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  • Neuroscience
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BRAIN AND BEHAVIOUR: Neuroscience

Index

• General Outcomes for Neurosciences
• Cerebrovascular Disease (Stroke and TIA)
• Delirium and Dementia (see Psychiatry)
• Stupor, Coma and the Unconscious patient
• Organic Brain Syndromes
• Head Injury
• Spinal Cord Disorders and Injury
• Seizure Disorders
• De-Myelinating Diseases
• Migraine and Headaches
• Parkinson's Disease and Neuro-degenerative Disorders
• Neuromuscular disorders
• Dizzyness and Vertigo
• Tumours
• CNS Infections
• Neuropathies
• Chronic Pain
• Neurogenetic Disorders

• General Outcomes for Neurosciences
  • TD 16: PROVIDE IMMEDIATE CARE IN MEDICAL EMERGENCIES
    • Intermediate & Advanced Life Support
      1. Describe the resuscitation and immediate management of patients suffering from neuromuscular respiratory failure (NEURO4)
  • Medical knowledge: ANATOMY (TD 8.1)
    • Autonomic Nervous System
      1. Describe the anatomy of the sympathetic nervous system and explain the main differences between it and the somatic nervous system.
      2. Explain how the anatomy of the parasympathetic nervous system differs from that of the sympathetic.
    • Cranial Nerves
      1. Describe the control of eye movement by cranial nerves III, IV and VI.
      2. Describe the functional neuro-anatomy underlying the following neurological deficits a) Visual fields – homonymous hemianopia, bi-temporal hemianopia; b) Pupils – relative afferent pupillary defect; c) Eye movements – oculomotor, trochlear and abducens palsies, internuclear ophthalmoplegia; d) Facial expression – forehead sparing, upper motor neuron facial palsy; e) Bulbar palsy – dysphonia, dysphagia, aspiration; f) Patterns of motor loss – monoparesis, hemiparesis, quadraparesis, paraparesis, differences between upper and lower motor neuron weakness; g) Patterns of sensory loss – peripheral neuropathy, hemi-anaesthesia, sensory level, Brown-Séquard Syndrome; h) Cauda equina syndrome. (NEURO4)
      3. Overview the organisation of the brainstem in its dorso-ventral and medio-lateral axes.
      4. List the symptoms associated with damage to cranial nerves
      5. Describe the course and exit foraminae of the cranial nerves from the skull vault, especially cranial nerves V, VII, IX, X and XII
      6. State which cranial nerves are associated with each sub-region of the brainstem and relate this to the organisation of the cranial nerve nuclei
      7. Describe the blood supply to the brainstem
      8. Describe the main peripheral targets in the head innervated by cranial nerves V, VII, IX, X and XII
      9. Overview functions of the cranial nerves, noting important reflexes
      10. Explain the consequences of vascular or physical lesions to different areas of the brainstem in terms of clinical signs.
      11. Explain the consequences of raised pressure in the posterior cranial fossa.
      12. Describe the functional neuro-anatomy underlying defects of facial expression including forehead sparing upper motor neuron facial palsy
      13. Describe the functional neuro-anatomy underlying a bulbar palsy including dysphonia, dysphagia and aspiration
    • Hypothalamus
      1. Describe the functional organisation of the hypothalamus
      2. Name the principal hypothalamic nuclei
      3. Describe the principal afferent and efferent connections of the hypothalamus
      4. Describe the hypothalamic autonomic and endocrine projections
      5. Describe the hypophyseal portal system
      6. Describe the hypothalamo-hypophyseal tract
      7. Describe the principal fibre tracts linking the hypothalamus with the brain stem reticular formation
    • Cerebral Cortex
      1. Name the main sulci and fissures of the cerebral cortex and the main lobes of the cerebral hemispheres (including the limbic lobe)
      2. Define projection fibres, association fibres, commissural fibres and name an example of each
      3. Define the terms primary cortex and association cortex, locate their relative positions on the brain surface and state the functional relationship between them
      4. Explain the significance of the homunculi associated with the pre- and post-central gyrus
      5. Define the concept of columnar organisation of the cortex (eg SI) and its relationship to somatotopic organisation in creating body maps (eg, creation of parallel maps for modality specific stimuli)
    • Vision
      1. Describe the functional neuro-anatomy underlying the following neurological deficits a) Visual fields – homonymous hemianopia, bi-temporal hemianopia; b) Pupils – relative afferent pupillary defect; c) Eye movements – oculomotor, trochlear and abducens palsies, internuclear ophthalmoplegia; d) Facial expression – forehead sparing, upper motor neuron facial palsy; e) Bulbar palsy – dysphonia, dysphagia, aspiration; f) Patterns of motor loss – monoparesis, hemiparesis, quadraparesis, paraparesis, differences between upper and lower motor neuron weakness; g) Patterns of sensory loss – peripheral neuropathy, hemi-anaesthesia, sensory level, Brown-Séquard Syndrome; h) Cauda equina syndrome. (NEURO4)
      2. Describe the functional neuro-anatomy underlying the visual field defects; homonymous hemianopia, bitemporal hemianopia
      3. Describe the functional neuro-anatomy underlying a relative afferent pupillary defect
      4. Describe the functional neuro-anatomy underlying eye movement defects; oculomotor, trochlear and abducens palsies and internuclear ophthalmoplegia (GEP/BB)
