Neurology

A.Y. 2019/2020
7
Max ECTS
84
Overall hours
SSD
MED/26 MED/27 MED/34
Language
Italian
Learning objectives
To understand and manage the method of clinical neurological analysis and therefore of the analytical and deductive path that leads to the diagnostic formulation.
To learn he basics of adult neurological semiology; interpretation of signs and symptoms of illness in terms of pathophysiology to recognize the main anatomical-clinical syndromes.
To know elements of developmental neurology.
To evaluate disease onset, its course and any associated co-morbidity, to identify possible causes and pathogenetic mechanisms.
To know how to select the exams useful for the diagnostic formulation; to know the pharmacological treatments, the modalities and duration of the same, the monitoring systems and the side effects.
To learn how to recognize and manage the emergency in neurology.
To learn basic elements of neurophysiological diagnosis, with particular reference to the clinical manifestations, EEG features and therapeutic framing of epilepsy.
To know the main diagnostic procedures of blood, cerebrospinal fluid and other tissue laboratory analysis neuroradiological, neurophysiological and genetic-molecular analysis and interpretation.
To know the clinical manifestations, the diagnosis and therapy of cerebrovascular pathology, infectious diseases of the central nervous system, neuro-oncology, neuro-traumatology, neurodegenerative diseases (Alzheimer's diseases and other dementias, extrapyramidal diseases, cerebellar syndromes, motor neuron diseases) and neuromuscular diseases (acquired and hereditary neuropathies , pathologies of the neuromuscular plaque, myopathies and muscular dystrophies)., immune-mediated diseases of the central and peripheral nervous system.
To acquire elements of functional assessment of neurological damage, in a neuro-rehabilitative setting.
Expected learning outcomes
The course consists of lectures and clinical activity at the patient's bedside and in the ambulatory setting.
Verification of learning takes place at the end of the course through an oral examination of the acquired knowledge.
Course syllabus and organization

