HU Credits: 4

Degree/Cycle: 2nd degree (Master)

Responsible Department: medicine

Semester: Yearly

Teaching Languages: Hebrew

Campus: Ein Karem

Course/Module Coordinator: Dr. Zvi Israel

Coordinator Email: israelz@hadassah.org.il

Coordinator Office Hours: By arrangement

Teaching Staff:
Prof Ronen Leker
Dr. Ido Paldor

Course/Module description:
1.One week of introductory lectures at the start of the academic year;
2. A single four week rotation between the clinical departments during the clinical year concluding with an oral examination;
3. A written multiple choice examination at the end of the academic year.

Course/Module aims:
Understand all the major categories of neurological disease, including epidemiology, etiology, diagnosis, differential diagnosis, treatment, prevention, complications and prognosis.

Learning outcomes - On successful completion of this module, students should be able to:
1.Perform a neurological examination; interpret pathological findings
2.Propose a rational differential neurological diagnosis
3.Recommend appropriate investigations; interpret results of those investigations
4.Formulate and justify a treatment plan

Attendance requirements(%):
100

Teaching arrangement and method of instruction: The four week rotation between the clinical departments includes:
teaching rounds (bedside teaching),outpatient clinics, attending surgery in the operating rooms and emergency room

Course/Module Content:
1.Neurological examination
a.Higher functions: Mini Mental State Exam (MMSE), memory, language (aphasias), praxis, spatial function and neglect, executive function, agnosia.
b.Cranial nerve function, relevance in terms of localization and differential diagnosis.
c.Pyramidal and motor function, power, tone, normal tendon reflexes, pathological reflexes and pyramidal reflexes.
d.Sensory function: pinprick, light touch, deep sensation, proprioception, vibration
e.Cerebellar function
f.Gait: evaluation and differential diagnosis of gait disorders
g.Localization of central nervous system deficit/dysfunction
h.Localization of peripheral nervous system dysfunction: spinal root/plexus/peripheral nerve/muscle.
i.Bulbar and pseudobulbar syndromes
j.Dysarthria
k.Evaluation and differential diagnosis of the comatose patient
l.Brain death, chronic vegetative state, minimally conscious state.

2.Cerebrovascular disease
a.Vascular risk factors – treatment and prevention
b.Treatment of acute stroke
c.Prevention of cerebrovascular disease
d.Neuroangiography: basic differential diagnoses
e.Diagnosis and management of stroke in the young
f.Intracerebral hemorrhage: cause, types, treatment
g.Subarachnoid hemorrhage: differential diagnosis, initial evaluation, treatment and management, complications – prevention and management.
h.Cerebral sinus vein thrombosis – diagnosis, management and treatment
i.Neurological rehabilitation following stroke.

3.Epilepsy
a.Treatment of status epilepticus
b.Various epilepsy syndromes: Generalized tonic clonic seizures, Petit Mal, Complex partial seizures, simple partial seizures, Jacksonian march, Juvenile myoclonic epilepsy, pseudoseizures.
c.Antiepileptic medications, indications for therapy, side effects
d.Surgical options

4.Multiple Sclerosis, Demyelinative diseases and Autoimmune diseases
a.Diagnosis treatment and management of multiple sclerosis
b.Differential diagnosis of demyelinative diseases including acute transverse myelitis, post infectious plexitis and disseminated encephalomyelitis.
c.Guillaine Barré syndrome, Acute Inflammatory Demyelinating Polyradiculoneuropathy
d.Myesthenia Gravis, Lambert-Eaton Myesthenic syndrome
e.Vasculitis of the nervous system: diagnosis, differential diagnosis and treatment.
f.Polymyalgia rheumatica and temporal arteritis

5.Parkinson’s disease and other extrapyramidal disorders
a.Diagnosis and treatment of Parkinson’s disease
b.Differential diagnosis of Parkinsonism
c.An approach to extrapyramidal disorders
d.Chorea, dystonia, dyskinesias, ballismus, akathisia, definitions and differential diagnoses
e.Essential tremor
f.Tics and Tourette syndrome
g.Deep Brain Stimulation – indications

6.Neuromuscular diseases
a.Signs and symptoms of peripheral nerve dysfunction
b.Differential diagnosis of neuropathy: distribution, large/small fiber, motor/sensory, pain, evolution of the deficit
c.Thoracic outlet syndrome
d.Amyotrophic Lateral Sclerosis
e.Differential diagnosis of muscular disease
f.Polymyositis, dermatomyositis
g.Deuchenne muscular dystrophy
h.Mitochondrial diseases

7.Neurooncology
a.Glial tumors, neural tumors, metastases and brain lymphoma
b.Differential diagnosis of intra-axial tumors
c.Types of primary brain tumor, treatment options and prognosis
d.Approach to the patient with an intra-axial brain tumor
e.Approach to the patient with brain metastases
f.Extra-axial tumors, differential diagnosis, treatment options and management
g.Skull base tumors, differential diagnosis, approach and surgical management
h.Spinal tumors, location-based differential diagnosis, management and treatment
i.Radiosurgery: concept and indications

