The seven general core competency
1. Patient care.
Demonstrate capability to provide comprehensive patient care that is compassionate, appropriate, and effective for the management of health problems, promotion of health and prevention of disease in the primary health care settings.
2. Medical knowledge base.
Mastery of a core medical knowledge which includes the biomedical sciences, behavioral sciences, epidemiology and statistics, clinical sciences, the social aspect of medicine and the principles of medical ethics, and apply them.
3. Clinical skill.
Demonstrate capability to effectively apply clinical skills and interpret the finding in the investigation of patient.
4. Communication.
Demonstrate capability to communicate effectively and interpersonally to establish rapport eith the patient, family, community at large, and professional associates, that results in effective information exchange, the creation of therapeutically and ethically sound relationship.
5. Information management.
Demonstrate capability to manager information which includes information access, retrieval, interpretation, appraisal, and application to patient’s specific problem, and maintening records of his or her practice for analysis and improvement.
6. Professionalism.
Demonstrate a commitment to carrying out professional responsibilities and to personal probity, a dherence to ethical principles, sensitivity to a diverse patient population, and commintment to carrying out continual-self-evaluation of his or her professional standard and competence.
7. Community-based and health system-based practice.
~ LECTURERS ~
NO
NAME
DEPARTMENT
PHONE
1 dr. Wayan Suarya, PAK. Anatomy 0817355247
2 dr. I Ketut Karna, AIF., M.Kes. Fisiology 08123814104
3 dr. I Wayan Sugiritama, M.Kes. Histology 08164732743
4 Dr. dr. I Made Jawi, M.Kes Pharmacology 08179787972
5 dr. Ida Bagus Ngurah, M.For. Pharmacology 08123687288
6 dr. A.A.B.N. Nuartha, SpS(K) Neurology 08179782240
7 Dr. dr. DPG. Purwa Samatra, SpS(K) Neurology 08123918731
8 dr. I Made Oka Adnyana, SpS(K) Neurology 0817347697
9 dr. IGN. Budiarsa, SpS Neurology 0811399673
10 dr. IGN. Purna Putra, SpS(K). Neurology 08123915763
11 Dr.dr.AAP laksmi Dewi, Sp.S(K) Neurology 0811388818
14 dr. Desak Ketut Indrasari Utami, SpS. Neurology 0811385099
15 dr. I Putu Eka Widyadharma, M.Sc., SpS(K) Neurology 081328049360
16 dr. Kumara Tini, Sp.S, FINS Neurology 081238701081
17 dr. I.A. Sri Wijayanti, M.Biomed, Sp.S Neurology 081337667939
18 dr. Made Susilawathy, Sp.S Neurology 08124690137
19 dr. Dewi Sutriani Maharini, Sp.A Pediatric 08123641466
20 Prof. DR. dr. Sri Maliawan, SpBS(K) Neuro Surgery 0811398466
22 Dr. dr. Tjok. Gd. Bagus Mahadewa, M.Kes., SpBS(K) Spinal
Neuro Surgery 0818484654
23 dr. Wayan Niryana, SpBS(K) Neuro Surgery 08179201958