Linea: Policlinico

Responsible
Prerequisites for admission
To achieve the course objectives, the student must have basic knowledge of neuroanatomy and neurophysiology of the central and peripheral nervous systems and the skeletal muscle, as well an adequate knowledge of the elements of general pathology.
In detail, this knowledge implies the following skills in detail:
1. Explain the anatomical relationships of the components of the CNS and the peripheral nervous system;
2. Distinguish the components of the above and subtentorial compartments (posterior fossa);
3. Describe the main functions of the following parts of the central nervous system: frontal lobe, parietal lobe, occipital lobe, temporal lobe, basal ganglia, thalamus, reticular system, spinal cord, together with the principles of generation and transmission of the nerve impulse and its integration in the various physiological pathways.
4. Describe the visual pathways: retina, disc, nerve, chiasm and optic tract, lateral geniculate body, optic radiation and occipital cortex; know the physiology of vision.
5. Describe the relationships of the midbrain, pons and medulla oblongata and locate the nuclei of the cranial nerves in the three regions of the brainstem;
6. Know the vascularization of the CNS and the regulation of the cerebral circulation, in particular the circle of Willis and the distribution of the anterior, middle and posterior cerebral arteries and of the lenticolostriate arteries; the venous sinus system and nature and function of the blood-brain barrier.
7. Identify the components of the ventricular and subarachnoid system and know the mechanisms of the CSF circulation;
8. Know the anatomy-physiology of the spinal cord.
9. Know the different parts of the peripheral nervous system: roots and ganglia, plexuses and course of the main nerve trunks: radial, median, ulnar, femoral, sciatic, tibial, peroneal.
10. Describe the components of the motor unit and the neuro-muscular junction and the organizational and functional principles of the striated muscular system.
11. Know the autonomic nervous system: the component of the sympathetic autonomic nervous system and its relations with the hypothalamus, the distribution of the cranio-sacral parasympathetic, role of the autonomous system in sexual, sphincter, pupillary functions and sweating.
Assessment methods and Criteria
The course is divided into lectures and clinical activities carried out at the patient's bed and in the outpatient setting.
The learning verification takes place at the end of the course through an oral exam that verifies the knowledge acquired during the course.
The test takes place in public session and focuses on the evaluation of knowledge of the semeiotics of the central and peripheral nervous system, on a diagnostic framing ability of the main nosographic pictures, of the respective differential diagnoses, of the use of instrumental tests aimed at diagnosis and of the principles of therapy of neurological diseases.
In particular, the student will have to demonstrate that he has learned how to:
1. Carry out an examination of mental functions including an examination of the state of consciousness and language; differentiate aphasia, dysarthria and confusion; differentiate dominant and non-dominant hemisphere disorders;
2. Examine the cranial nerves; distinguish eye disorders from cortical or brain stem lesions; locate visual disturbances; distinguish central and peripheral facial paralysis; recognize and describe brainstem lesion disorders;
3. Examine the motor functions: tests of strength, tone, trophism, involuntary movements, deep and superficial reflexes; distinguish central and peripheral paralysis;
4. Examine coordination;
5. Examine primary (pain-temperature, position, pallesthesia) and secondary (stereognosia, graphestesia, discrimination) sensory functions; discuss the meaning of a sensory level and sensory dissociation; distinguish the lesions of roots - plexus - nerve trunk - neuromuscular junction - muscle.
6. Examine the stand and locomotion; distinguish disorders from cerebellar lesions hemispherical and vermian;
7. Investigate the presence of signs of meningeal irritation.
Particular emphasis is given to learning the elements characterizing neurological emergencies, such as coma, the increase in intracranial pressure, the state of epileptic illness, subarachnoid hemorrhage, trauma, infections of the nervous system, spinal cord compression.
Neurologia
Course syllabus
Neurological semeiotics
1.1 Semiotics of the cranial nerves
1.2 Paralysis from involvement of the upper motor neuron (cortico-spinal-pyramidal and cortico-bulbar), from involvement of the lower motor neuron and differential diagnosis of paralysis (monoplegia, hemiplegia, paraplegia, tetraplegia, paralysis of isolated muscle groups)
1.3 Extrapyramidal disorders
1.4 Examination of coordination and standing. Cerebellar symptoms and ataxias
2. Examination of sensitivity: tactile, pain, thermal, proprioceptive, vibratory, pallesthesic sensitivity, discriminatory sensory functions.
2.1 Sensitive syndromes from: nerve trunk injury, root injury, spinal cord injury, cortical injury
3. 1 Speech disorders: clinical forms of aphasia, joint disorders, apraxia, agnosia