8.Basic neurosurgical approaches
a.Stereotactic procedures, concept and practice
b.Craniotomy
c.Approaches to the skull base
d.Measuring intracranial pressure
e.Spinal approaches

9.Hydrocephalus and intracranial pressure
a.Pathogenesis: obstructive hydrocephalus, communicating hydrocephalus, malabsorptive hydrocephalus, overproduction of cerebrospinal fluid
b.High pressure hydrocephalus: causes, differential diagnosis, significance, management and treatment
c.Increased intracranial pressure
d.Idiopathic intracranial hypertension (pseudotumor cerebri)
e.Low intracranial pressure – diagnosis and treatment

10.Headache
a.Differential diagnosis with stress on life-threatening diseases: hemorrhagic stroke, subarachnoid hemorrhage, meningitis
b.Neurological evaluation to differentiate between primary headache and symptomatic headache
c.Treatment of migraine and tension headache
d.Cluster headache
e.Trigeminal neuralgia

11.Infections of the nervous system
a.Bacterial meningitis: diagnosis and treatment
b.Differential diagnosis of aseptic meningitis
c.Lumbar puncture: findings and interpretation
d.Brain abscess, epidural and subdural empyema, postoperative infections
e.Meningo-encephalitis: differential diagnosis and treatment
f.Poliomyelitis
g.Neurological complications of AIDS
h.Prion disease and subacute sclerosing panencephalitis

12.Head trauma
a.Management of head trauma
b.Surgical evacuation of traumatic hemorrhage: approach, indications and management
c.Ways of measuring intracranial pressure
d.Increased intracranial pressure: differential diagnosis and management
e.Noninvasive techniques of managing increased intracranial pressure
f.Invasive techniques of managing increased intracranial pressure
g.Herniation syndromes

13.Drugs /medications in neurology: indications, side effects and neurological complications
a.Tricyclic antidepressants
b.Anticonvulsants
c.Analgesics and narcotics
d.Medications for dementia
e.Medications for Parkinson’s disease
f.Antiplatelet therapy

14.Spinal disease
a.Spinal degenerative disease: diskopathy, spondylolisthesis
b.Surgical approach in the management of spinal disorders
c.Tumors of the spinal column and spinal cord: intramedullary, intradural extramedullary and extradural tumors
d.Cauda equine and conus medullaris syndromes
e.Syringomyelia
f.Spinal trauma: initial management, decision making and surgical approaches
g.Anterior spinal artery syndrome
h.Brown-Sequard syndrome

15.Sleep disorders
a.Narcolepsy and cataplexy
b.Obstructive sleep apnea

16.Metabolic and endocrine disorders and neurological manifestations of systemic disease.
a.Thyroid disease
b.Lack of vitamins B1, B12
c.Electrolyte disturbances, syndrome of inappropriate ADH secretion, cerebral salt wasting syndrome
d.Hepatic and uremic encephalopathy
e.Neurological complications of collagen diseases and systemic autoimmune disorders

17.Behavioral neurology
a.Alzheimers disease
b.Multi-infarct dementia
c.Frontotemporal dementia
d.Frontal syndromes
e.Multisystem atrophies
f.Normal pressure hydrocephalus
g.Wernicke-Korsakoff encephalopathy
h.Transient global amnesia

18.Neurological investigations
a.Lumbar puncture
b.Electroencephalography
c.Evoked potentials
d.Nerve conduction velocity, electromyography
e.Imaging in neurology: CT, MRI, angiography, PET, DTI

19.Neuroopthalmology and neurootology
a.Examination of the pupil and its significance
b.Differential diagnosis of a swollen optic disk
c.Visual fields; correlation of defects with localization
d.Workup of diplopia
e.Horners syndrome
f.Ptosis
g.Optic neuritis
h.Internuclear opthalmoplegia
i.Eye movements
j.Anterior ischemic optic neuropathy
k.Hearing loss – approach, differential diagnosis with respect to the CNS

Required Reading:
Aminoff,Greenberg,Simon, Clinical Neurology Lange

Lindsay,Boe,Callandri: Neurology and Neurosurgery Illustrated

Additional Reading Material:
Harrison's Principles of Internal Medicine, Neurology section

Wilkins and Remgachary: Neurosurgery

Allen and Miller: Essentials of Neurosurgery: A guide to Clinical Practice

Course/Module evaluation:
End of year written/oral examination 100 %
Presentation 0 %
Participation in Tutorials 0 %
Project work 0 %
Assignments 0 %
Reports 0 %
Research project 0 %
Quizzes 0 %
Other 0 %

Additional information:
Minimum prerequisites for taking the end of year MCQ are a 100% attendance record and passing the end-of rotation oral/physical examination