    • Central Nervous System
      1. Describe the structure of reticular formation and the location of main nuclei or neuronal aggregates.
      2. Know the main afferents and efferents of reticular formation.
      3. Understand the concept of dermatomes and their clinical significance
      4. Explain the general functions of reticular formation.
      5. Understand the reticular activating system and the role in sleep and wakefulness.
      6. Describe the role reticular formation in the control of autonomic nervous system.
    • The Brainstem & Cerebellum
      1. Describe the main gross anatomical features of the cerebellum, including its input and output pathways and its lobular arrangement. (BB2, GEP/BB)
      2. Describe the microanatomical arrangement of the cerebellum including the cortical morphology and connections of the deep nuclei. (BB2, GEP/BB)
      3. Describe the functional subdivisions of the cerebellum and the effect of injury in different regions. (BB2, GEP/BB)
      4. Describe the functional significance of the cerebellar connections to the vestibular system (BB2, GEP/BB)
    • Circulation System of the Brain
      1. Describe the principal arteries of the brain, thalamus and spinal cord (GEP/BB)
      2. Explain the possibilities for collateral circulation through the Circle of Willis (GEP/BB)
      3. Describe the relationship of the blood supply to major functional areas of the brain (GEP/BB)
      4. Describe the venous drainage of the brain and spinal cord (GEP/BB)
      5. Describe the major vascular disorders with regard to the blood supply to the CNS (GEP/BB)
    • Neural Pathways
      1. Describe the anatomy of the spinal canal and the organisation of the dorsal and ventral roots. Describe the trajectory of the roots, the numbers of cervical, thoracic, lumbar and sacral roots and their relationship to the sympathetic ganglia.
      2. Describe the functional neuro-anatomy underlying patterns of sensory loss including peripheral neuropathy, hemianaesthesia, sensory level and Brown-Séquard syndrome
      3. Draw a cross-section of the cord to show the principal ascending and descending tracts located within the white matter. (GEP/BB)
      4. Describe the functional neuro-anatomy underlying patterns of motor loss including monoparesis, hemiparesis, quadraparesis, paraparesis and the differences between upper and lower motor neuron weakness
    • The Limbic System
      1. Be able to describe limbic structures - the hippocampus, the amygdaloid and the septal nuclei
      2. Be able to explain the principal connections between the foregoing limbic structures and the hypothalamus, anterior and dorso-medial thalamic nuclei, prefrontal cortex and midbrain reticular formation.
      3. Be able to describe the effects of lesions in the amygdala and fornix
      4. Discuss the theories of prefrontal cortex function based on clinical evidence
      5. Discuss the theories of temporal lobe function based on clinical evidence
    • The Cranial Cavity and Meninges
      1. Describe the arrangement of the dura mater, arachnoid mater and pia mater in the cranial cavity and outline their functions.
      2. Explain the functions of the falx cerebri and the tentorium cerebelli in stabilising the brain during movement
    • Surface Anatomy of the Back and Spine
      1. Be able to make the positon of the end of the spinal cord in the vertebral canal
    • Spinal Regions, Vertebrae and Intervertebral Discs
      1. Identify the major gross anatomical features of the spinal cord and meninges
      2. Draw a cross section of the spinal cord showing grey and white matter, dorsal and ventral horns
      3. Identify the main blood supply and venous drainage of the spinal cord
      4. Describe the pathways of the principal ascending and descending tracts within the white matter
      5. Describe the basic neurological deficits related to spinal cord injuries
    • Dermatomes
      1. Define the terms dermatome and myotome and show the distribution of cutaneous dermatomes on the body
    • The Spinal Cord
      1. Describe the organisation of the spinal cord in the vertebral column and the arrangement of dorsal and ventral roots
    • Skull, Mandible and Facial Bones
      1. Know the main functions of the skull (BB2)
      2. Name and locate the skull bones
      3. Review the main anatomical features of the skull (BB2)
      4. Describe the difference between the skull of a new born and an adult
      5. Name and locate the foramina of the skull
      6. Be able to identify skull landmarks and explain their significance (BB2)
      7. Identify the cranial nerves related to each skull foramina
      8. Be able to describe the development of the skull and the common developmental abnormalities (BB2)
    • Surface Anatomy of the Head and Neck
      1. Indicate the course of the common and internal carotid arteries in relation to the surface of the neck
      2. Describe the attachments and actions of the sternocleidomastoid muscle and give its nerve supply
      3. Outline the nervous innervation of the pharynx and briefly review how they control swallowing
      4. Describe how the vocal folds produce sound and variation in pitch
    • Nasal Cavity and Sinuses
      1. Be able to identify the paranasal sinuses (BB2)
    • Surface Anatomy - General
      1. Be able to identify the different dermatomes on the limbs to assess somatosensation
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Autonomic Nervous System
      1. Explain what transmitters are used in these systems (GEP/BB)
      2. Explain the functions of the cortical association areas, particularly the posterior parietal association area and the frontal association areas (GEP/BB)