Neurological conditions:
Acute cerebro-vascular diseases: ischemic stroke and cerebral hemorrhage, transient ischemic attacks, small vessel disease, subarachnoid hemorrhage, aneurysms, arteriovenous malformations.
Brain tumors and intracranial hypertension syndrome
Cranio-cerebral trauma
Role of neuroimaging
Headaches
Encephalitis and meningitis
Demyelinating diseases, in particular Multiple Sclerosis
Parkinson's disease and Parkinsonisms
Dementias, with particular reference to Alzheimer's disease and Frontotemporal
Lobar Dementia
Consciousness disorders, epilepsy (symptoms and elements of therapy)
Affections of the Peripheral Nervous System
Amyotrophic lateral sclerosis and other spinal amyotrophies
Acute and chronic polyneuropathies: Guillain-Barré syndrome, CIDP.
Myasthenia gravis
Progressive Muscular Dystrophies and Myopathies
Elements of paediatric neurology
Teaching methods
Teaching is provided through lectures that address the entire program of the course. The teaching material used in the course consists of power point presentations and videos that reproduce both the physiological characteristics and the pathological changes in the various contexts of disease of neurological objectivity.
The in-depth study of neurological semeiotics and the principles of nosological classification take place at the neurological hospital beds and specialist clinics of the IRCCS Ga 'Granda Maggiore Policlinico Hospital. The training activities at the patient's bed and in the outpatient clinics include the presentation of the cases, with reference to the collection of the anamnesis, the neurological examination, the evaluation of laboratory, neuroimaging, neurophysiological and biomolecular tests. In this context, the interaction with the teachers is individualized per student or for groups of no more than three students, allowing the verification on the field of the effective knowledge of the principles and their applications in the given clinical context.
Teaching Resources
Lewis P. Rowland. Merritt's Textbook of Neurology, 2015
Neurochirurgia
Course syllabus
Acute cerebro-vascular diseases: ischemic stroke and cerebral hemorrhage, transient ischemic attacks, small vessel disease, subarachnoid hemorrhage, aneurysms, arteriovenous malformations.
Brain tumors and intracranial hypertension syndrome
Cranio-cerebral trauma
Role of neuroimaging
Headaches
Encephalitis and meningitis
Demyelinating diseases, in particular Multiple Sclerosis
Parkinson's disease and Parkinsonisms
Dementias, with particular reference to Alzheimer's disease and Frontotemporal
Lobar Dementia
Consciousness disorders, epilepsy (symptoms and elements of therapy)
Affections of the Peripheral Nervous System
Amyotrophic lateral sclerosis and other spinal amyotrophies
Acute and chronic polyneuropathies: Guillain-Barré syndrome, CIDP.
Myasthenia gravis
Progressive Muscular Dystrophies and Myopathies
Elements of paediatric neurology
Teaching methods
Lessons and lectures are the main part of teaching. They are focused on the neurosurgical part of the entire program of the course. The teaching material used in the course consists of power point presentations in which are present neurosurgical concetps, neuroradiological images and videos of neurosurgical procedures. At the end of every lesson clinical cases, with direct contribution of students, are discussed.
The in-depth study of clinical cases analysed or similar ones takes place at the neurosurgical ward and specialist clinics of the IRCCS Ga 'Granda Maggiore Policlinico Hospital. The training activities at the patient's bed and in the outpatient clinics include the possibility to discuss clinical cases with colleagues and to follow surgical procedures.
Teaching Resources
H. Richard Winn, Youmans and Winn Neurological Surgery. 8th edition
Medicina fisica e riabilitativa
Course syllabus
Characteristics of human gait and description of the phases of gait cycle.
Clinical evaluation of normal and pathological gait (ataxic gait, hemiparetic gait, steppage gait, spastic paraparesis gait, parkinsonian gait).
Instrumental evaluation of gait and gait analysis.
Teaching methods
Teaching is provided through lectures. The teaching material used in this course is made of power point presentations and videos that reproduce both the features of physiological human gait and the modifications of gait due to lesions of central and peripheral nervous systems. Instrumental techniques for gait analysis and assessment are shown and described.
Teaching Resources
Whittle's Gait Analysis, 5th Edition. Churchill Livingstone 2012.
Medicina fisica e riabilitativa
MED/34 - PHYSICAL AND REHABILITATION MEDICINE - University credits: 1
Lessons: 12 hours
Neurochirurgia
MED/27 - NEUROSURGERY - University credits: 1
Lessons: 12 hours
Neurologia
MED/26 - NEUROLOGY - University credits: 5
Lessons: 60 hours

Linea: San Donato

Responsible
Medicina fisica e riabilitativa
MED/34 - PHYSICAL AND REHABILITATION MEDICINE - University credits: 1
Lessons: 12 hours
Professor: Tesio Luigi
Neurochirurgia
MED/27 - NEUROSURGERY - University credits: 1
Lessons: 12 hours
Professor: Meola Giovanni
Neurologia
MED/26 - NEUROLOGY - University credits: 5
Lessons: 60 hours
Professors: Bet Luciano, Martinelli Boneschi Filippo, Meola Giovanni

