Walid M. Reda Ashour M.D Neurology, Lecturer of Neurology, Faculty of Medicine, Zagazig University, Egypt walidashour2000@yahoo.com

2. NEUROLOGY
DR.WALID REDA ASHOUR
LECTURER OF NEUROLOGY

3. INTRODUCTION

4. WHAT IS NEUROLOGY?
Neurology is the branch of medicine that
deals with diseases of the nervous system.

5. MAJOR DIVISIONS
CENTRAL
NERVOUS
SYSTEM
NERVOUS
SYSTEM
PERIPHERAL
NERVOUS
SYSTEM

6. CENTRAL NERVOUS SYSTEM

7. Intracranial
Intracranial Spinal
Spinal
part
part part
part
1. Cerebrum 1- Spinal cord
2. Brain stem
2- Cauda equina
3. Cerebellum

8. I- INTRACRANIAL PART

9. 1- CEREBRUM
Two (2) cerebral hemispheres.
Connected to:
1. Each other by CORPUS CALLOSUM.
2. Brain stem by CEREBRAL PEDUNCLES.
- Outer gray matter (cerebral cortex) contains certain
areas with specific functions.
- Inner white matter composed of nerve fibers
conducting impulses TO & FROM cerebral cortex

10. EACH cerebral hemisphere divided into :
FOUR ( 4 )
LOBES:
1. Frontal
2. Parietal
3. Temporal
4. Occipital

11. 2- Brain stem
Formed of :
1- Midbrain
2- Pons
3- Medulla
Connected to:
1. Cerebral hemisphere
by cerebral peduncles
2. Cerbellum by cerebellar
peduncles

12. BRAIN STEM contains motor nuclei of cranial
nerves:
• 3 & 4 in MIDBRAIN
• 5, 6 &7 in PONS
• 9, 10, 11 & 12 in MEDULLA
N.B. 1, 2 & 8
are sensory nerves have no
motor nuclei

13. NAMES OF CRANIAL NERVES
• 1 Olfactory
• 2 Optic
• 3 Oculomotor
• 4 Trochlear
• 5 Trigeminal
• 6 Abducent
• 7 Facial
• 8 Vestibulocochlear
• 9 Glossopharyngeal
• 10 Vagus
• 11 Accessory
• 12 Hypoglossal

14. CLASSIFICATION OF CRANIAL NERVES
• SENSORY : contain only sensory fibers
1- Olfactory
2- Optic
8- Vestibulocochlear
• MOTOR : contain only motor fibers
3- Oculomotor
4- Trochlear
6- Abducent
11- Accessory
12- Hypoglossal
• MIXED : contain both sensory and motor fibers
5- Trigeminal
7- Facial
9- Glossopharyngeal
10- Vagus

15. Sensory cranial nerves
N. Name Function Assessment
1 Olfactory Smell Examination of
smell
2 Optic Vision Acuity, field &
fundus
8 Vestibular Equilibrium Caloric and
part rotational chair
Cochlear Hearing Watch test,
part Weber test

16. Motor cranial nerves
N. Name Function Assessment
3 Oculomotor Motor to superior, inferior and Ptosis, pupil, eye
medial recti; inferior oblique & movements &
levator palpebrae superioris squint
Parasympathetic to sphincter
papillae and ciliary muscle
4 Trochlear Motor to superior oblique Look to opposite
shoulder
6 Abducent Motor to lateral rectus Lateral eye
movement
11 Accessory Motor to sternocleidomastoid Elevaton of
and trapezius shoulders and
neck rotation
12 Hypoglossal Motor to muscles of tongue Tongue
movements

17. Mixed cranial nerves
N. Name Function Assessment
5 Trigeminal Muscles of Face sensations &
mastication & power of muscles of
sensations of face mastication
7 Facial Muscles of facial Muscles of facial
expression & taste expression & taste
sensation in ant. 1/3 sensation in ant. 1/3 of
of tongue tongue
10 Vagus Sensation and Palatal and pharyngeal
movements of reflexes & movements of
Larynx, pharynx, uvula
thoracic and
abdominal organs
9 Glossopharyngeal Taste in post 2/3 of Taste & general
tongue & gen. sensation and
sensation pharyngeal reflex

18. 3- CEREBELLUM
• Behind the brain stem
• Formed of : * Medline vermis
* Two cerebellar
hemispheres
• Composed of :
Outer grey matter and inner
white matter

19. CEREBELLAR PEDUNCLES
MB
Pons C
MO
 Superior peduncle connects cerebellum with MIDBRAIN.
 Middle peduncle connects cerebellum with PONS.
 Inferior peduncle connects cerebellum with MEDULLA
OBLONGATA

20. CEREBELLAR HEMISPHERES AND VERMIS
Left right
Hemisphere hemisphere
VERMIS
Cerebellar Hemispheres are the two bilateral structures.
Vermis is the unpaired midline structure between
the two hemispheres.

21. II- SPINAL PART

22. 1- SPINAL CORD
• Inside spinal canal
• End at lower border of L1 vertebra.
• Its lowermost 3 segments S3,4,5 = Conus.
• The above 4 segments L4,5 & S1,2 = Epiconus.
• Inner grey matter (cells) surrounded by
white matter.

23. SPINAL CORD

24. SPINAL CORD TRACTS
• White matter contains ascending and
descending nerve fibers (TRACTS):
1- ASCENDING
• Lateral & Ventral spinothalamic.
• Gracile & Cuneate.
• Spinocerebellar.
• Lissauer’s.
2- DESCENDING
• Corticospinal (pyramidal).
• Reticulospinal, vestibulospinal, tectospinal, rubrospinal &
olivospinal

25. 2- CAUDA EQUINA
• Collection of LUMBOSACRAL ROOTS which
fills the lower part of the spinal canal below
L1 vertebra.

26. THE MOTOR SYSTEM

27. Motor pathway

28. UPPER MOTOR NEURON
(pyramidal system)
* Originates in motor area 4 & premotor area 6
* Terminates at the anterior horn cells (AHCs)
of the different levels of the spinal cord.
* It supplies the opposite side of the body.

29. LOWER MOTOR NEURON
• Formed of AHCs & Peripheral motor nerves
(which transmit the motor impulses to the
voluntry muscles).

30. EXTRA PYRAMIDAL SYSTEM
• Originates from centers at various levels of CNS
mainly the BASAL GANGLIA.
• It controls the opposite side of the body.
CEREBELLAR SYSTEM
• Composed of Neo, Archi & Paleo- cerebellum.
• It co-ordinates the movements of the same side of
the body.

31. UMNL LMNL
Tone Increased, with Decreased
‘clasp knife’ quality
Clonus Present Absent
Fasciculations Absent Present
Muscle Wasting Absent, but disuse Present (within 2-3
atrophy eventually weeks)
results
Tendon Reflexes Increased. Extensor Decreased or
plantar reflexes. absent. Flexor
plantar reflexes.
Distribution Whole limbs, with Specific muscle
more weakness in groups affected (e.g.
the upper limb in the distribution of
extensors and lower a spinal segment, or
limb flexors just the proximal
muscles, etc.)

33. Thank you