Theme 1:
The nervous
system I and
senses
Summary
1
,Inhoud
Week 1: Loss of muscle strength ............................................................................................................. 7
Anatomy .............................................................................................................................................. 7
The peripheral nervous system ....................................................................................................... 7
Muscles ............................................................................................................................................ 9
Joints of the spinal column .............................................................................................................. 9
Meninges ....................................................................................................................................... 10
Spinal cord ..................................................................................................................................... 11
The autonomic nervous system .................................................................................................... 17
Membrane potentials and action potentials..................................................................................... 18
Basic physics of membrane potential............................................................................................ 18
Neuron action potential ................................................................................................................ 18
Signal transmission in nerve trunks............................................................................................... 20
Contraction of skeletal muscle .......................................................................................................... 21
General mechanism of muscle contraction................................................................................... 21
Energetics of muscle contraction .................................................................................................. 22
Excitation of skeletal muscle: neuromuscular transmission ............................................................. 23
The nervous system and muscles ...................................................................................................... 24
Structure ........................................................................................................................................ 24
Visualising the peripheral nervous system .................................................................................... 26
The nerve ....................................................................................................................................... 26
Physiology ...................................................................................................................................... 27
The muscle..................................................................................................................................... 28
Physiological measurements of the central nervous system: ....................................................... 31
Causes of neurological diseases .................................................................................................... 32
Strength and sensation ..................................................................................................................... 33
The spinal reflex ............................................................................................................................ 33
Sensory feeling .............................................................................................................................. 35
Central sensory pathways ............................................................................................................. 35
Segmentation of the spinal cord ................................................................................................... 36
Clinically relevant reflexes ............................................................................................................. 37
Examination of the motor and sensory system............................................................................. 37
Non-organic disorders ................................................................................................................... 40
Neuromuscular disorders .................................................................................................................. 41
Classification .................................................................................................................................. 41
Diagnostics..................................................................................................................................... 41
2
, Muscular diseases ......................................................................................................................... 42
Congenital muscular diseases ....................................................................................................... 43
Acquired muscular diseases .......................................................................................................... 45
Diseases of the neuromuscular junction ....................................................................................... 46
Disorders of motor neurons, nerve roots and peripheral nerves ..................................................... 48
Signs and symptoms ...................................................................................................................... 48
Diseases of the nerve cell body ..................................................................................................... 49
Disorders of the nerve root ........................................................................................................... 50
Mononeuropathy .......................................................................................................................... 51
Polyneuropathies .......................................................................................................................... 52
Hereditary neuropathies ............................................................................................................... 54
Week 2: Impaired sensibility ................................................................................................................. 55
Anatomy ................................................................................................................................................ 55
Innervation of the pelvis ............................................................................................................... 55
Lumbosacral plexus ....................................................................................................................... 56
Innervation of the lower extremity ............................................................................................... 58
Brachial plexus............................................................................................................................... 63
Innervation of the upper extremity............................................................................................... 64
Embryological background of innervation patterns ...................................................................... 68
Nerve compression........................................................................................................................ 70
General design of the nervous system .............................................................................................. 75
Central nervous system synapses ................................................................................................. 75
Electrical events during neuronal excitation ................................................................................. 75
Sensory receptors, neuronal circuits for processing information ..................................................... 77
Classification of nerve fibres ......................................................................................................... 78
Transmission and processing of signals in neuronal pools............................................................ 78
Somatic sensations: I. General organisation, the tactile and position senses .................................. 79
Detection and transmission of tactile sensations ......................................................................... 79
The dorsal column-medial lemniscal system (DC-ML system) ...................................................... 79
Anterolateral pathway .................................................................................................................. 81
Somatic sensations: II. Pain, Headache and Thermal sensations ...................................................... 83
Pain suppression: “analgesia” ....................................................................................................... 83
Clinical abnormalities of pain and other somatic sensations ........................................................ 83
Headache ....................................................................................................................................... 84
Thermal sensation ......................................................................................................................... 84
Motor functions of the spinal cord ................................................................................................... 85
3