24 dr. Made Wiranadha, Sp. THT-KL Otorhinolaryngology 08123968294
25 Dr.dr. Putu Pramana Suarjaya, SpAn., M.Kes. Anasthesi 0811394811
26 dr. Widhiasih, Sp.RAD Radiology 081916442626
27 dr. Ni Putu Sriwidnyani, SpPA Anatomy Phatology 081337115012
28 dr. I Nyoman Wande, SpPK Clinical Phatology 08128768555
29 dr. Muliani, M.Biomed Anatomy 085103043575
Regular Class (Class A)
No Name Group Departement Phone (3Venuerd floor)
1 dr. Ni Made Renny Anggreni Rena , Sp.PD A1 Interna 081803651656 3R.3.01nd floor: 2 dr. I Made Krisna Dinata, S.Ked A2 Fisiology 08174742566 3R.3.02nd floor: 3 dr. I Made Dwijaputra Ayustha, Sp.Rad A3 Radiology 08123670196 3R.3.03nd floor: 4 dr. I Made Bagiada, Sp.PD A4 Interna 08123607874 3R.3.04nd floor: 5 dr. I Made Agus Kresna Sucandra, Sp.An A5 Anasthesi 08123621422 3R.3.05nd floor: 6 dr. I Ketut Wibawa Nada, Sp.An A6 Anasthesi 08123650164 3R.3.06nd floor: 7 dr. I Ketut Suanda, Sp.THT-KL A7 ENT 081337788377 3R.3.07nd floor: 8 dr. I Made Pande Dwipayana, Sp.PD A8 Interna 08123657130 3R.3.08nd floor: 9 dr I Gusti Ayu Dewi Ratnayanti, M.Biomed A9 Histology 087761499889 3R.3.20nd floor: 10 dr. I Gusti Ngurah Mahaalit Aribawa , Sp.An A10 Anasthesi 0811396811 3R.3.21nd floor: 11 dr. I Gde Haryo Ganesha, S.Ked A11 DME 081805391039 3R.3.22nd floor: 12 dr. Ni Wayan Winarti , Sp.PA A12 PathologyAnatomy 087860990701 3R.3.23nd floor:
English Class (Class B)
No Name Group Departement Phone (3Venuerd floor)
1 dr. I Gusti Nyoman Darma Putra , Sp.KK B1 Dermatology 08124644451 3R.3.01nd floor: 2 dr. I Gusti Ayu Sri Mahendra Dewi, Sp.PA(K) B2 PathologyAnatomy 081338736481 3
nd floor:
R.3.02
3 dr. I Gusti Ayu Sri Darmayani, Sp.OG B3 DME 081338644411 3R.3.03nd floor: 4 dr. I Gusti Ayu Putu Eka Pratiwi, M.Kes.,Sp.A B4 Pediatric 08123920750 3
nd floor:
R.3.04
5 dr. Made Agus Dwianthara Sueta, Sp.B B5 Surgery 081338648424 3R.3.05nd floor: 6 dr. I Putu Eka Widyadharma, MSc,SpS B6 Neurology 081328049360 3R.3.06nd floor: 7 dr. I Gst.Ngr.Ketut Budiarsa , Sp.S B7 Neurology 0811399673 3R.3.07nd floor: 8 dr. I Gede Ketut Sajinadiyasa, Sp.PD B8 Interna 081237068670 3R.3.08nd floor: 9 dr. I Wayan Juli Sumadi, Sp.PA B9
Anatomy
Pathology 082237407778 3
nd floor:
10 dr. I Made Muliarta, M.Kes B10 Fisiology 081338505350 3R.3.21nd floor: 11 dr. Ni Made Linawati,M.Si B11 Histology 081337222567 3R.3.22nd floor: 12 dr. I B. Putrawan, Sp.PD B12 Interna 081236194672 3R.3.23nd floor:
Basic Neuroscience Semester IV
Day/Dat
e
Activity
Class B
Class A
Venues
Conveyer
1 March 27th
2015 Introduction lecture. Individual Learning SGD Break SP/Self Assessment Plenary 08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-10.00 12.00-13.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room -Discussion room -Class room
dr. K. Karna.
Facilitators
dr. K. Karna.
