical features of lower motor neuron paralysis.
3. topical diagnosis
(1) lesion of cortex
(2) lesion of internal capsule
(3) lesion of brain stem
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(4) lesion of spinal cord
(5) lesion of Peripheral nerve
Segment 12 Muscular Atrophy
【Objective and demand】 to master the concept and clinical situation of muscular atrophy.
1. the definition of muscular atrophy.
2. muscular atrophy caused by muscular diseases
3. muscular atrophy caused by lesion of neuron.
Segment 13 Gait Disorders
to comprehend the purport and diagnostic points of each gait disorders
1. hemiplegic gait
2.spastic paraplegia gait
3. festinating gait
gait
5. hysterical gait
6. wadding gait
ge gait
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Segment 14 Involuntary Movement
【Objective and demand】 to Master the clinical features and significations of every
kind of involuntary movements
1. static tremor.
2. rigidity
3. chorea
4. athetosis
5. hemiballismus
6.torsion spasm
7.Gilles de la Tourtte syndrome
Segment 15 Ataxia
【Objective and demand】 to master clinical features and the concept of ataxia.
【 Content of lecture】
1. cerebellar ataxia
2. cerebral ataxia
3. sensibility ataxia
4. vestibular ataxia
Chapter 3 The Clinical Methods of Neurology
Segment 1 Taking the history
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【Objective and demand】 to master the methods and contents of collect the history.
1. asking history is an important part of diagnostic procedures through the
communication between the doctor and the patient.
2. content of inquisition
(1)general data
(2)chief complaint
(3)present history
(4)past history
(5)review systems
(6)personal history
(7)marital history
(8)family history
Segment 2 Neurological Examination
【Objective and demand】 to master the methods and clinical significations of the
neurological examination.
1.general examination
(1)conscious state
(2)mental state
(3)Kernig sign and Brudzinski sign
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(4)caput and nucha
(5)limbs and trunk
2. the examination of cranial nerves
(1)olfactory nerve
(2)optic nerve
(3)oculomotor, trochlear and abducent nerves
(4)trigeminal nerve
(5)facial nerve
(7)acoustic nerve
(8)glossopharyngeal and vagus nerves
(9) accessary nerve
(10)hypoglossal nerve
3. the examination of motor system
(1) the shape and nutrition of muscles
(2) muscular tension
(3) muscles force
(4) involuntary movement
(5) coordinate movement
4. the examination of sensation
(1)pain sensation
(2)temperature sensation
(3)touch sensation
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(4)vibratory sensation
(5)joint position sensation
(6)cortical sensation
5.the examination of the reflexes
(1)the classification of reflexes
(2) biceps reflexes
(3) triceps reflexes
(4)knee jerk (patellar reflex)
(5)ankle jerk
(6) abdominal reflexes
(7)Babinski sign , Openheim sign, Chaddock sign,Gordon sign
6.the functional examination of autonomic nerve
(1)general observation (skin color ,temperature ,sweat more or less ,etc.)
(2)the reflexes examination of autonomic nerve(sweating test,eye-heart reflexe ,etc.)
Chapter 4 The Special Techniques For Neurological Diagnosis
Segment 1 The Examination of Cerebral Spinal Fluid(CSF)
1.to master the formed mechanisms and of abnormal CSF.
2.to master characters of normal CSF.
1.the indications, contraindications and complications of lumber puncture.
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2.the characters of normal CSF.
3.the characters and the clinical significations of abnormal CSF.
Segment 2 Others Special Techniques For Neurological Diagnosis
CT, MRI, X-ray, DSA, EEG, EMG , TCD, SPECT, PET,
Biopsy of muscle and Gene detection .etc.
Chapter 5 The Diagnostic Principles Of Neurological Diseases
to master the topical diagnosis and the etiological diagnosis of neurological diseases.
【Content of lecture】 Establishment of diagnosis
1.Where is the lesion ? ( including the numbers and the level of lesion)
2.What is the lesion?
3.What causes the lesion or symptom?
4. localization
(1)muscles.
(2)peripheral nerves (spinal roots ,plexuses distal peripheral nerves,
neuromuscular junction)
(3)spinal cord (segment lever ,gray or white matter, ascending or descending tracts)
(4)cerebellum (vermis or hemisphese)
(5) medulla oblongata
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(6) pons
(7) midbrain
(8) basal ganglia, thalamus, hypothalamus
(9)cerebral hemisphere (lobe ,side, cortical or sub cortical, convexity or base)
Chapter 6 Diseases of the Peripheral Nerves
Segment 1 Cranial Nerve Diseases
Part 1 Trigeminal Neuralgia

