Neuroscience Syllabus

Atlantic University School of Medicine

September - December Semester 2013

I. Instructor: Dr. Sudhakar Avancha II. Class Schedule: Monday Friday 8:00 AM to 10:00 AM III. Of>ice Hours: Monday to Friday Without Appointment (Walk-in): 7: 30 AM to 8:00 AM and from 12 PM to 1 PM By Appointment: 1:00 PM to 3:00 PM IV. Exam Policy There will be two mid-term exams followed by a comprehensive Oinal exam. Class presentations or projects, group discussion, & clinical case studies, which are held throughout the semester, will also be considered appropriately while determining the Oinal grades of the course. All Questions in the exams will be typically in USMLE format. I (incomplete) or W (withdrawn) grades will be reported to the OfOice of the Registrar in compliance with the policies of Atlantic University School of Medicine. V. Grading: Honors = 92% and above Passing = 70% to 91%; Failing = Below or 70% VI. Textbook: Required texts: Snell, Richard S. Clinical Neuroanatomy, 7th edition, Lippincottt, Williams-Wilkins, 2010, ISBN 978-0-7817-9427-5, or Westmoreland, Barbara and Snell, Richard S. Clinical Neuroanatomy for Medical Students, 5th edition, Lippincott-Raven, 2001, ISBN 0-781-72831-2 Crossman, AR, Neary, D. Neuroanatomy: An Illustrated Colour Text, 3rd edition, Chrurchill-Livingstone, ISBN 0-443-10036-5 Recommended texts: Netter's Atlas of Neuroscience, D Felton and AN Shetty, 2nd edition, Saunders, 2010, ISBN 978-1-4160-5418-9 Nolte, J and Angevine, JB. The Human Brain in Photographs and Diagrams, 2nd edition, Mosby, 2000, ISBN 0-323-01126-8

Neuroscience Syllabus
Goldberg, Stephen. Clinical Neuroanatomy Made Ridiculously Simple. While any edition is acceptable, the latest one is 3rd, MedMaster, ISBN 0-94078-o57-7 Fix, James D. Neuroanatomy, 4th edition, Lippincott-Williams Wilkins, 2009, ISBN 0- 7817-7245-1 and/or Fix, James D. High Yield Neuroanatomy, 4th edition, Lippincott- Williams Wilkins, 2009, ISBN 978-0-7817-7946-3 Kandel, Eric R., Schwartz JH and Jessel, TM. Principles of Neural Science, 4th edition, 2000, Mc Graw-Hill N 0-8385-7701-6

Learning Objectives
Purpose: The purpose of this course is to provide the necessary knowledge essential to understanding the complexities of the human nervous system. Emphasis will be based upon developing a foundation in the basic and applied neurosciences which will permit understanding of both normal and pathological states of the nervous system essential for clinical practice. Goal: Provide the student with a Oirm knowledge, based upon rote and critical thinking methodology, of the human nervous system and its pathology relevant for high quality medicine. Objectives: The course investigates both anatomy and physiology, the former including gross and microscopic anatomy of normal and abnormal human brain, brainstem, cerebellum, spinal cord and peripheral nerve states. Understanding normal and abnormal physiological principles involved in the "web" of neuronal pathways, their neurotransmission and interface with glial structures will lead to an understanding of disease states, their diagnosis and treatment. The student will then be able to identify principles of development, differentiate somatic and visceral components, learn the functional anatomy of the central and peripheral nervous system, their pathways and interdependent states, which will lead to a critical thinking approach to anatomical and functional diagnoses, as well as treatment of disease states.

Format: Traditional lecture and discussion methodology will be used to explore course material and laboratory assignments. It is necessary to enhance both focus and self discipline necessary as well as critical thinking through presentation of clinical material in the form of case presentation for the learning process.

Neuroscience Syllabus

Course Outline:
Week 1: Introduction to and Development of the central nervous system (Chapters one and 29, Snell or equivalent) Early embryological stages in formation of the neural tube; speciOic objectives: understanding the ectoderm, mesoderm and endoderm differentiation; the neural plate, fold and groove. Early development of the brain, primary and secondary vesicles, derivatives of the mature brain with speciOic understanding of the telencephalon, diencephalon, mesencephalon and rhombencephalon, the important Olexures, blood supply and ventricular system; common pathological states such as craniosynostosis, Chiari syndromes, meningomyelocele, hydrocephalus. Relevance of USMLE in this category, including the heel spot test for inborn errors of metabolism and infectious sequelae will be provided by the instructor. Week 2 and 3: Structure and function of neurones and glia (Chapters 2, 3 Snell and or equivalent) Basic structure of the neurone with speciOic understanding of function, axonal transport and pathology. Axonal terminals, synapse and central nervous system myelination with speciOic understanding relevance to neurotransmission and disease states such as the demyelinating diseases. Peripheral nervous system, nerve Oibers and sheath with speciOics in understanding neuropathies, the Guillain-Barre syndrome... Structure and function of the synapse, synaptic integration, action potential, refractory period with speciOics of neurotransmitter release, nerve conduction, action of local anesthestics, drugs and toxins affecting transmssion with consideration for the potential for biological and chemical warfare, peripheral nerve injury (Wallerian degeneration and repair with concepts of nerve growth factors). Glial cells and their important role in neural function as in GABA/Glutamate metabolism and role in potassium metabolism, both relevant to epilepsy and other disorders. Concepts of the blood brain barrier, edema and neoplastic formation from glial cells. Week 4: Sensory receptors: (Chapters 5 and 6 Snell or equivalent) Mechanism of sensory receptors transduction and functions; the neuromuscular junction. SpeciOic concepts will be structure and function as related pain and analgesia; muscle activity, myasthenia gravis and its differentation. Week 5: Blood circulation and supply to the central nervous system (CNS) (Chapter 28 Snell or equivalent with angiography presentation) Review of relevant CNS development, arterial and venous supply, the carotid and vertebral circulation, circle of Willis and other anastomoses with water shed concepts and speciOic concepts of occlusion of major arterial branches in cerebrum and brainstem, arteriovenous malformation and aneurysm formation, stroke and intracerebral et al hemorrhage;