, Muscle spindle ............................................................................................................................... 85
Golgi tendon organ ........................................................................................................................ 86
Neurological pain syndromes ............................................................................................................ 87
Pain in the neck and arm ............................................................................................................... 87
Pain in back and leg ....................................................................................................................... 88
Pain in the trunk ............................................................................................................................ 90
Complex regional pain syndrome .................................................................................................. 90
Diseases of the spinal cord ................................................................................................................ 91
Loss of function due to spinal injury ............................................................................................. 92
Traumatic spinal cord injuries ....................................................................................................... 93
Spinal cord compression due to non-traumatic causes ................................................................ 94
Myelopathy without spinal cord compression .............................................................................. 95
Week 3: Dizziness The sense of hearing ............................................................................................... 96
Tympanic membrane and the ossicular system + the cochlea ..................................................... 96
Central auditory mechanisms........................................................................................................ 96
Vestibular sensation and maintenance of equilibrium ..................................................................... 97
Anatomy, physiology and immunology of the nose, paranasal sinuses and face ............................. 99
Anatomy ........................................................................................................................................ 99
Nasal mucosa............................................................................................................................... 101
Physiology .................................................................................................................................... 102
Diseases of the nose, paranasal sinuses and face ........................................................................... 104
Nosebleeds .................................................................................................................................. 104
Inflammations of the nasal cavity ............................................................................................... 104
Sinus inflammations .................................................................................................................... 104
Anatomy and physiology of the ear ................................................................................................ 106
Anatomy ...................................................................................................................................... 106
Central auditory system .............................................................................................................. 108
The cochlea.................................................................................................................................. 108
Audiology......................................................................................................................................... 111
Basic principles of audiometry .................................................................................................... 112
Audiologic examination ............................................................................................................... 113
Behavioural audiometric testing ................................................................................................. 114
Objective hearing tests ................................................................................................................ 115
The external ear .............................................................................................................................. 116
Anatomy ...................................................................................................................................... 116
Non-inflammatory diseases and injuries to the external ear ...................................................... 117
4
The nervous
system I and
senses
Summary
1
,Inhoud
Week 1: Loss of muscle strength ............................................................................................................. 7
Anatomy .............................................................................................................................................. 7
The peripheral nervous system ....................................................................................................... 7
Muscles ............................................................................................................................................ 9
Joints of the spinal column .............................................................................................................. 9
Meninges ....................................................................................................................................... 10
Spinal cord ..................................................................................................................................... 11
The autonomic nervous system .................................................................................................... 17
Membrane potentials and action potentials..................................................................................... 18
Basic physics of membrane potential............................................................................................ 18
Neuron action potential ................................................................................................................ 18
Signal transmission in nerve trunks............................................................................................... 20
Contraction of skeletal muscle .......................................................................................................... 21
General mechanism of muscle contraction................................................................................... 21
Energetics of muscle contraction .................................................................................................. 22
Excitation of skeletal muscle: neuromuscular transmission ............................................................. 23
The nervous system and muscles ...................................................................................................... 24
Structure ........................................................................................................................................ 24
Visualising the peripheral nervous system .................................................................................... 26
The nerve ....................................................................................................................................... 26
Physiology ...................................................................................................................................... 27
The muscle..................................................................................................................................... 28
Physiological measurements of the central nervous system: ....................................................... 31
Causes of neurological diseases .................................................................................................... 32
Strength and sensation ..................................................................................................................... 33
The spinal reflex ............................................................................................................................ 33
Sensory feeling .............................................................................................................................. 35
Central sensory pathways ............................................................................................................. 35
Segmentation of the spinal cord ................................................................................................... 36
Clinically relevant reflexes ............................................................................................................. 37
Examination of the motor and sensory system............................................................................. 37
Non-organic disorders ................................................................................................................... 40
Neuromuscular disorders .................................................................................................................. 41
Classification .................................................................................................................................. 41
Diagnostics..................................................................................................................................... 41
2
, Muscular diseases ......................................................................................................................... 42
Congenital muscular diseases ....................................................................................................... 43
Acquired muscular diseases .......................................................................................................... 45
Diseases of the neuromuscular junction ....................................................................................... 46
Disorders of motor neurons, nerve roots and peripheral nerves ..................................................... 48
Signs and symptoms ...................................................................................................................... 48
Diseases of the nerve cell body ..................................................................................................... 49
Disorders of the nerve root ........................................................................................................... 50
Mononeuropathy .......................................................................................................................... 51
Polyneuropathies .......................................................................................................................... 52
Hereditary neuropathies ............................................................................................................... 54
Week 2: Impaired sensibility ................................................................................................................. 55
Anatomy ................................................................................................................................................ 55
Innervation of the pelvis ............................................................................................................... 55
Lumbosacral plexus ....................................................................................................................... 56
Innervation of the lower extremity ............................................................................................... 58
Brachial plexus............................................................................................................................... 63
Innervation of the upper extremity............................................................................................... 64
Embryological background of innervation patterns ...................................................................... 68
Nerve compression........................................................................................................................ 70
General design of the nervous system .............................................................................................. 75
Central nervous system synapses ................................................................................................. 75
Electrical events during neuronal excitation ................................................................................. 75
Sensory receptors, neuronal circuits for processing information ..................................................... 77
Classification of nerve fibres ......................................................................................................... 78
Transmission and processing of signals in neuronal pools............................................................ 78
Somatic sensations: I. General organisation, the tactile and position senses .................................. 79
Detection and transmission of tactile sensations ......................................................................... 79
The dorsal column-medial lemniscal system (DC-ML system) ...................................................... 79
Anterolateral pathway .................................................................................................................. 81
Somatic sensations: II. Pain, Headache and Thermal sensations ...................................................... 83
Pain suppression: “analgesia” ....................................................................................................... 83
Clinical abnormalities of pain and other somatic sensations ........................................................ 83
Headache ....................................................................................................................................... 84
Thermal sensation ......................................................................................................................... 84
Motor functions of the spinal cord ................................................................................................... 85
3
, Muscle spindle ............................................................................................................................... 85
Golgi tendon organ ........................................................................................................................ 86
Neurological pain syndromes ............................................................................................................ 87
Pain in the neck and arm ............................................................................................................... 87
Pain in back and leg ....................................................................................................................... 88
Pain in the trunk ............................................................................................................................ 90
Complex regional pain syndrome .................................................................................................. 90
Diseases of the spinal cord ................................................................................................................ 91
Loss of function due to spinal injury ............................................................................................. 92
Traumatic spinal cord injuries ....................................................................................................... 93
Spinal cord compression due to non-traumatic causes ................................................................ 94
Myelopathy without spinal cord compression .............................................................................. 95
Week 3: Dizziness The sense of hearing ............................................................................................... 96
Tympanic membrane and the ossicular system + the cochlea ..................................................... 96
Central auditory mechanisms........................................................................................................ 96
Vestibular sensation and maintenance of equilibrium ..................................................................... 97
Anatomy, physiology and immunology of the nose, paranasal sinuses and face ............................. 99
Anatomy ........................................................................................................................................ 99
Nasal mucosa............................................................................................................................... 101
Physiology .................................................................................................................................... 102
Diseases of the nose, paranasal sinuses and face ........................................................................... 104
Nosebleeds .................................................................................................................................. 104
Inflammations of the nasal cavity ............................................................................................... 104
Sinus inflammations .................................................................................................................... 104
Anatomy and physiology of the ear ................................................................................................ 106
Anatomy ...................................................................................................................................... 106
Central auditory system .............................................................................................................. 108
The cochlea.................................................................................................................................. 108
Audiology......................................................................................................................................... 111
Basic principles of audiometry .................................................................................................... 112
Audiologic examination ............................................................................................................... 113
Behavioural audiometric testing ................................................................................................. 114
Objective hearing tests ................................................................................................................ 115
The external ear .............................................................................................................................. 116
Anatomy ...................................................................................................................................... 116
Non-inflammatory diseases and injuries to the external ear ...................................................... 117
4