1.To master the concept, clinical situations and drug treatments of trigeminal neuralgia.
2.To familiarize differential diagnosis.
3.To familiarize nerve-block therapy, electrocoagulation, operation treatment of trigeminal
neuralgia.
4. To familiarize the common factors of secondary trigeminal neuralgia.
1.etiological factor unknown.
2.clinical features onset in middle-aged and elderly people, manifestation of attack,
trigger spot, tic douloureux and no positive physical signs.

3.diagnosis and differential diagnosis to distinguish between primary trigeminal neuralgia
and secondary trigeminal neuralgia, further more, other pains of face.
4.therapy drug treatment such as carbamazepine, phenytoin, nerve-block therapy,
electrocoagulation, operation treatment.
Part 2. Idiopathic Facial Palsy (Bell’s palsy)
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1.To master the concept, clinical situations and drug treatment. of idiopathic facial palsy.
2.To master the differences between peripheral facial paralysis and central facial paralysis.
3.To familiarize etiological factor, identification diagnosis of idiopathic facial palsy,
anatomy of facial nerve.
1.etiological factor unknown.
2.clinical features acute onset, symptoms and physical signs of mono side peripheral
facial palsy.
3.diagnosis and differential diagnosis to compare primary facial palsy to secondary
facial palsy, central facial paralysis.
4．Therapy hormone treatment in the acute period, nerve nutrition therapy, physiotherapy and
operation treatment.
Segment 2 Spinal Nerve Diseases

Part 1 Guillain-Barre Syndrome(GBS)
1.To master the concept of Guillain-Barre syndrome (GBS).
2.To master clinical situations, main ports of diagnosis and therapeutic principle.
3.To master differential diagnosis.
4. To comprehend etiological factors.
1.etiological factor and pathogenesis
etiological factor unknown.
pathogenesis autoimmune disease is great suspected.
2. epidemiological study
3.clinical features infectious history before attack, acute or subacute onset, symmetry
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flaccid paralysis of limbs, end-brushed sensory disorders, the lesion of cranial nerves,
albumino-cytological dissociation in CSF.
4.diagnosis and differential diagnosis clinical diagnosis standard. distinguish between GBS
and poliomyelitis, hypokalemic periodic paralysis and so on .
5.therapy the application of plasma exchange (PE) ,intravenous immunoglobulin (IVIG)
and corticosteroids, assisted respiration, giving the right prescription for some symptoms,
prevention and disposal of complications.
Chapter 7 Spinal Cord Diseases
Segment 1 Overview
1.Dissection character of spinal cord.
2.The relationship of segments of spinal cord and vertebral body.
3.The characters of spinal cord `s blood supply .
4.The apposition and common etiological factors of spinal cord lesion.
5.The main clinical situations of spinal cord disease and the characters of transverse lesion.
Segment 2 Acute Myelitis

1.To mastery the concept and clinical situation.
2.To familiarity diagnosis, differential disgnosis, the therapy and nursing care of
acute myelitis.
1.etiological factor and pathology

(1)etiological factor unknown. one cause of acute myelitis may be abnormality
immune response evoked by virus infection.
(2)pathological alteration of acute myelitis.
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2.clinical features to narrate the clinical situation of acute transverse myelitis (including
stage of shock, stage of recovery) and the characters of CSF and MRI.
3.diagnosis and differential diagnosis to compare acute myelitis with acute epidural abscess,
tuberculosis of spine, metastatic tumor and hematomyelia.
4.therapy drug treatments such as corticosteroids, PE，nursing care, preventing various
kinds of complications and rehabilitative treatment.
Chapter 8 Cerebrovascular Diseases (CVD)
Segment 1 Overview
1. to master the blood supply of the brain .
2. to master the classification of CVD, the common etiological factor and risk factor of CVD.
1. Concept
(1) CVD The term of CVD designates any abnormality of the brain resulting from
various pathological process of the blood vessels.
(2)Stroke The stroke is a syndrome characterized by the acute onset of a neurologic
deficit that reflects focal/diffused involvement of the CNS and is the
result of a disturbance of the cerebral circulation.
2.The classifications of CVD
3.The blood supply of the brain the internal carotid artery system and the vertebral
-basilar artery system, their branches. the circle of willis：its conformation
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and the adjustment to cerebral blood circulation.
4.The adjustment and the pathophysiology of blood circulation
5.The common etiological factors of CVD
(1)Vascular disorder—Atherosclerosis, Inflammatory disorders (TB, syphilitic arteritis,
SLE, etc.), Congenital vascular malformation (aneurysm, AVM ), Lesions of any cause.
(2)Heart diseases and blood kinetics changes--Hypertention or hypotension, Atrial
fibrillation, Rheumatic heart disease, arrhythmias etc.
(3)Others
6.The common risk factors of CVD hypertension, cardiac disease, diabetes ,TIA,
Smoking，alcohol, hyperlipemia, and so on .
Segment 2 Transient ischemic attack (TIA)
【Objective and demand】 To master clinical situations, diagnosis, differential diagnosis
and therapy .
1.conception TIA is brief, repeated, reversible episodes of focal ischemic
neurological disturbance. The duration of which should be less than 24h
(usually lasting about several min to 1h). Repeated TIAs of uniform
type are more often a warning sign of ischemic stroke.
2.etiology and pathogenesis
(1)etiology
(2)pathogenesis the theory of microemboli, the theory of cerebrovasvular spasm，
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and so on.
3. clinical findings
(1)Basic features transient episode (<24h), reversible, resolve completely, repeated
and uniform type .
(2)The Common symptoms/signs and Characteristic symptoms/signs of TIA of the
anterior circulation and the posterior circulation. Possible symptom/sign of
TIA of the anterior circulation and the posterior circulation.
3.diagnosis and differential diagnosis
(1)Diagnosis mainly depend upon history. But the causes of TIA are very important.
(2)differential diagnosis Partial seizure, Méniere Disease and the cardiac diseases, etc.
4.treatment and prevention
(1) Treatment in terms of etiology
(2) Drugs for prevention Antiplatelet agents, Anticoagulation therapy, Others.
(3) Cerebral protective agents
5. Prognosis 1/3 will develop into cerebral Infarction afterward,
1/3 recurrence, 1/3 resolved.
Segment 3 Cerebral infarction
1. to master the concept and common etiological factors of cerebral thrombosis and
cerebral embolism.
2.to master the clinical findings of cerebral thrombosis and cerebral embolism.
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3.to familiarize pathological process and pathophysiological characters of ischemic stroke.
4.to familiarize treatments of ischemic stroke.
5.to familiarize the types a large area infarction, cerebral watershed infarction,
hemorrhagic infarct, multiple infarct.
6.to comprehend the pathogenesis of ischemic stroke.
1.Conception of Cerebral infarction Cerebral infarction (CI) is necrosis and malacia of
brain tissues due to ischemia and anoxia of the brain, which is in turn caused by deprived
or insufficient blood supply in brain.
2.Cerebral thrombosis
(1)conception
(2)etiology and pathogenesis Atherosclerosis-the most common cause of Cerebral
thrombosis, Arteritis, vascular malformation, blood dyscrasia, vascular spasm,
indeterminate.
(3)pathology 4/5 located in region of ICA territory, 1/5 located in region of V-B A.
(4)pathophysiology central necrotic region and ischemic penumbra.
(5)clinical types complete stroke: reaches peak within several hours (<6h);
progressive stroke: reaches peak within 48h;
reversible ischemic neurological deficit (RIND): Lasting >24h and
recovering within 3ws.
(6)clinical findings general features; clinical syndromes of cerebral infarction.
(7)assisted examination including CT, MRI, angiography, examination of CSF.
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CT is normal at the day of onset of the stroke, shows the low density of the
infarct after 24~48h. CT is preferred for initial diagnosis since it can make
the critical distinction between ischemia and hemorrhage.
(8)diagnosis and differential diagnosis
Diagnosis can be made depending on the clinical features (Patients presenting with
focal central nervous system dysfunction of sudden onset, Lasting more
than 24h); CT and MRI changes.
Differential diagnosis intracerebral hemorrhage, cerebral embolism,
intracranial space-occupying lesion.
(9) treatment:
A. therapeutic principle in acute stage.
Medical treatment: Thrombolytic agents, Antiplatelet agents, Anticoagulation agents,
Fibrinogen degradation therapy, Neuroprotective agents, Antiedema
agents and so on.
Surgical treatment
Physical therapy and rehabilitation
B. Preventive measures
3.Cerebral embolism
(1)conception embolism produces stroke when cerebral arteries occluded by the distal
passage of thrombus from the heart, aortic arch, or large cerebral arteries.
(2)etiology cardiogenic cerebral embolism, non cardiogenic cerebral embolism, and
unknown source. cardiogenic cerebral embolism is the most common one.
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(3)pathology the usual places, paying attention to compare it with cerebral thrombosis.
(4)clinical findings common specialties
localization diagnosis
Primary diseases
(5)assisted examinations cranial CT, MRI, CSF, ECG, Ultrasonography, Echocardiography.
(6)diagnosis and differential diagnosis evidence to diagnosis; paying attention to
compare it with cerebral thrombosis and intracerebral hemorrhage.
(7)treatment including cerebral embolism and primary disease.
4. Intracerebral hemorrhage
(1) to master clinical findings and therapy.
(2) to familiarize etiology and pathogenesis. Hypertension is the most common underlying
cause of nontraumatic intracerebral hemorrhage. Others：cerebral atherosclerosis,
hematopathy, cerebral amyloid angiopathy CAA , aneurysm, AVM.
(3)to comprehend pathology.
【 Content of lecture】 (Diagnosis and treatment are the focal points, and Localization diagnosis
is the difficult point.)
(1)conception Intracerebral hemorrhage means primary and nontraumatic
intracerebral hemorrhage.
(2)etiology and pathogenesis Half of the patients suffer from hypertension combined
with arteriolar atherosclerosis, it is the most common cause of the disease.
(3)pathology the usual places and pathologic changes.
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(4)clinical findings
A. general features
B. diagnosis of sites of hemorrhage: basal ganglion hemorrhage,
pontine hemorrhage(midbrain hemorrhage),
cerebellar hemorrhage,
lobar hemorrhage and cerebral ventriculus hemorrhage.
(5)assisted examinations CT computerized tomography is chosen first. Lesion: high
density (hematoma) surronded by low density(edema).
diagnosis senile patients after 50 years of age, past history of hypertension,
onset during activity, sudden onset, CT scan.
To pay attention to compare it with cerebral thrombosis, traumatic intracranial hematoma,
and coma due to other causes.
(7)treatment
A. medical treatment keep quiet, rest in bed, avoid meeting, keep water-electrolyte
balance and nutrition, control brain edema, decrease ICP,
control blood pressure, prevent complications.
B. the indication and contraindications of surgical therapy
5. Subarachnoid hemorrhage (SAH)
(1) to master clinical findings and treatment
(2) to familiarize etiological factors
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(1)conception SAH is an acute hemorrhagic cerebralvascular disease in which vessels on
surface of brain and spinal cord rupture suddenly due to many causes,
blood flow into the subarachnoid space, called primary SAH.
(2)etiology and pathogenesis Congenital aneurysm is the most common etiology,
AVM is a less frequent cause of SAH,
Hypertensive arteriosclerosis aneurysm is the third
cause of SAH,
Moyamoya disease is the forth cause,
Others include tumor and arteritis.
A series of pathologic process after hemorrhage..
(3)pathology 85%~90% of intracranial aneurysms locate anterior in the circle of Willis,
they are mainly single, they are multiple in about 10%—20% of cases,
locating in the opposite site of the same vessel, called mirror aneurysm.
(4) clinical findings The classic (but not invariable) presentation of SAH is the sudden
onset of an unusually severe generalized headache, patients often describe it
as “the worst headache I ever had in my life”. Nuchal rigidity and other
evidence of meningeal irritation are common. Preretinal globular
subhyaloid hemorrhages (found in 20% of cases) are most suggestive
of the diagnosis.
Complications recurrence of hemorrhage: Recurrence;
arterial vasospasm;
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acute or subacute hydrocephalus;
seizures.
(5)assisted examinations CT, MRI, MRA, DSA and CSF.
diagnosis the history of a sudden severe headache with confusion, nuchal rigidity,
a nonfocal neurologic examination, CSF is grossly bloody,
CT will usually confirm that hemorrhage has occurred and may help to
identify a focal source.
to pay attention to compare it with intracerebral hemorrhage, intracranial infection,
intracranial tumor and tumor associated stroke.
(7)treatment to control hemorrhage, prevent and cure late cerebrovascular spasm,
to eliminate etiological factors, and to prevent repea.
including general treatment, medicine treatment and surgical treatment.
Chapter 9 Infections of the central nervous system
Segment 1 Herpes simplex virus encephalitis
【 Objective and demand】
1.to master clinical features and treatment

2.to familiarize etiological factors and pathogenesis
3.to comprehend the characters of pathology changes
1.etiological factor and pathogenesis The most common virus leading to the
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infectious disease in the central nervous system is herpes simplex virus(HSV).
2. pathology The hemorrhagic necrosis of temporal lobe and frontal lobe is common.
3.clinical features the infection history before onset, prodromal period symptom,
psychiatric symptom and neural symptom.
4.assisted examination the examination of CSF, serology and CT、MRI.
diagnosis according to the clinical features, assisted examination.
To distinguish between herpes simplex virus encephalitis and the other viral encephalitis,
such as herpes zoster viral encephalitis, enteric viral encephalitis, cytomegalovirus
encephalitis, acute disseminated encephalomyelitis.
6. treatment
therapeutic principle to diagnose and treat it in the earlier period,
to decrease the fatality rate.
method of treatment the treatment to aim at etiological factor, immunization therapy,
the treatment aiming directly at symptom and support.
Chapter 10 Demyelinating diseases of the CNS
Segment 1 Overview
【Conception】 a group of diseases of the brain and spinal cord in which demyelination
is a prominent feature.
【Objective and demand】 to comprehend the concept and pathological standard of
demyelinating diseases.
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【 Content of lecture】 The conception and pathological standard of demyelinating diseases .
Segment 2 Multiple sclerosis (MS)
1. to master clinical features, diagnosis, differential diagnosis and treatment.
2. to comprehend the relationship between multiple sclerosis and neuromyelitis optica.
【 Content of lecture】(the clinical findings is the focal point, while the hard point is the treatment.)
1.conception Multiple Sclerosis is a kind of autoimmune diseases characterized
by demyelination of CNS
2.etiology and pathogenesis The etiological factor is unknown. At present it is looked as
a kind of auto-immune diseases which is resulted by the infection of CNS.
It is related to genetic susceptibility and environmental factors.
3.pathology
characteristic: multiple demyelinated plaques in white matter of CNS.
position: white matter around the lateral ventricles and spinal cord, optic nerve,
brain stem and cerebellum.
acute stage: hyperemia, edema, demyelination, infiltration of inflammatory cells
in perivascular distribution.
recovery stage: astrocyte proliferition, forming of astrocytic scab.
4.clinical features The main feature is the multiplicity in space and time.
Paying attention to the symptom and physical signs.
5.clinical classifications (to be based on the procedure )
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Repea-Remission MS, Secondary progress MS, Primary progress MS, Benign MS.
6.assisted examination examination of CSF, evoked potential(EP), MRI.
7.the standard of diagnosis clinical definite MS(CDMS),
laboratory-supported definite MS(LSDMS),
clinical probable MS(CPMS),
and laboratory-supported probable MS(LSPMS).
8.differential diagnosis
To pay attention to be compared with acute disseminated encephalomyelitis,
cerebral arteritis, vascular malformation of brain stem or spinal cord,
systemic lupus erythematosus (SLE), Sjogren Syndrome, Behcet disease,
cervical syndrome, tropical spastic paraplegia,and cerebral lymphoma.
9.treatment
(1)destination To prevent the progress of the disease, deterioration in acute phase, and
repea in remission phase.
(2)the drugs that can be applied hormone, interferon, immunosuppression,
immunoglobulin, and plasma exchange.
(3)To adopt the treatment plan to aim directly at symptom and support. Its destination is to
relieve distress that be resulted by neurologic handicap.
Chapter 11 Movement disorders
Segment 1 Parkinson disease
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1.to master clinical situations and treatment principle of Parkinson disease. .
2.to comprehend .the alteration characters of pathology and biochemistry of Parkinson disease
etiological factor unknown.
To relate possibly with age and aging, environmental agents and genetic factors.
2 pathology and biochemistry
pathology The main changes of pathology are the degeneration, loss of pigmentation
and cells in the substantia nigra. Lewy body in the basal gangalia,
sympathetic ganglia and brainstem.
The main alterations of biochemistry and pathology is the deficiency of DA.
3.clinical features more common in above 60 years old human,
the onset of the disease is usually insidious,progress gradually,
the main symptoms: static tremor, rigidity, bradykinesia and the
abnormality of postur and gait, ect.
To diagnose this disease according to the clinical features, assisted examination.
differential diagnosis
Parkinsonism: postencephalitic parkinsonism, drug or toxin-induced parkinsonism(CO, Mn),
arteriosclerotic parkinsonism.
Depression: a trial of antidepressant drug treatment may be helpful.
Essential(benign, familial) tremor: family history, early onset, nod or head shake.
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Parkinsonism associated with other neurologic diseases.
5.therapy the principles of drug treatment.
the common drugs such as Artane, Kemadrin, Amantadine, Madopar and Sinemet.
Segment 2 Chorea Minor
1 to master manifestation and treatments