      3. Discuss the function of the sympathetic and parasympathetic nervous systems (GEP/BB)
      4. Describe the anatomy of the peripheral sympathetic and parasympathetic nervous systems (GEP/BB)
      5. Explain the hierarchical model of visual perception. (GEP/BB)
    • Consciousness, Coma and Persistent Vegetative States
      1. Define the terms consciousness, coma and sleep (BB2)
      2. Define what consciousness is and its components. (BB2)
      3. Describe how consciousness is measured using the Glasgow coma scale (BB2)
      4. Describe the anatomical correlates of consciousness.
      5. Describe the neuroanatomical systems (reticular formation) which govern arousal
      6. To understand the mechanism of action of general anaesthesia
      7. Give a classification of unconscious states. (BB2)
      8. Describe the neurophysiological processes behind sleep and consciousness
      9. Define the terminology used for vegetative states. (BB2)
      10. Appreciate the effect of pathological processes of this system on conscious level (BB2)
      11. Explain the difference between conditions closely related to the vegetative state such as minimally conscious state and akinetic mutism.
      12. Explain the prognosis and outcome of the vegetative state. (BB2)
    • Vision
      1. Describe the receptive fields of cells in the visual cortex
      2. Explain the 'grandmother cell' or hierarchical model of visual perception.
      3. Explain the functions of the following cortical areas: the posterior parietal association area; the inferotemporal association area; the dorsolateral association area
    • General Outcomes for Nervous System Physiology
      1. Describe the main types of peripheral sensory receptors
      2. State the main neurotransmitters employed in the CNS and understand how the associated receptors mediate their action
      3. Be able to describe the essential differences between afferent and efferent nerves.
      4. Define the term neurotrophic factor and explain the neurotrophic hypothesis (GEP/BB)
      5. To understand the basis of the resting membrane potential
      6. to obtain quantitative data on the 2-point discrimination thresholds on different parts of the body
      7. Describe the structure of a typical cell membrane (GEP/M&P)
      8. Review how action potentials are generated, propagated along axons and explain reasons for failure. (GEP/BB)
      9. Describe the basic organisation of the peripheral and central nervous system (GEP/BB)
      10. Outline the pathway of, and name the enzymes involved in, the synthesis of noradrenaline and adrenaline.
      11. To explain the simple action potential & saltatory conduction
      12. Define the term neuromodulator and give examples of such
      13. Briefly describe how nerve conduction studies and electromyography are performed and how they can detect peripheral nerve abnormalities. (GEP/BB)
      14. Describe the synthesis, storage and release of acetylcholine.
      15. Name and identify the major parts of the adult nervous system and describe their primary functions (GEP/BB)
      16. Explain the origin of osmotic forces acting in the cell (GEP/M&P)
      17. Describe the role of glial cells in the nervous system (GEP/BB)
      18. Describe how epsps and ipsps are generated at excitatory and inhibitory synapses within the CNS
      19. Explain the different ways in which plant and animal cells cope with osmotic forces (GEP/M&P)
      20. Explain how noradrenaline and adrenaline are released from sympathetic nerves, how they act, and how they are inactivated.
      21. Differentiate nicotinic from muscarinic effects.
      22. Review synaptic transmission and explain the importance of termination of transmitter action, and give two different examples of how this is achieved. (GEP/BB)
      23. Describe the role of polysynaptic reflexes in the spinal cord
      24. Explain why there is an imbalance in potassium concentration inside and outside animal cells (GEP/M&P)
      25. Explain the importance of termination of transmitter action, and give two different examples of how this is achieved
      26. Describe the distribution of α- and ß-adrenoceptors and how different tissues/organs respond to adrenoceptor stimulation.
      27. Describe the control of muscle length and tension involving muscle spindles and tendon organs.
      28. Describe how epsps and ipsps are generated at excitatory and inhibitory synapses within the CNS. (GEP/BB)
      29. Describe the process of nerve regeneration and state the criteria for determining its success (GEP/BB)
      30. Explain the necessity for a sodium pump (GEP/M&P)
      31. Give examples of drugs (agonists / antagonists) selective for α- and ß-adrenoceptors, and for subtypes of these receptors. Discuss the therapeutic uses of these drugs.
      32. State the main neurotransmitters employed by sensory afferents and in CNS neurons and their associated receptors. (GEP/BB)
      33. Briefly explain why regeneration in the CNS fails to occur (GEP/BB)
      34. Review how action potentials are propagated along axons and explain reasons for failure
      35. Describe the special features of voltage gated sodium channels (GEP/M&P)
      36. Define the term neuromodulator and give examples of such (GEP/BB)
      37. Briefly describe how nerve conduction studies and electromyography are performed and how they can detect peripheral nerve abnormalities
      38. Draw a diagram of the ionic currents occurring during an action potential (GEP/M&P)
      39. Describe and explain the effects of anti-cholinesterase drugs (neostigmine, pyridostigmine)
    • Motor Systems
      1. Identify the brain regions involved in the control of voluntary movement.
      2. Be able to describe the regions of the cortex involved in motor control
      3. Understand the functions of the specific brain regions in the control of voluntary movement.
      4. Be able to describe the functional characteristics of the major motor tracts (pyramidal, reticulospinal and vestibulospinal) and their origins (GEP/BB)
      5. Describe the anatomy and physiology of muscle spindle and Golgi tendon organs.
      6. Describe the pathophysiologic mechanisms of spasticity, clonus, hyperreflexia and decorticate and decerebrate postures. (GEP/BB)
      7. Describe the main descending motor tracts.
      8. Describe the concept of lower motoneurone and upper motoneurone lesions, muscle tone & spasticity.
      9. Explain the main medical conditions associated with the damage to the motor system.
      10. Describe the acute and chronic deficits arising from lesioning of individual motor tracts and the acute and chronic deficits arising from lesioning the motor cortex; be able to compare with lesions of the lower motorneurone.
      11. Name cholinergic agonists and antagonists; describe their receptor selectivity and possible therapeutic uses.
      12. Explain the mechanisms of action of different kinds of neuromuscular blocking agents.
    • The Physiology of Pain
      1. Be able to define the following terms: pain, nociceptor, allodynia, hyperalgesia, spontaneous pain and referred pain.
      2. Be able to state the four main components involved in pain transmission & perception
      3. Be able to describe the biological significance of acute, prolonged and chronic pain.
      4. Be able to describe how tissue damage leads to altered activation of nociceptors and cells in the spinal cord.
      5. Be able to describe the chemical anatomy of nociceptors.
      6. Describe the main mechanisms whereby nociceptive transmission can be blocked or modulated.
      7. Review the ascending pathways by which fast and slow pain is transmitted from the periphery to the cortex.
      8. To understand the mechanism of action of local anaesthesia
      9. Be able to discuss the role of cells in the substantia gelatinosa in the gating of nociceptive transmission and comment on its clinical importance.
      10. Be able to summarise the functions of different brain areas in pain processing
      11. Be able to explain the concepts of peripheral and central sensitisation.
    • The Vestibular System
      1. Be able to list the functional roles of the vestibular system
      2. Describe how the vestibular system detects angular and linear acceleration
      3. Describe the vestibule-ocular reflexes and how they are tested. Define nystagmus and vertigo. (GEP/BB)
      4. Be able to describe the central pathways of the vestibular system
      5. Be able to list the clinical signs of vestibular system dysfunction
      6. Be able to describe tests for balance disorders
    • Brainstem and Cranial Nerves
      1. List the symptoms associated with damage to cranial nerves
      2. Define the main sub-regions of the brainstem and their associated functions.
      3. Briefly state the main functions of the reticular formation
      4. Briefly describe functions of the reticular formation
      5. Review the blood supply to the brainstem
    • Cerebral Function
      1. Explain the term cerebral dominance, how it may be demonstrated, and describe the lateralisation of functions associated with language, and how it is related to left or right handedness
      2. Describe the functions of the non-dominant hemisphere
      3. Define the terms agnosia, apraxia and aphasia
      4. Describe the main effects of lesions of the occipital, parietal, temporal and frontal cortices
      5. Describe the consequences of severing the corpus callosum - split brain syndrome
    • Somatosensory Pathways
      1. Describe the pathways to the brain for touch receptors; describe the clinical manifestations of lesions in these pathways (GEP/BB)
      2. Describe the pathways to the brain for proprioceptive receptors; describe the clinical manifestations of lesions in these pathways (GEP/BB)
      3. Describe the pathways to the brain for pain receptors; describe the clinical manifestations of lesions in these pathways (GEP/BB)
      4. To produce a clear description of the changes in sensory perception in a subject with circulation occluded in one arm. Discuss the neurophysiological processes in the arm that are responsible for these perceptual changes.
      5. Describe the organisation of somatosensory (VP) thalamus (GEP/BB)
      6. to discuss the concept of somatosensory receptive fields on the body surface, how density and size of these fields may affect the localisation of touch stimuli
      7. List the differences that may be encountered when a lesion is located at the peripheral, spinal, posterior fossa (brainstem), or supra-tentorial (thalamus/cortex) levels (GEP/BB)
    • The Neural Control of Movement
      1. Draw a diagram of the connections of the major components of the motor system (motor cortex, basal ganglia, cerebellum, brainstem, spinal cord and a-motoneurons) (GEP/BB)
      2. Review the main functions of non-neuronal cells in the PNS and CNS in health and disease (BB2)
      3. Outline the main fuction of each part of the motor system (GEP/BB)
      4. Review the main neurotransmitters used by the nervous system (BB2)
      5. Review the main pathways by which the sensory modalities of touch, pain and proprioception are transmitted from the periphery to the brain, where they decussate, the basic tests used to assess their integrity and the clinical signs associated with damage (BB2)
      6. Define the area of the brain occupied by the motor cortex, its major inputs and outputs and its topographic arrangement (in terms of the distorted motor homunculus representation) (GEP/BB)
      7. Know the main components of the motor system with particular emphasis on the monosynaptic reflex and the corticospinal (pyramidal) tract, their clinical significance, how to test reflexes and how to recognise damage to the motor system (BB2)
      8. Define the main functions of the motor association cortex (GEP/BB)
      9. Name the pathways that comprise the pyramidal and extra-pyramidal systems and describe their main functions (GEP/BB)
      10. Review the organisation and functions of the cranial nerves, the basic tests used to assess their integrity and the clinical signs associated with their damage (BB2)
      11. Review the functional organisation of the cerebral hemispheres, including higher mental functions and tests associated with them (BB2)
      12. Describe the basic neurological sequence involved in executing a voluntary movement (GEP/BB)
      13. Know the distribution of the principal arteries of the brain and spinal cord and the main functional areas of the brain and spinal cord that they cover (BB2)
    • Control of Behaviour
      1. Describe the neural control of drinking
      2. Describe the neural control of food intake
      3. Describe the neural control of urination
      4. Describe the neural control of defecation
      5. Describe how hypothalamic lesions can modify motivated behaviour
    • Basal Ganglia
      1. Describe the morphology and blood supply of the caudate and lentiform nuclei and the associated internal capsule (BB2, GEP/BB)
      2. Describe the principal afferent and efferent connections of the caudate nucleus and putamen (striatum). (BB2, GEP/BB)
      3. Describe the connections of the globus pallidus & subthalamic nucleus. (BB2, GEP/BB)
      4. Explain the circuitry of the substantia nigra and its association with Parkinson's disease. (BB2)
      5. Describe the role of the basal ganglia in motor control and discuss how their damage can lead to Parkinson’s disease, Huntington’s chorea, ballismus and athetosis. (BB2)
    • Neuropharmacology
      1. Define drug targets within a typical chemical synapse in the nervous system
      2. Review the circuitry of the basal ganglia, its main neurotransmitters and its pathological modifications in Parkinson’s disease and Huntington’s disease
      3. Explain the importance of the blood-brain barrier as a determinant of efficacy
      4. Describe the mechanisms of action, pharmacokinetics, adverse effects and limitations of drugs used in the treatment of Parkinson’s disease (e.g. L-DOPA, dopaminergic agonists, cholinergic antagonists, MAOB inhibitors).
      5. Appreciate the importance of drug delivery systems in neurology.
      6. Describe the treatment of Huntington’s disease.
      7. Give examples of side-effects fo drugs used in neuropharmacology and describe their impact on disease management
      8. Briefly review future directions in the management of Parkinson’s disease and Huntington’s disease.
      9. Define the concept of treatment-resistance, and give examples of causes underlying this phenomenon
    • Physiology of Memory and Learning
      1. Define learning, and describe the conditions under which it occurs.
      2. State the differences between classical conditioning and operant conditioning
      3. Define short- and long-term memory, and consolidation.
      4. Define anterograde and retrograde amnesia, and state some of the major causes of these.
      5. Describe the possible synaptic mechanisms underlying memory formation
      6. State the role of the hippocampus and the amygdala in memory.
      7. Briefly outline the effects of frontal and temporal lobe lesions on memory.
    • Spinal Reflexes
      1. Define the term motor unit and describe how the force of muscle contraction is controlled by impulse frequency and by recruitment of motor units.
      2. Describe the anatomy and physiology of muscle spindle and Golgi tendon organs.
      3. Draw a diagram of the monosynaptic reflex arc (for patellar or ankle jerk).
      4. Describe the control of muscle length and tension involving muscle spindles and tendon organs.
      5. Describe the role of polysynaptic reflexes in the spinal cord
      6. Describe the concept of lower and upper motoneurone lesions, muscle tone & spasticity.
    • The Peripheral Nervous System
      1. List the changes that occur after nerve injury - distal to the injury; in the dorsal root ganglion; proximal to the injury (GEP/BB)
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • Hydrocephalus
      1. Describe the pathology, presentation, investigation and management of hydrocephalus (NEURO4)
    • General topics
      1. Demonstrate an awareness of the breadth of neurological pathology
  • Clinical skills: INTERPRETING FINDINGS AND INITIAL ASSESSMENT (TD 14 a-b)
    • Interpreting findings and initial assessment
      1. Interpret historical and examination findings in order to begin to formulate a differential diagnosis, suggest reasonable investigations and produce a management plan including pharmacological therapy where appropriate (NEURO4)
  • Medical knowledge: PHARMACOLOGY (TD 8.10)
    • 5-HT Transmission
      1. Describe the 5-HT pathways in the central nervous system. (BB2)
      2. List and characterise the main types of 5-HT receptors. (BB2)
      3. Describe the mechanism of action of drugs that act on 5-HT systems. (BB2)
    • Synaptic Transmission
      1. Describe the neuronal structures involved in synaptic transmission. (BB2)
      2. Describe the main steps involved in neurotransmission. (BB2)
      3. Describe the effects of neurotransmitters at postsynaptic level. (BB2)
      4. List and classify major types of neurotransmitters. (BB2)
      5. Review the basic mechanisms underlying neuronal excitability. (BB2)
    • Dopaminergic Systems
      1. Describe the dopaminergic pathways in the central nervous system. (BB2)
      2. List and characterise the main types of dopaminergic receptors. (BB2)
      3. Describe the mechanism of action of drugs that act on dopaminergic systems. (BB2)
      4. Review the main circuits involved in the control of movement. (BB2)
    • Drug Dependence and Addiction
      1. Explain mechanisms underlying pharmacodynamic and pharmacokinetic tolerance. (BB2)
      2. Give examples of major drugs that cause dependence and induce tolerance. (BB2)
  • Medical knowledge: CLINICAL FEATURES of DISEASE (TD 8 b)
    • Hydrocephalus
      1. Describe the pathology, presentation, investigation and management of hydrocephalus (NEURO4)
    • General Outcomes for Neurological Disorders
      1. Be able to describe the Kluver - Bucy syndrome, temporal lobe epilepsy and Wernicke-Korsakoff syndrome.
  • Medical knowledge: PSYCHOLOGY (TD 9 a-g)
    • General Outcomes for Learning and Conditioning
      1. Distinguish different types of conditioning and learning. (BB2)
      2. Describe the role of learning in addictive behaviours.
      3. Illustrate the relevance of learning principles in medicine.
      4. Provide examples of psychological treatments based on theories of learning. (BB2)
    • Drug Dependence
      1. Describe physical and psychological drug dependence. (BB2)
  • Clinical skills: HISTORY (TD 13 a-b)
    • Examination of the CNS inc. Cranial Nerves
      1. Appreciate the anatomical / physiological basis of the neurological examination including the cranial nerves and their functions and the supporting basic neuroanatomy
      2. Know how to gain consent to examine a person / patient’s cranial nerves (BB2)
      3. Know how to position a patient / person correctly prior to examining their cranial nerves. (BB2)
      4. Be able to demonstrate the appropriate techniques required to perform a systematic examination of cranial nerves II, III, IV, V, VI, VII and XII. (BB2)
      5. Be able to perform clinical examination of cranial nerves III - VII and XI - XII
      6. Associate specific tests with cranial nerves, sensory modalities and ascending or descending pathways
      7. The student should know the principles of the examination with reference to the basic neuroanatomy and neurophysiology of the cranial nerves and pathways
    • Examination of the Nervous System - General
      1. Appreciate the anatomical basis of the central neurological examination (BB2)
      2. Appreciate the anatomical / physiological basis of the peripheral neurological examination (BB2)
      3. Perform and present an examination of the conscious level, the cranial nerves and the neurology of the upper and lower limbs
      4. How to gain consent to examine a person / patient’s peripheral neurological system (BB2)
      5. Know how to gain consent to examine a person / patient's neurological system(s)
      6. Know how to position a patient / person correctly prior to examining their peripheral neurological nervous system, gait and cerebellar system. (BB2)
      7. Know how to correctly identify some simple abnormalities of the neurological system including signs of stroke disease
      8. Be able to perform a cutaneous sensory examination (low threshold touch; pinprick; point position sensation; vibration; temperature)
      9. Know how to identify the common clinical signs that show a patient has neurological deficit and / or the patient is unwell. (BB2)
      10. Be able to identify the common clinical signs that show a patient has neurological deficit and / or the patient is unwell. (BB2)
      11. Appreciate how to systematically observe a patient from the end of the bed using the 'feet to face' principle, identifying some common abnormalities of peripheral neurological disease. (BB2)
      12. Know how to systematically observe a patient from the end of the bed using the 'feet to face' principle, identifying some common abnormalities of central neurological disease. (BB2)
      13. Be able to perform a reflex tendon examination of the following reflexes: beceps, triceps, knee, ankle and plantar flexor
      14. Be able to demonstrate the appropriate techniques required to perform a systematic examination of a patient’s peripheral neurological system including gait and cerebellar disorders. (BB2)
      15. Be able to perform an EMG (electromyography) of the muscles of the upper limb and interpret the data generated
      16. Be able to perform a sensory and motor examination of the hand to assess the functions of the main nerves that innervate the hand
      17. Know how to perform the associated clinical examination and investigations required to complete a neurological assessment. (BB2)
      18. Appreciate how to perform the associated clinical examination and investigations required to complete a neurological assessment. (BB2)
      19. Appreciate how to complete the neurological assessment of a patient. (BB2)
    • Examination of the PNS
      1. Appreciate the anatomical and physiological basis of the peripheral neurological examination
      2. Know the correct techinque used to perform a limited motor and sensory examination of the upper and lower limbs
    • Taking a History
      1. Take, record and present a neurological history, including a drug history (NEURO4, NEURO4, NEURO4)
  • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Examining the Patient
      1. The anatomical / physiological basis of the neurological examination – including the cranial nerves and their functions, and the supporting basic neuroanatomy
      2. Perform an examination of the cranial nerves and the neurology of the upper and lower limbs (NEURO4, NEURO4)
      3. How to gain consent to examine a person / patient’s neurological system(s)
      4. How to correctly identify some simple abnormalities of the neurological system including signs of stroke disease.
      5. The correct technique used to make an assessment of a patient’s eyes – including visual acuity, visual fields, ocular movements and pupillary reflexes
  • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Neurological Investigations
      1. Describe the role of clinical neurophysiology in the investigation of neurological disease (NEURO4, NEURO4)
      2. Describe the role of clinical neurophysiology in the investigation of neurological disease
      3. Interpret the following features of CSF – cell count, protein content, glucose content, xanthochromia, oligoclonal bands
      4. Interpret historical and examination findings in order to begin to formulate a differential diagnosis, suggest reasonable investigations and produce a management plan including pharmacological therapy where appropriate (NEURO4)
    • Neurological Imaging
      1. Describe the different types of neuro-imaging techniques available to investigate the nervous system (GEP/BB)
      2. Demonstrate an ability to distinguish between CT, T1 & T2 weighted images and recognise gross abnormalities (NEURO4, NEURO4)
      3. Define the role of functional imaging in the vegetative state. (BB2)
  • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • General Outcomes for Neurological Diagnosis
      1. Interpret historical and examination findings in order to begin to formulate a differential diagnosis, suggest reasonable investigations and produce a management plan including pharmacological therapy where appropriate (NEURO4)
  • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Emergency Management
      1. Describe the resuscitation and immediate management of patients suffering from the following emergency conditions; coma, injury to the head and spine, meningitis, neuromuscular respiratory failure and status epilepticus
    • Management of Neurological Disorders
      1. Interpret historical and examination findings in order to begin to formulate a differential diagnosis, suggest reasonable investigations and produce a management plan including pharmacological therapy where appropriate (NEURO4)
  • Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
    • Deep Brain Stimulation
      1. Understand the principles underlying deep brain stimulation and appreciate the impact of this technique in neurology.
  • Clinical skills: INTERACTION WITH PATIENTS (TD 15 a-b)
    • Interacting with Patients - General
      1. Present historical and examination findings to a medical practitioner (NEURO4)
  • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
    • Pharmacological Therapy - Neurological Disorders (General)
      1. Take, record and present a neurological history, including a drug history (NEURO4, NEURO4, NEURO4)
      2. Interpret historical and examination findings in order to begin to formulate a differential diagnosis, suggest reasonable investigations and produce a management plan including pharmacological therapy where appropriate (NEURO4)
  • Professional issues: ETHICS and LAW (TD 20 a-g)
    • End of Life Ethics
      1. Define ethical issues such as the end of life decision.
• Cerebrovascular Disease (Stroke and TIA)
  • General Outcomes for Cerebrovascular Disease
  • Transient Ischaemic Attacks (TIAs)
  • Cerebrovascular Accident (CVA / Stroke)
    1. Describe the pathology, presentation, investigation and management of stroke (NEURO4)
    2. Describe the pathophysiology of stroke in relation to risk factors. (BB2)
    3. Recognise the common neurovascular syndromes and mechanisms of stroke. (BB2)
    4. Understand the role of thrombolysis in the treatment of acute ischaemic stroke. (BB2)
    5. Understand the principles of management of patients who have suffered a stroke. (BB2)
  • Cerebrovascular Disease in Older People (CVA & TIA)
• Delirium and Dementia (see Psychiatry)
  • General Outcomes for Delirium and Dementia
    1. Describe the pathology, presentation, investigation and management of dementia (NEURO4)
    2. Be able to classify dementia
    3. Be able to describe the pathogenesis of Alzheimer's disease.
    4. Be able to describe alterations in cholinergic neurotransmission in Alzheimer's disease.
    5. Be able to describe the main types of acetylcholinesterase inhibitors and their use in dementia.
    6. Be able to describe the use of memantine and its rationale.
    7. Be able to discuss new therapeutic approaches in Alzheimer's disease.
• Stupor, Coma and the Unconscious patient
  • General
    1. Describe the functional neuro-anatomy underlying coma (NEURO4)
    2. Perform and present an examination of the conscious level (NEURO4, NEURO4)
    3. Describe the resuscitation and immediate management of patients suffering from coma (NEURO4)
  • The Collapsed patient in A & E
• Organic Brain Syndromes
  • General
• Head Injury
  • General Outcomes for Head Injury
    1. Describe the pathology, presentation, investigation and management of head injury (NEURO4)
    2. Review the anatomical features of the cranium relevant to head injury.
    3. Describe the resuscitation and immediate management of patients suffering from injury to the head (NEURO4)
    4. Understand the pathological changes which occur in the brain following head injury.
    5. Be able to provide an overview of the types of intracranial injury which occur and the basic principles of their management after head injury.