2 March 30th
2015 Lecture Individual Learning SGD Break SP/Self Assessment Plenary 08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-10.00 12.00-13.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room -Discussion room -Class room
dr. K. Karna
Facilitators
dr. K. Karna
3 March 31th
2015
Lecture: Nervous system: neuron, synapsis, medulla spinalis, nn cranialis, brain stem. Individual Learning SGD Break SP/Self Assessment Plenary 08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-10.00 12.00-13.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room -Discussion room -Class room dr. Suarya Facilitators dr. Suarya 4 April 1st
2015 Lecture formation reticularis, cerebellum, telencehalon. Individual Learning SGD Break SP/Self Assessment Plenary 08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-10.00 12.00-13.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room -Discussion room -Class room dr. Suarya Facilitators dr. Suarya 5
April 2nd
2015
Lecture diencephalon, ganglia basalia, saraf pembau, meningen, liquor, vascularisasi SSP Individual Learning SGD Break SP/Self Assessment Plenary 08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-10.00 12.00-13.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room -Discussion room -Class room dr. Suarya Facilitators dr. Suarya 6 April 6th
SGD Break
SP/Self Assessment Plenary
10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00
13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00
Discussion room
-Class room
Histology Pathology Anat 7
April 7th
2015
Lecture
Individual Learning SGD
Break
SP/Self Assessment Plenary
08.00-09.00
09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00
09.00-10.00
12.00-13.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00
Class room
-Discussion
room -Class room
Clinical Patho. Pharmacology
Facilitators
Clinical phato. & Pharmacology 8
April 8th
2015
Evaluation 09.00-11.00 09.00-11.00 Class room LECTURER, FACILITATORS.
Clinical Neuroscience Semester IV
Topic and Schedule Regular and English Class
1 April 9th
2015
Vertigo, bell’s palsy and Meniere Disease Hearing loss and Tinnitus IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00
Class room Class room
Disc. Room
Class room
dr. IA Sri Wijayanti, M.Biomed, Sp.S dr. Made Wiranadha Sp.THTKL
Facilitators.
Topik: Cerebral Palsy Lesi batang otak
dr. IA Sri Wijayanti, M.Biomed, Sp.S dr. Made Wiranadha Sp.THTKL
2 April 10th
2015
Kejang Demam (pediatric)
Seizure, Epilepsy and Status Epilepticus IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Class room Disc. Room Class room
dr. Dewi Sutriani Maharini, Sp.A
Dr. dr. DPG Purwa Samatra, Sp.S(K)
Facilitators.
Topik: Duchene muscular dystrophy, pina Bifida,
fenilketonuria
dr. Dewi Sutriani Maharini, Sp.A/Dr.dr. DPG Purwa Samatra, Sp.S(K).
3 April 13th
2015
Tension Headache and Cluster
Imaging interpretasi x-Ray tengkorak dan tulang belakang IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Class room Disc. Room Class room
dr. Made Oka Adnyana, Sp.S(K)
dr. Made Widhiasih, SpRad
Facilitators.
Topik: artritis kranial, CT can otak dan interpretasi
dr. Made Oka Adnyana, Sp.S(K)/
dr. Made Widhiasih, SpRad
4 April14th
2015
Migren and Neuralgia Trigeminal Imaging IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Class room Disc. Room Class room
dr. Made Oka Adnyana, Sp.S(K)
dr. Made Widhi Asih, SpRad
Facilitators.
dr. Made Oka Adnyana, Sp.S(K)/dr. Made Widhi Asih, SpRad 5 April15th 2015 HNP, Radicular syndrome, Neurogenic Bladder
Acute and refered pain IL/Self Ass. SGD Break. Student project Plenary 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Disc. Room Class room
Dr. dr. Pt. Pramana, Sp.AN., M.Kes. Facilitators.
dr. Kumara Tini, Sp.S, FINS/ Dr. dr. Pt. Pramana, Sp.AN.,M.Kes. 6 April16th 2015 Dementia/Alzheimer Movement Disorder/ Neurogeriatric IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Class room Disc. Room Class room
dr. Eka Widyadharma, M.Sc,Sp.S(K)
dr. IA Sri Wijayanti, M.Biomed, Sp.S
Facilitators.
Topik: Alzheimer, MCI, Afasia, gangguan gerak lainnya
dr. Eka Widyadharma, M.Sc,Sp.S(K)/
dr. IA Sri Wijayanti, M.Biomed, Sp.S 7
April17th
2015
CTS, TTS, peroneal palsy
Neuropathic pain, neuropati, HNP IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Class room Disc. Room Class room
dr. Eka Widyadharma, M.Sc,Sp.S(K)
dr. Eka Widyadharma, M.Sc,Sp.S(K)
Facilitators.
Topik: ALS, Multiple sclerosis
dr Eka Widyadharma, M.Sc,Sp.S(K
8 April 20th
2015
CNS Tumor primer dan sekunder
Traumatic Brain Injury, hematom epidural, hematom subdural. IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Class room Disc. room Class room
dr. Made Susilawathi, Sp.S
Prof. Dr. dr. Sri Maliawan, SpBS(K)
Facilitators.
Topik: hidrosefalus
dr. Made Susilawathi, Sp.S/ Prof. Dr. dr. Sri Maliawan, SpBS(K) 9
April 21st 2015
TIA, Infark cerebral, hematoma intraserebral, SAH
Stroke 2 ( manage ) Stroke 3 ( surgical )
IL/Self Ass. SGD Break. Student project Plenary 08.00-09.00 10.00-10.30 10.30-11.00 09.00-10.00 11.00-12.30 12.30-13.00 13.00-14.00 14.00-15.00 09.00-10.00 11.00-11.30 11.30-12.00 10.00-11.00 13.30-15.00 13.00-13.30 12.00-13.00 15.00-16.00 Class room Disc. room Class room
dr. AABN. Nuartha, Sp.S(K)
dr. AABN. Nuartha, Sp.S(K)
dr. Wayan Niryana, M.Kes, SpBS(k)
Facilitators.
Niryana, M.Kes, SpBS 10
April 22nd 2015
Trauma Medula spinalis, Complete spinal
transection, acute medulla compression Amnesia Pasca Trauma IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Disc. room Class room
Dr.dr. Tjokorda GB. Mahadewa, M.Kes., SpBS(K)Spinal
dr. IGN. Budiarsa, Sp.S
Facilitators.
Topik: sindrom kauda equina, Siringomyelia, mielopati, dorsal root syndrome Dr.dr. TjokordaGB. Mahadewa, M.Kes., SpBS(K)Spinal/dr. IGN. Budiarsa, Sp.S 11 April23th 2015
GBS, Myastenia Grafis Ensefalopati, Koma IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Disc room Class room
dr. IGN Budiarsa, Sp.S dr. Kumara Tini, Sp.S, FINS
Facilitators.
Topik: Mati batang otak, syndrome horner
dr. IGN Budiarsa, Sp.S/ dr. Kumara Tini, Sp.S, FINS
12 April 24th
2015
Meningitis, ensefalitis, malaria serebral, Rabies CNS HIV/AIDS, Poliomielitis, tetanus, tetanus neonatorum IL/Self Ass. SGD Break. Student project Plenary 08.00-08.30 08.30-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 09.00-09.30 09.30-10.00 10.00-11.30 13.30-15.00 11.30-12.00 10.00-11.30 15.00-16.00 Class room Disc room Class room
dr. Susilawathi, Sp.S
dr. Indrasari Utami, Sp.S
Facilitators.
Topik: infeksi sitomegalo virus, toksoplasmosis serebral, abses otak
dr. Susilawathi, Sp.S/ dr. Indrasari Utami, Sp.S April 27th
2015
April 28th
2015
April 29th
2015
April307th
2015
May 4th
2015
Basic clinical skill Fungsi saraf kranial
Basic clinical skill Motorik, koordinasi, sensorik
Basic clinical skill Fungsi luhur dan refleks
Basic clinical skill Tulang belakang dan meningeal sign, tanda ischialgia
Basic clinical skill Pemeriksaan Diagnostik 08.00-11.00 08.00-11.00 08.00-11.00 08.00-11.00 08.00-11.00 11.00-13.00 11.00-13.00 11.00-13.00 11.00-13.00 11.00-13.00 Skill Lab Skill Lab Skill Lab Skill Lab Skill Lab
dr. I.A Sri Wijayanti, M.Biomed, Sp.S
dr. I Putu Eka Widyadharma, M.Sc, Sp.S(K)
dr.DSK. Indrasari Utami, Sp.S
dr. Ni Made Susilawathi, Sp.S
Radiologi dan elektrodiagnostik
May 7th
2015 EVALUATION 08.30-10.30 08.30-10.30
Team lectures :
1. dr. Wayan Suarya, PAK.
2. dr. I Ketut Karna, AIF., M.Kes.
3. Prof. Dr.dr. Nyoman Mangku Karmaya,
M.Repro.
4. dr. I Wayan sugiritama, M.Kes.
5. Dr. dr. I Made Jawi, M.Kes.
6. dr. Ida Bagus Ngurah, M.For.
7. dr. A.A.B.N. Nuartha, Sp.S(K)
8. Dr. dr. DPG. Purwa Samatra, Sp.S(K)
9. dr. I Made Oka Adnyana, Sp.S(K)
10.dr. IGN. Budiarsa, Sp.S
11.dr. Desak Ketut Indrasari Utami, Sp.S
12.dr. I Putu Eka Widyadharma, M.Sc.,
Sp.S(K)
13.dr. Kumara Tini, Sp.S, FINS
14. dr. I.A Sri Wijayanti, M.Biomed, Sp.S
15. dr. Made Susilawathy, Sp.S
16. dr. Dewi Sutriani Maharini, Sp.A
17. Prof. Dr. dr. Sri Maliawan, Sp.BS(K)
18. Dr.dr. Tjokorda GB. Mahadewa, M.Kes.,
Sp.BS(K)Spinal
19. dr. Wayan Niryana, M.Kes, Sp.BS(K)
20. dr. Made Wiranadha Sp.THTKL
21. Dr.dr. Putu Premana Suarjaya, Sp.An.,
M.Kes.
LEARNING PROGRAME
BASIC NEUROSCIENCE
Day 1
stNEUROPHYSIOLOGY
dr. K. Karna, PFK, M.Erg.
AIMS :
To comprehend the general functions of the nervous system include sensory detection, information processing and responsible for controlling a variety of bodily activities such as contraction of muscle and secretion of gland.
LEARNING OUTCOMES :
Apply its concepts and principles in the approach of patient with neurological disorders
CURRICULUM CONTENTS :
I. GENERAL DESIGN OF THE NERVOUS SYSTEM (NS) 1. Cells of the NS (Neurone and Neuroglia)
2. Sensory division of the NS – sensory receptors 3. Motor division – the effectors
4. Processing of information – memory 5. Memory storage
II. MAJOR LEVEL OF THE CNS 1. Cortical level
2. Subcortical level 3. Spinal cord level
III. CENTRAL NERVOUS SYSTEM SYNAPSES 1. Types of synapses
2. Physiologic anatomy of the synapses
3. Chemical substances that function at synaptic transmission 4. Electrical events during neuronal excitation and inhibition 5. Special function of dendrites in exciting neurons
6. Relation of state of excitation - the neuron to rate of firing 7. Some special characteristics of synaptic transmission.
ABSTRACT
I. The nervous system (NS) includes both sensory (input) and motor (output) system interconnected by complex intgrative mechanisms.
The nervous system divided into the central nervous system (CNS) and the peripheral nervous system (PNS)
a. The CNS includes the brain and and spinal cord, which contain nuclei and tracts. Nuclei are grouping of neuron cell bodies within the CNS. Tract are grouping nerve fibers that interconnect regions of the CNS
b. The PNS consists of nerves, ganglia and nerve plexuses. Nerve is cablelike collection of many axons, may be mixed (contains both sensory and motor fibers). Ganglia is grouping of neuron cell bodies located outside the CNS
1. Cells of the nervous system
a. The neuron is the basic structural and functional unit of the NS, which typically consist of a cell body (soma), several dendrites, and a single axon. Neuron structure is related to function, which have receptive and integrative zone (dendrite and cell body), trigger zone (axon hillock), and conductive region (axon) especially in terminal end of axon has secretive synaptic transmitter.
Electrochemical activity in neuron include
- Membrane potential: polarization, depolarization, repolarization, hyperpolarization. - Graded electrogenesis: i.e graded potential, receptor potential, EPSP, IPSP.
- Site of origin of conducted impuls (action potential), all or none transmission, incoming signal in terminal end of the axon as trigger to secreting transmitter synaptic
Neuron communicate with muscle, gland, and other neurons at junction its called neuromyal junction, neuroglandular, and synapses. Synapses are found in dendrite, soma, and axon (axodendrtic, axosomatic, axoaxonic synapses).
b. The four major types of glial cells (Neuroglia ) in the CNS are astrocytes, oligodendrocytes, microglia, and ependymal cells. Glial cells help support the neuron both physically and metabolically. For instance function of the astrocytes as glue, scaffold, establishing blood brain barrier, repair brain injuries and neural scar formation, take up glutamate and GABA, take up excess K+ ECS, and enhance synaptic formation and to strengthen synaptic transmission. oligodendrocytes form myelin sheath, line internal cavity of the CNS contribute to the formation CSF (ependymal cells), microglia as scavenger.
c. Synaptic transmission involves release of neurotransmitter from the presynaptic cell, diffusion of neurotransmitter across the synaptic cleft and binding of neurotransmitter to receptors on the postsynaptic cell. It ends when the neurotransmitter dissociates from the receptor and is removed from the synaptic cleft.
2. Much of the activity in the NS arises from mechanism that stimulate sensory receptor located at the distal termination of sensory neuron. Signal travel over peripheral nerves to reach the spinal cord and are then transmitted throughout the brain. Incoming sensory massages are processed and integrative with information stored in various pools of neurons such that the resulting signals can be used to generate appopriate motor response
II. SELF – STUDY , ESSAY QUESTION
1. Describe the structure of neuron and explain significance of its principal regions. 2. Classify neurons on the basis of their structure and function.
3. Describe the location, the major types, and functions of the supporting cells. 4. Explain how the graded potential and action potential differ
5. Define polarization, depolarization, repolarization and hyperpolarization.
6. Explain the actions of voltage regulated Na+ and K+ channels and describe the event that occur during the production of an action potential.
7. Explain how action potentials are regenerated a long myelinated and non myelinated axon..
8. Describe the events that occur in the interval between the electrical excitation of axon and the release of neurotransmitter.
9. Compare the characteristics of EPSPs and action potential 10. Explain the synaptic transmission exhibits special characteristic
11. Explain how sensory receptors are categorizeds. Give examples of functional of functional categories and explain how tonic and phasic receptors differ
12. Describe the classification of the sensory division – sensory receptors.
14. Explain how the mechanical energy is tranduced/ converted into nerve impulses by the organ Corti and how pitch perception is accomplished.
15. Give examples the following modalities are tested : sense of pain, temperatur, touch, vibration , and sense of positition
16. Distinguish between and compare monosynaptic and polysynaptic reflexes.
III. Scenario / case study
a) A man falls into deep sleep with one arm under his head. This arm is paralyzed when he awakens, but it tingles, and pain sensation in it is still intact
1. What is the reason for the loss of the motor function without loss of pain sensation is that in the nerves to his arm
2. What is a thorough general physical examination should be made in this case. 3. Which one of the sensory test should be done
4. Which one of the reflex test should be done
5. Describe general physical examination should always be done in motor system of this case b) Arthritis is common painfull condition caused by inflammation of one or more joints.
1. Why the joint to developed hyperalgesia in this case?
c) In some diseases of the NS, myelin may be lost over one or more internodes of many axons without interruption of the axon. For instance Guilain – Barre syndrome, diphtheria, and multple sclerosis
1. Why the conduction of nerve impulses may be slowed or blocked. d) 74-year-old man suddenly found that he couldnot move his left arm and leg.
Examination in the emergency departement demonstrated weakness in the left arm and leg, especially in the distal part of these extremities.The patient also had difficulty in using the muscles of his lower face, and the left side of his tongue was not as strong as the right side. Babinski’s sign was present on the left side. In an examination 1 month later, the distribution of weakness had not changed, although the weakness was not quite as profound. The left biceps, triceps, patellar, and ankle jerk reflexes were markedly increase, and there was ankle clonus on the left. The ability of the patient to recognize tactile and vibratory stimuli was reduced on the left side of the face and body and proprioception was impaired in the left arm and leg.
1. Which part of the NS is most likely affected by the stroke? (spinal cord on the left, precentral and post central gyri on the right, internal capsul on the right, cerebellar on the left, BG on the right.)
2. Which of the following provides evidence indicating that the paralysis is of the spastic type
Day 2nd
NEUROPHYSIOLOGY dr. K. Karna, PFK, M.Erg.
I. ABSTRACT
II. SELF – STUDY , ESSAY QUESTION
1. Give examples of strech reflexes, including those that are frequently tested clinically.
2. Describe the muscle spindles and analyze their function as part of feed back system that maintains muscle force
3. Describe the Golgi tendon organs and analyze their function as part of feed-back system that maintains muscle force
4. Define reciprocal innervation, inverse stretch reflex, clonus and lengthening reaction 5. Describe in general terms how posture and movement are regulated
6. Discuss the function of the cerebral cortex, cerebellum, basal ganglia, and corticospinal and corticobulbar tracts in skilled voluntary movement
7. Describe the postural reflexes that are integrated in the medulla oblongata, the pons, the midbrain, in the cerebral cortex.
8. What is meant by the terms upper motor neuron and lower motor neuron?.Contrast the effects of lower motor neuron lesions with those of lesions affecting each of types of upper motor neurons
9. What is the Babinski sign? What is it physiologic and pathologic significance?
III. Scenario / case study
a) 78-year-old man suddenly developed a right sided hemiplegia. He was unable to give a satisfactory history because the only words that he could speake were curse words. However, he did not his had approciately response to questions
1. Which part of the brain produced the speech disorder in this patient? 2. What other neurological deficit in this patient likely to have
Day 3rd
NEUROANATOMY
dr. I Wayan Suarya, PAK.
AIMS:
1. Describe the common function, special characteristic, structure and division of nervous system, spinal cord.
2. Describe the features, parts, structure function of brainstem, localization of the ascending and descending tracts in the brainstem,.
3. Describe of cranial nerves, functional structures (general and special), and clinical examination of cranial nerves lesion.
LEARNING OUTCOME:
Describe the common function, special characteristic, anatomical structure and division of nervous system, spinal cord.
1. Describe structure and division of neuron, neuroglia, synapse.
2. Describe the parts, white and gray matters nuclei, tracts of the spinal cord. 3. Describe source, purposes and journey of each tracts.
4. Describe upper motor neuron (UMN), lower motor neuron (LMN), and clinical differentiations of lesion of UMN versus LMN.
5. Describe 12 couples of cranial nerves: nuclei, receptors, effectors and qualities of each cranial nerves.
1. General function, special characteristic, anatomical structure and division of nervous system,. 2. Division of neuron, neuroglia and synapses.
3. Parts, structure in white and gray matters of spinal cord. 4. Sources, purposes and how the journey of each tracts. 5. Parts of nuclei of the gray matter of spinal cord.
6. UMN, LMN, the structures or parts, how the journey and clinical differentiations lesion of UMN versus LMN.
ABSTRACTS OF LECTURES:
Nervous system have 2 parts: that are Central nervous system (CNS) and pheripheral nervous system (PNS) and have base characteristics: that are irritability and conductivity so that human being may to integrate with internal and external enmvironments. Main component of nervous system are: neuron, neuroglias and blood vessels. Base anatomical structure of nervous system is neuron, base physiological structure is reflex arc. The neuron divide by measure (4-120 micron): small, moderate and great; and by cytoplasmic protrusion: unipolar, bipolar and multipolar (type I and II). One neuron to the others be contact/connect as: synapse (synapsis). In synapse be related with a substance: neurotransmitter. The reflex arc in simple reflex is receptor, afferen/sensory, efferen/motor, effector; intercalate neuron or interneuron addition in the complex or coplicated reflex. Reflex is very impoprtant and routine examination in neurological clinic. