Theme 3:
The nervous
system III
Summary
1
,Inhoud
Week 9: Consciousness..........................................................................................................................7
Medical history.......................................................................................................................................7
Dualism...........................................................................................................................................7
Monism, localism and materialism.................................................................................................7
Informationalism............................................................................................................................7
How technology transformed death...............................................................................................8
Neuroanatomy.................................................................................................................................10
Cranial nerves...............................................................................................................................14
Development of brain stem and cranial nerves............................................................................18
Behavioural and motivational mechanisms of the brain – The limbic system and the hypothalamus
..........................................................................................................................................................20
Activating: driving systems of the brain........................................................................................20
Neurohormonal control of brain activity......................................................................................20
The limbic system.........................................................................................................................20
Specific functions of other parts of the limbic system..................................................................21
Sleep.................................................................................................................................................23
Sleep disorders.............................................................................................................................27
The brainstem and cranial nerves.....................................................................................................28
The cranial nerves.........................................................................................................................28
Eye movements............................................................................................................................29
Facial sensation............................................................................................................................30
Taste.............................................................................................................................................31
Facial movement..........................................................................................................................31
Hearing.........................................................................................................................................31
Chewing, speaking and swallowing...............................................................................................31
Examination of the cranial nerves................................................................................................32
Examination of a comatose patient..............................................................................................32
Abnormal respiration....................................................................................................................34
Bulbar or pseudobulbar disorder?................................................................................................34
Autonomic nervous system, hypothalamus and pituitary gland.......................................................36
The sympathetic nervous system.................................................................................................36
Parasympathetic nervous system.................................................................................................37
Afferent fibres of the autonomic nervous system........................................................................37
The hypothalamus........................................................................................................................37
2
, Autonomic regulation of blood pressure and heart action...........................................................38
Autonomic control of the eye.......................................................................................................38
Cerebral meninges and the cerebrospinal fluid system....................................................................40
Clinical problems associated with cerebrospinal circulation disorders.........................................40
Epilepsy and paroxysmal disorders...................................................................................................41
Seizures.........................................................................................................................................41
Epileptic seizures..........................................................................................................................41
Classification of epilepsy syndromes............................................................................................42
Epileptic seizures in childhood......................................................................................................43
Treatment.....................................................................................................................................43
Sleep disorders.............................................................................................................................44
Altered consciousness......................................................................................................................47
Impaired consciousness................................................................................................................47
Treating comatose patients..........................................................................................................48
Herniation syndromes..................................................................................................................49
Metabolic coma............................................................................................................................50
Non-convulsive status epilepticus................................................................................................51
Altered but not lowered consciousness........................................................................................51
Head and brain injuries.....................................................................................................................52
Severity of brain injuries...............................................................................................................52
Initial assessment and treatment.................................................................................................52
Skull fractures...............................................................................................................................53
Post-traumatic intracranial complications....................................................................................54
The prognosis after head injury....................................................................................................55
Infections of the central nervous system and meninges..................................................................57
Neuroborreliosis...........................................................................................................................57
Brain death.......................................................................................................................................58
Organ donation.............................................................................................................................58
Medical decision-making regarding incompetent patients...............................................................60
Week 10: Transient loss of consciousness............................................................................................61
The nervous system and muscles.........................................................................................................61
Structure.......................................................................................................................................61
Visualising the peripheral nervous system...................................................................................63
The nerve......................................................................................................................................63
Physiology.....................................................................................................................................64
The muscle....................................................................................................................................65
3
, Physiological measurements of the central nervous system:.......................................................68
Autonomic nervous system and the adrenal medulla......................................................................69
General organisation of the autonomic nervous system..............................................................69
The sympathetic nervous system.................................................................................................69
The parasympathetic nervous system..........................................................................................69
Basic characteristics of sympathetic and parasympathetic function............................................70
Pharmacology of the autonomic nervous system.........................................................................71
Cerebral blood flow..........................................................................................................................73
Physiology: transient loss of consciousness......................................................................................75
Transient loss of consciousness........................................................................................................78
Differential diagnosis....................................................................................................................79
Primary evaluation........................................................................................................................82
Pharmacology in epilepsy.................................................................................................................83
Epilepsy and antiseizure medication............................................................................................83
Drug interactions..........................................................................................................................87
Management of epilepsy..............................................................................................................88
Cardiology.........................................................................................................................................90
Bradycardia...................................................................................................................................91
Atrial tachyarrhythmias................................................................................................................92
Ventricular tachyarrhythmias.......................................................................................................93
Myocardial disease.......................................................................................................................94
Week 11: Dementia..............................................................................................................................96
The higher cerebral functions...........................................................................................................96
Functions of the cerebral cortex...................................................................................................96
Aphasia.........................................................................................................................................96
Apraxia..........................................................................................................................................97
Agnosia.........................................................................................................................................97
Aprosody......................................................................................................................................98
Spatial disorders...........................................................................................................................98
Cognitive disorders.......................................................................................................................99
Memory........................................................................................................................................99
Physical causes for psychological dysregulation.........................................................................101
Delusions and hallucinations......................................................................................................101
Ill-defined symptoms..................................................................................................................102
Testing of higher cerebral functions...........................................................................................102
Cortical dysfunction........................................................................................................................104
4
The nervous
system III
Summary
1
,Inhoud
Week 9: Consciousness..........................................................................................................................7
Medical history.......................................................................................................................................7
Dualism...........................................................................................................................................7
Monism, localism and materialism.................................................................................................7
Informationalism............................................................................................................................7
How technology transformed death...............................................................................................8
Neuroanatomy.................................................................................................................................10
Cranial nerves...............................................................................................................................14
Development of brain stem and cranial nerves............................................................................18
Behavioural and motivational mechanisms of the brain – The limbic system and the hypothalamus
..........................................................................................................................................................20
Activating: driving systems of the brain........................................................................................20
Neurohormonal control of brain activity......................................................................................20
The limbic system.........................................................................................................................20
Specific functions of other parts of the limbic system..................................................................21
Sleep.................................................................................................................................................23
Sleep disorders.............................................................................................................................27
The brainstem and cranial nerves.....................................................................................................28
The cranial nerves.........................................................................................................................28
Eye movements............................................................................................................................29
Facial sensation............................................................................................................................30
Taste.............................................................................................................................................31
Facial movement..........................................................................................................................31
Hearing.........................................................................................................................................31
Chewing, speaking and swallowing...............................................................................................31
Examination of the cranial nerves................................................................................................32
Examination of a comatose patient..............................................................................................32
Abnormal respiration....................................................................................................................34
Bulbar or pseudobulbar disorder?................................................................................................34
Autonomic nervous system, hypothalamus and pituitary gland.......................................................36
The sympathetic nervous system.................................................................................................36
Parasympathetic nervous system.................................................................................................37
Afferent fibres of the autonomic nervous system........................................................................37
The hypothalamus........................................................................................................................37
2
, Autonomic regulation of blood pressure and heart action...........................................................38
Autonomic control of the eye.......................................................................................................38
Cerebral meninges and the cerebrospinal fluid system....................................................................40
Clinical problems associated with cerebrospinal circulation disorders.........................................40
Epilepsy and paroxysmal disorders...................................................................................................41
Seizures.........................................................................................................................................41
Epileptic seizures..........................................................................................................................41
Classification of epilepsy syndromes............................................................................................42
Epileptic seizures in childhood......................................................................................................43
Treatment.....................................................................................................................................43
Sleep disorders.............................................................................................................................44
Altered consciousness......................................................................................................................47
Impaired consciousness................................................................................................................47
Treating comatose patients..........................................................................................................48
Herniation syndromes..................................................................................................................49
Metabolic coma............................................................................................................................50
Non-convulsive status epilepticus................................................................................................51
Altered but not lowered consciousness........................................................................................51
Head and brain injuries.....................................................................................................................52
Severity of brain injuries...............................................................................................................52
Initial assessment and treatment.................................................................................................52
Skull fractures...............................................................................................................................53
Post-traumatic intracranial complications....................................................................................54
The prognosis after head injury....................................................................................................55
Infections of the central nervous system and meninges..................................................................57
Neuroborreliosis...........................................................................................................................57
Brain death.......................................................................................................................................58
Organ donation.............................................................................................................................58
Medical decision-making regarding incompetent patients...............................................................60
Week 10: Transient loss of consciousness............................................................................................61
The nervous system and muscles.........................................................................................................61
Structure.......................................................................................................................................61
Visualising the peripheral nervous system...................................................................................63
The nerve......................................................................................................................................63
Physiology.....................................................................................................................................64
The muscle....................................................................................................................................65
3
, Physiological measurements of the central nervous system:.......................................................68
Autonomic nervous system and the adrenal medulla......................................................................69
General organisation of the autonomic nervous system..............................................................69
The sympathetic nervous system.................................................................................................69
The parasympathetic nervous system..........................................................................................69
Basic characteristics of sympathetic and parasympathetic function............................................70
Pharmacology of the autonomic nervous system.........................................................................71
Cerebral blood flow..........................................................................................................................73
Physiology: transient loss of consciousness......................................................................................75
Transient loss of consciousness........................................................................................................78
Differential diagnosis....................................................................................................................79
Primary evaluation........................................................................................................................82
Pharmacology in epilepsy.................................................................................................................83
Epilepsy and antiseizure medication............................................................................................83
Drug interactions..........................................................................................................................87
Management of epilepsy..............................................................................................................88
Cardiology.........................................................................................................................................90
Bradycardia...................................................................................................................................91
Atrial tachyarrhythmias................................................................................................................92
Ventricular tachyarrhythmias.......................................................................................................93
Myocardial disease.......................................................................................................................94
Week 11: Dementia..............................................................................................................................96
The higher cerebral functions...........................................................................................................96
Functions of the cerebral cortex...................................................................................................96
Aphasia.........................................................................................................................................96
Apraxia..........................................................................................................................................97
Agnosia.........................................................................................................................................97
Aprosody......................................................................................................................................98
Spatial disorders...........................................................................................................................98
Cognitive disorders.......................................................................................................................99
Memory........................................................................................................................................99
Physical causes for psychological dysregulation.........................................................................101
Delusions and hallucinations......................................................................................................101
Ill-defined symptoms..................................................................................................................102
Testing of higher cerebral functions...........................................................................................102
Cortical dysfunction........................................................................................................................104
4