Neuroscience Syllabus
angiography. The effects of trauma, the blood brain versus cerebrospinal Oluid brain barrier. Week 6: Meninges and Ventricular System (Chapters 18 , 19 and 27 Snell or equivalent) Structure and function of meninges, subarachnoid space and cisterns with speciOics of meningioma formation, meningitis, headache involving vasculature, transtentorial herniation and Kernohan's notch concepts. The lumbar puncture and analysis. Subarachnoid hemorrhage. Ventricles and cerebrospinal Oluid formation and absorption with speciOics of hydrocephalus, CT and MRI analysis. Week 7: Spinal Cord (Chapters 7, 20 and 21 Snell or equivalent) Spinal cord, nerve roots, dermatomes, myotomes, conus and cauda equina with speciOics of spinal cord injury, meningitis, myelogram, cord, cauda equina and conus medullaris syndromes, compressions and stenosis. Pathways involving white and interface with gray matter with speciOics of pain control, gate theory, discriminative touch. Brown-Sequard syndrome, neurosyphyllis, amyotrophic lateral sclerosis, subacute combined degeneration, Friedrich's ataxia. Multiple sclerosis. Radicular pathology associated with herpes zoster and injuries will be noted as well as concepts of nerve blocks. Patient evaluation tactics will be described. Pain relief with varied tactics including ablation, stimulation and intrathecal drugs will be noted. Week 8 and 9: The Brainstem (Chapters 8-10, 12, 23 Snell or equivalent) Structures, pathways and nuclei together with cranial nerves ascending and descending pathways and decussations; the reticular formation, medial longitudinal fasciculus; sources of neurotransmitters: catecholamines and serotonin. The cerebello-pontine angle. SpeciOics will describe Parkinsonism and disease, acoustic neuroma and neuroOibromatosis, locked in syndrome and varied vascular syndromes: Wallenberg, Benedickt and Weber...brainstem injury, cranial nerve dysfunction, multiple scerosis... Week 10: The Cerebellum (Chapters 10, 11 and 22 Snell or equivalent) Structure and function beyond coordination. Divisions and nuclei together with peduncular relationships and targets. Syndromes relate to varied sites and nuclei and involve motor coordination as well behavioral and sensory modiOications. Neoplasms and hematoma will be addressed as well Chiari syndromes. Week 11 The Thalamus and Hypothalamus (Chapters 13, 24 and 25 Snell or equivalent) The diencephalon with focus on the thalamus will be noted with speciOics adressing the thalamic pain syndrome or targets used in therapy for pain and involuntary movement disorders. The related third ventricle and pineal gland and its melatonin function noted together with neoplastic differential as well as Vein of Galen pathology. The hypothalamus,

Neuroscience Syllabus
its divisions and tracts as well as its relationship to the pituitary gland: anterior and posterior will be addressed noting homeostasis and the neuroendocrine system, neoplasms. The craniopharyngeoma. Introduction to the autonomic nervous system. Week 12: The Cerebrum (Chapters 14 and 15 Snell or equivalent) Varied anatomical sections will be analyzed together with their function, dominance, speech, male and female differentiation, memory function to include executive cognitive functions, sleep, behavior, arousal and ageing. SpeciOics involving PenOield's studies and epilepsy, subcortical degeneration, Alzheimer's versus treatable dementias, disorders of circulation will be noted such as infarction, neoplasm... Means of evaluating the patient with standard neurological tactics and mini-mental status exam will be given. Visual Oields... Week 13: Reticular formation and Limbic system (Chapters 16 with review of 9, 12 and 13-15 Snell or equivalent) The limbic system of Papez will be explored together with its ramiOication in behavior and arousal; olfaction and memory. Its pathways are extensive include the thalamus and hippocampus as well as the cingulate gyrus and prefrontal areas. Male and female differences will be noted. SpeciOics will be psychoses such as schizophrenia, importance of the amygdala in behavior as potential for violence, epilepsy...The Kluver-Bucy syndrome...the treatment of behavioral disorders with cingulotomy and the potential of amygdalotomy for violence; the role of amygdalectomy for complex partial seizures. Week 14: The Basal Ganglia (Chapter 17 with review of Chapter 13 Snell or equivalent) The role of dopamine with type one and two receptors as well as the direct and indirect pathways including the subthalamic nucleus and its interface with globus pallidus interior and ventrolateral thalamus/cerebrum. Substantia nigra and the effect of oxidative degeneration. The basal ganglia have a rich blood supply and therefore are susceptible to varied toxins. SpeciOic pathology is noted in Wilson's disease, Huntington's chorea, essential tremor and Parkinsonism will be noted along with other involuntary movement disorders as well as treatment tactics that are medication, stimulation and ablation of targets. Week 15: The Autonomic Nervous System (Chapter 26 Snell or equivalent) This will be an expansion of prior discussions and include the ganglia, role in causalgic pain syndromes, visceral control (cardiovascular, pulmonary, gastrointestinal); the role of sympathectomy, vagal stimulation in epilepsy... Horner's syndrome, Hirschsprung's disease will be noted...Acetylcholine, nitric oxide and norepinhrine, epinephrine will be addressed along with receptor concepts in pharmacology. The syllabus may vary slightly. The student will be informed in case there are signi8icant changes.