Linea: San Giuseppe

Responsible
Prerequisites for admission
To achieve the course objectives, the student must have basic knowledge of neuroanatomy and neurophysiology of the central and peripheral nervous systems and the skeletal muscle, as well an adequate knowledge of the elements of general pathology.
In detail, this knowledge implies the following skills in detail:
1. Explain the anatomical relationships of the components of the CNS and the peripheral nervous system;
2. Distinguish the components of the above and subtentorial compartments (posterior fossa);
3. Describe the main functions of the following parts of the central nervous system: frontal lobe, parietal lobe, occipital lobe, temporal lobe, basal ganglia, thalamus, reticular system, spinal cord, together with the principles of generation and transmission of the nerve impulse and its integration in the various physiological pathways.
4. Describe the visual pathways: retina, disc, nerve, chiasm and optic tract, lateral geniculate body, optic radiation and occipital cortex; know the physiology of vision.
5. Describe the relationships of the midbrain, pons and medulla oblongata and locate the nuclei of the cranial nerves in the three regions of the brainstem;
6. Know the vascularization of the CNS and the regulation of the cerebral circulation, in particular the circle of Willis and the distribution of the anterior, middle and posterior cerebral arteries and of the lenticolostriate arteries; the venous sinus system and nature and function of the blood-brain barrier.
7. Identify the components of the ventricular and subarachnoid system and know the mechanisms of the CSF circulation;
8. Know the anatomy-physiology of the spinal cord.
9. Know the different parts of the peripheral nervous system: roots and ganglia, plexuses and course of the main nerve trunks: radial, median, ulnar, femoral, sciatic, tibial, peroneal.
10. Describe the components of the motor unit and the neuro-muscular junction and the organizational and functional principles of the striated muscular system.
11. Know the autonomic nervous system: the component of the sympathetic autonomic nervous system and its relations with the hypothalamus, the distribution of the cranio-sacral parasympathetic, role of the autonomous system in sexual, sphincter, pupillary functions and sweating.
Assessment methods and Criteria
The course is divided into lectures and clinical activities carried out at the patient's bed and in the outpatient setting.
The learning verification takes place at the end of the course through an oral exam that verifies the knowledge acquired during the course.
The test takes place in public session and focuses on the evaluation of knowledge of the semeiotics of the central and peripheral nervous system, on a diagnostic framing ability of the main nosographic pictures, of the respective differential diagnoses, of the use of instrumental tests aimed at diagnosis and of the principles of therapy of neurological diseases.
In particular, the student will have to demonstrate that he has learned how to:
1. Carry out an examination of mental functions including an examination of the state of consciousness and language; differentiate aphasia, dysarthria and confusion; differentiate dominant and non-dominant hemisphere disorders;
2. Examine the cranial nerves; distinguish eye disorders from cortical or brain stem lesions; locate visual disturbances; distinguish central and peripheral facial paralysis; recognize and describe brainstem lesion disorders;
3. Examine the motor functions: tests of strength, tone, trophism, involuntary movements, deep and superficial reflexes; distinguish central and peripheral paralysis;
4. Examine coordination;
5. Examine primary (pain-temperature, position, pallesthesia) and secondary (stereognosia, graphestesia, discrimination) sensory functions; discuss the meaning of a sensory level and sensory dissociation; distinguish the lesions of roots - plexus - nerve trunk - neuromuscular junction - muscle.
6. Examine the stand and locomotion; distinguish disorders from cerebellar lesions hemispherical and vermian;
7. Investigate the presence of signs of meningeal irritation.
Particular emphasis is given to learning the elements characterizing neurological emergencies, such as coma, the increase in intracranial pressure, the state of epileptic illness, subarachnoid hemorrhage, trauma, infections of the nervous system, spinal cord compression.
Neurologia
Course syllabus
Neurological semeiotics
1.1 Semiotics of the cranial nerves
1.2 Paralysis from involvement of the upper motor neuron (cortico-spinal-pyramidal and cortico-bulbar), from involvement of the lower motor neuron and differential diagnosis of paralysis (monoplegia, hemiplegia, paraplegia, tetraplegia, paralysis of isolated muscle groups)
1.3 Extrapyramidal disorders
1.4 Examination of coordination and standing. Cerebellar symptoms and ataxias
2. Examination of sensitivity: tactile, pain, thermal, proprioceptive, vibratory, pallesthesic sensitivity, discriminatory sensory functions.
2.1 Sensitive syndromes from: nerve trunk injury, root injury, spinal cord injury, cortical injury
3. 1 Speech disorders: clinical forms of aphasia, joint disorders, apraxia, agnosia