    6. Be able to list and show examples of different types of skull fractures (BB2)
  • Aphasia
  • Intra-cranial Haemorrhage
  • Sub-arachnoid Haemorrhage
  • Raised Intracranial Pressure
• Spinal Cord Disorders and Injury
  • General Outcomes for Spinal Cord Disorders and Injuries
  • Myelopathy
  • Paraplegia
• Seizure Disorders
  • General Outcomes for Seizure Disorders
  • Epilepsy (General)
    1. Be able to describe the main types of epileptic seizure.
    2. Describe the pathology, presentation, investigation and management of epilepsy (NEURO4)
    3. Describe the various mechanisms that may underlie epileptic seizures.
    4. Demonstrate knowledge of therapeutics, pharmacokinetics, side effects and interactions for Carbamezapine, Phenytoin & Valproate (NEURO4)
    5. Describe the resuscitation and immediate management of patients suffering from status epilepticus (NEURO4)
• De-Myelinating Diseases
  • Multiple sclerosis
    1. Describe the pathology, presentation, investigation and management of multiple sclerosis (NEURO4)
    2. Describe the neuroimmunological aspects of multiple sclerosis
    3. Be able to explain the symptoms, the progression of multiple sclerosis and its prognosis
    4. Interpret the presence of oligoclonal bands in CSF (NEURO4)
    5. Describe the present treatment of multiple sclerosis
• Migraine and Headaches
  • General
    1. Can describe the pathophysiology, clinical symptoms and basic treatments of headache (BB2)
    2. Understand the difference between primary and secondary headaches (BB2)
    3. Describe the pathology, presentation, investigation and management of headache (NEURO4)
    4. Understand the distinguishing symptoms of the primary headaches
    5. Understand the role of genetic and environmental factors in headache (thresholds and triggering / precipitating factors) (BB2)
    6. Review the central structures involved in primary headache
  • Pharmicological managment
  • Diagnosis
  • Acute headache
    1. Describe the pathology, presentation, investigation and management of subarachnoid haemorrhage (NEURO4)
    2. Interpret the following features of CSF – cell count & xanthochromia (NEURO4)
• Parkinson's Disease and Neuro-degenerative Disorders
  • General Outcomes for Neurodegenerative Disorders
    1. Describe Huntington’s chorea, ballismus and athetosis, and explain the deficits in basal ganglia function that lead to these syndromes. (GEP/BB)
  • Parkinson's Disease
    1. Demonstrate knowledge of therapeutics, pharmacokinetics, side effects and interactions for carbidopa / levodopa (NEURO4)
    2. Describe the pathology, presentation, investigation and management of parkinson's disease (NEURO4)
    3. Can describe the pathophysiology, clinical symptoms and basic treatments of movement disorders (BB2, BB2, BB2)
    4. Describe the motor deficits seen in Parkinson’s disease and explain the theory of direct and indirect pathways used to explain the motor deficits (GEP/BB)
  • Motor Neurone disease
    1. Describe the pathology, presentation, investigation and management of motor neuron disease
    2. Describe the pathology, presentation, investigation and management of motor neuron disease (NEURO4)
• Neuromuscular disorders
  • Myasthenia Gravis
    1. Describe the pathology, presentation, investigation and management of myasthenia gravis (NEURO4)
• Dizzyness and Vertigo
  • General
    1. Interpret the history and examination in order to begin to formulate a differential diagnosis for a patient complaining of dizziness, suggest reasonable investigations and produce a management plan including pharmacological therapy where appropriate. (NEURO4)
• Tumours
  • General Outcomes for Tumours
    1. Describe the pathology, presentation, investigation and management of brain tumours (NEURO4)
  • Meningioma
• CNS Infections
  • General
  • Meningitis
    1. Describe the pathology, presentation, investigation and management of infective meningitis (NEURO4)
    2. Interpret the following features of CSF – cell count, protein content, glucose content (NEURO4)
    3. Describe the resuscitation and immediate management of patients suffering from meningitis (NEURO4)
    4. Meningitis: blind treatment, flow chart (CSP3)
• Neuropathies
  • General
    1. Able to describe how neurological disease presents within the community (NEURO4)
    2. Describe the pathology, presentation, investigation and management of peripheral neuropathies
    3. Awareness of chronic neurological diseases in the community recognising how these patients are managed in the community (NEURO4)
    4. Describe the pathology, presentation, investigation and management of peripheral neuropathy (NEURO4)
    5. Describe the presentation, examination and management of patients with headaches in primary care (NEURO4)
  • Guillaine Barre Syndrome
• Chronic Pain
  • General
    1. Consider explanations for unusual pain phenomena.
    2. Describe the pathology, presentation, investigation and management of spondylosis (NEURO4)
    3. Describe the resuscitation and immediate management of patients suffering from injury to the spine (NEURO4)
    4. Be able to describe and evaluate the Gate theory of pain
    5. Be able to describe psychological methods of pain assessment.
    6. Be able to describe psychological pain management techniques and evaluate evidence of their efficacy
  • Opioids
  • Anaesthesia
  • Treatment
• Neurogenetic Disorders
  • General
    1. Demonstrate an awareness of the fundamental mechanisms of genetic disorder, drawing on neurological examples (NEURO4)

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