2.to comprehend the etiological factors .
1.etiological factor and pathogenesis Chorea minor is the common manifestation of
rheumatic fever in nervous system and related with the infection of A tribe haemolytic
streptococcus probably.
2.clinical features more common in those children from 5 to 15 years old,
subacute or insidious onset,
early symptom: irritability, inattention, unsteady gait,
easily dropping objects, and so on.
typical clinical features including involuntary chorea, dystoni,
weakness, automatic action disturbance,
emotional changes and the findings of
rheumatic fever.
3. assisted examination
(1)serum tests rapid erythrocyte sedimentation, increased WBC.
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(2) EEG unspecific.
(3) image tests 29~85% patients present low density focus in caudate nucleus on CT.
To diagnose it according to the clinical features, assisted examination.
To compare chorea minor to habit spasm, congenita Chorea,
Gilles de la Tourette syndrome,
dystonia musculorum deformans, Huntington Chorea
and hepatolenticular degeneration.
5. therapy general disposal, treatment aiming directly at symptom and etiological factors.
Chapter 12 Neurological degeneration diseases
Part 1 Motor neuron disease (MND)
1.to master clinical classifications and features, diagnosis and differential diagnosis.
2.to comprehend the new progress of treatment.
1. etiology and pathogenesis unknown
2.pathology selective death of motor neuron
3.clinical findings (the features of the four types and the relationship among them) .
(1)amyotrophic lateral sclerosis (ALS)
(2)progressive spinal muscular atrophy(PSMA)
(3)progressive bulbar palsy(PBP)
33
(4)primary lateral sclerosis(PLS)
4.assisted examination
(1)neurological electrophysiology
(2)muscle biopsy
(3)others such as biochemical test of blood, examination of CSF, MRI ,and so on.
5.diagnosis and differential diagnosis;
(1)diagnosis the common diagnostic standard and the standard (E1 Escorial,1994)
(2) paying attention to be compared with spinal muscular atrophy, cervical syndrome,
multifocal motor neuropathy(MMN) and benign fasciculation.
6.treatment (1)riluzole (2)vitamin E (3)treatment to aim directly at symptom..
(4) treatment to aim directly at support.
Chapter 13 Epilepsy
1.to master the main points of prevention and cure of epilepsy and status epilepticus.
2.to master the clinical situations and the main points of diagnosis.
1. etiological classifications primary epilepsy and secondary epilepsy.
2. etiological factors and effecting factors
(1) etiological factors genetic factor, brain injury, and so on..
(2) effecting factors age, the change of endocrine, sleep, etc.
3.clinical findings
34
(1)the concept, specialities, and clinical classifications of seizure.
(2)detailed explaintion (simple partial seizure, complex partial seizure, petit mal,
generalized tonic-clonic seizure and statue epilepticus).
(3)the conception of epileptic syndrome.
4. diagnosis and differential diagnosis
(1)the process of diagnosis
A. to decide if this is epilepsy or not (according to history, clinical findings,
EEG, and so on).
B. to find its clinical classification of the seizure.
C. to find the etiological factors (primary or secondary).
(2)differential diagnosis to pay attention to compare it with migraine, TIA, syncope,
hypoglycemia and pseudo-seizure.
5.treatment:
(1)the whole treatment plan includes treatment aiming to etiology and symptom,
surgical treatment.
(2)to explain the application of AEDs detailedly.
(3)the prevention and treatment of status epilepticus.
Chapter 14 Headache
Segment 1 Migraine

1. to master diagnosis, differential diagnosis and treatment of migraine.
2.to master the clinical situation of migraine.
35
etiological factor unknown. relating possibly with ① Heredity;
② Endocrine and metabolism; ③ Other factors.
pathogenesis unknown.
2.clinical features the common characters of migraine，recommend detailedly migraine
with Aura (Classic Migraine), migraine without Aura (common
Migraine). Recommend briefly attack process and attack characters
of the special type of migraine.
diagnosis according to the clinical features, assisted examination.
to compare migraine with others vascular headache, cluster headache,
pained ophthalmoplegia and carotodynia.
4.therapy
the objective of therapy to terminate the attack of headache, to relieve following symptom,
and to prevent relapse of headache.
therapy method ( onset stage ) Acetaminophen, Naproxen, Ibuprophen, and so on.
preventive treatments Propranolol, Flunarizine, Nimodipine, Pizotifen and so on.
Chapter15 Diseases of Neuromuscular Junction and Muscle
Segment 1 Myasthenia Gravis (MG)
36
1.to master clinical features, diagnosis and treatments of MG.
2.to familiarize classifications and the therapy of myasthenic crisis.
1.etiology and pathogenesis
MG is an autoimmune disease in the neuromuscular junction that depends on cellular
immunity, while be mediated by AChR-Ab. Complements take part in the formation of
this disease. Most of the patients with MG have abnormalities in the thymus, e.g. thymic
hyperplastic or thymoma. The general opinion is that virus infection or other nonspecific
factorsinvades the thymus in genetically predisposed individuals leading to the
development of MG.
2. clinical features
MG can arise at any age, the onset of the disease is usually insidious and follows a
slowly progressive course. Many factors can evoke this disease, Precipitating factors
include concurrent infection, stress, weariness, menses, pregnancy or parturition. Main
clinical features: MG features with fluctuated muscular weakness in intensity during
the day and easy fatigability. Typically, the weakness varies in distribution and severity
from day to day. Characterized by abnormal weakness, which being worse at the end
of the day or after exertion and tends to improve after rest or AchE treatment. The
weakness often begins with the lateral or bilateral extra-ocular muscles, leading to
asymmetric ocular palsies (e.g. diplopia, strabismic) and ptosis. Osserman Classification.
Crisis describes a rapidly developed weakness in the bulbar muscles and respiratory
insufficiency that necessitates assisted ventilation. It is the leading cause of death in patients
37
with MG. The classification and the etiological factors of myasthenic crisis.
3.assisted examination
(1)X-rays and CT scans of the chest may reveal a coexisting thymoma in patients over 40 years.
(2)EMG increased decrement (> 10%) of the evoked CMAP upon repeated stimuli at 3
or 5 Hz. Single fiber myography shows reduced amplitude of MEPP and
increased variability (jitter) or more blockade of impulses.
(3)The anti-AChR Ab present in 85-90% of patients with generalized MG and in 50%
of patients with ocular MG, but not present in healthy individuals.
to diagnose according to clinical situations, anticholinesterase drug tests，
and electromyography examination.
to compare myasthenia gravis with amyosthenia syndrome
5.therapy anticholinesterase drug.
therapy of etiological factors(including immuno-suppressive drugs, immune
globulin, plasmapheresis and the resection of thymus gland)
disposal of crisis .
Segment 2 Periodic paralysis

1.to .master clinical situations, diagnosis, prevention and treatment hypokalemic
periodic paralysis.
2.to comprehend the types of periodic paralysis.
38
1.etiological factor and pathology a ion channel disease.
hypokalemic periodic paralysis is the most type.
2.clinical features more common in prime men,
many agents can evoke this disease such as fatigue , alcohol abuse, eating
high-carbohydrate meal, and so on.
acute onset,
flaccid paralysis of the limbs,
hypokalemia, the change of electrocardiograph,
recovery after taking kalium
to diagnose it according to the clinical features, assisted examination and drug test.
to compare periodic paralysis with periodic paralysis of hyperthyrosis, GBS.
4.therapy to make up for kalium when attacking.
5.prevention
the restriction of natrium，avoiding overeating, catching a chill, alcohol abuse and fatigue.
high potassium and low natrium diet. Acetazolamide or oral potassium supplements
often prevent attacks.
39

The Curriculum Outlineof Neurology

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The Curriculum Outline of Neurology

For Nepalese Medical Students

2. mastering the topical diagnosis and qualitative diagnosis of neurological disease.

4. mastering the basic operation technique such as lumbar puncture.

 Teaching contents and time distribution (to see table 1)

Table 1 teaching contents and time distribution (1 class hour = 40 minutes)

Chapter3 The clinical methods 5 4 6

Chapter7 Diseases of the spinal cord 2 2 acute myelitis 3

Chapter16 Diseases of neuromuscular 4 2 4

the relationship between neurology and psychiatry.

1.the concept of the neurology .

2.the methods of studying the neurology.

3.the new progress of the neurology.

Segment 1 Consciousness Disorders

kinds of consciousness disorders.

【Objective and demand】 to grasp the classification and features of aphasia.

1.the concept of the aphasia

Segment 3 Intelligence Disorders and Amnestic Syndrome

intelligence disorders and amnestic syndrome.

1. intelligence disorder (1) inherent; (2)secondary.

2. acute amnetic syndrome.

3. chronic amnetic syndrome.

Segment 4 Optic Nerve

1. anatomy and physiology

2. symptoms and signs

 a defect of visual acuity

 visual field defect, partial defect, bitemporal hemianpsia.

 changes in pupil, fundus oculit and light reflex.

 light reflex examination (direct and indirect )

Segment 5 Oculomotor , Trochlear and Abducent Nerves

【Objective and demand】

1. anatomy and physiology of cranial nerves (Ⅲ 、Ⅳ、 Ⅵ )

2. symptoms and signs

(1) double vision

(2) lid drop

(3) eyeball movement disorders

(4) changes in pupil and light reflexes

(5) distinguish between nuclear ophthalmoplegia and internuclear ophthalmoplegia.

(6) one and a half syndrome.

Segment 6 Facial Nerve

【Objective and demand】

1. to master the situation of bell’s palsy

1. anatomy and physiology of facial nerve.

2. peripheral facial palsy (including entire half of the face ).

3. central facial palsy.

Segment 7 Acoustic Nerve

1. anatomy and physiology of cochlear and vestibular nerves.

2. signs and symptoms

(1)cochlear nerve a. tinnitus b. deafness c.hyperacusis

(2)vestibular nerve a. vertigo

c. general symptoms: nausea ,vomiting, etc.

if no sound is heard in the closed ear, nerves deafness is suspected.

Rinne test: normally, air conduction is greater than bone conduction.

Segment 8 Bulbar Palsy

1. anatomy and physiology of glossopharyngeal and vagus nerves.

2. symptoms and signs

(1) aphonia or dysphonia

(3) loss of sensation in pharynx, tonsils, fauces and back of tongue.

(4) loss of taste in posterior one third of tongue .

(6) differential diagnosis: Pseudobulbar palsy

Segment 9 Syncope and Seizure

differential diagnosis of syncope and seizure.