Neurological conditions:
Acute cerebro-vascular diseases: ischemic stroke and cerebral hemorrhage, transient ischemic attacks, small vessel disease, subarachnoid hemorrhage, aneurysms, arteriovenous malformations.
Brain tumors and intracranial hypertension syndrome
Cranio-cerebral trauma
Role of neuroimaging
Headaches
Encephalitis and meningitis
Demyelinating diseases, in particular Multiple Sclerosis
Parkinson's disease and Parkinsonisms
Dementias, with particular reference to Alzheimer's disease and Frontotemporal
Lobar Dementia
Consciousness disorders, epilepsy (symptoms and elements of therapy)
Affections of the Peripheral Nervous System
Amyotrophic lateral sclerosis and other spinal amyotrophies
Acute and chronic polyneuropathies: Guillain-Barré syndrome, CIDP.
Myasthenia gravis
Progressive Muscular Dystrophies and Myopathies
Elements of paediatric neurology
Teaching methods
Teaching is provided through lectures that address the entire program of the course. The teaching material used in the course consists of power point presentations and videos that reproduce both the physiological characteristics and the pathological changes in the various contexts of disease of neurological objectivity.
The in-depth study of neurological semeiotics and the principles of nosological classification take place at the neurological hospital beds and specialist clinics of the IRCCS Ga 'Granda Maggiore Policlinico Hospital. The training activities at the patient's bed and in the outpatient clinics include the presentation of the cases, with reference to the collection of the anamnesis, the neurological examination, the evaluation of laboratory, neuroimaging, neurophysiological and biomolecular tests. In this context, the interaction with the teachers is individualized per student or for groups of no more than three students, allowing the verification on the field of the effective knowledge of the principles and their applications in the given clinical context.
Teaching Resources
Lewis P. Rowland. Merritt's Textbook of Neurology, 2015
Neurochirurgia
Course syllabus
Acute cerebro-vascular diseases: ischemic stroke and cerebral hemorrhage, transient ischemic attacks, small vessel disease, subarachnoid hemorrhage, aneurysms, arteriovenous malformations.
Brain tumors and intracranial hypertension syndrome
Cranio-cerebral trauma
Role of neuroimaging
Headaches
Encephalitis and meningitis
Demyelinating diseases, in particular Multiple Sclerosis
Parkinson's disease and Parkinsonisms
Dementias, with particular reference to Alzheimer's disease and Frontotemporal
Lobar Dementia
Consciousness disorders, epilepsy (symptoms and elements of therapy)
Affections of the Peripheral Nervous System
Amyotrophic lateral sclerosis and other spinal amyotrophies
Acute and chronic polyneuropathies: Guillain-Barré syndrome, CIDP.
Myasthenia gravis
Progressive Muscular Dystrophies and Myopathies
Elements of paediatric neurology
Teaching methods
Lessons and lectures are the main part of teaching. They are focused on the neurosurgical part of the entire program of the course. The teaching material used in the course consists of power point presentations in which are present neurosurgical concetps, neuroradiological images and videos of neurosurgical procedures. At the end of every lesson clinical cases, with direct contribution of students, are discussed.
The in-depth study of clinical cases analysed or similar ones takes place at the neurosurgical ward and specialist clinics of the IRCCS Ga 'Granda Maggiore Policlinico Hospital. The training activities at the patient's bed and in the outpatient clinics include the possibility to discuss clinical cases with colleagues and to follow surgical procedures.
Teaching Resources
H. Richard Winn, Youmans and Winn Neurological Surgery. 8th edition
Medicina fisica e riabilitativa
Course syllabus
Characteristics of human gait and description of the phases of gait cycle.
Clinical evaluation of normal and pathological gait (ataxic gait, hemiparetic gait, steppage gait, spastic paraparesis gait, parkinsonian gait).
Instrumental evaluation of gait and gait analysis.
Teaching methods
Teaching is provided through lectures. The teaching material used in this course is made of power point presentations and videos that reproduce both the features of physiological human gait and the modifications of gait due to lesions of central and peripheral nervous systems. Instrumental techniques for gait analysis and assessment are shown and described.
Teaching Resources
Whittle's Gait Analysis, 5th Edition. Churchill Livingstone 2012.
Medicina fisica e riabilitativa
MED/34 - PHYSICAL AND REHABILITATION MEDICINE - University credits: 1
Lessons: 12 hours
Neurochirurgia
MED/27 - NEUROSURGERY - University credits: 1
Lessons: 12 hours
Neurologia
MED/26 - NEUROLOGY - University credits: 5
Lessons: 60 hours
Professor(s)
Reception:
Giovedi 14.00-16.00
Policlinico San Donato
Reception:
Monday 11.00 - 12.00 a.m.
IRCCS Istituto Auxologico Italiano, Piazzale Brescia no. 20, 20149 Milano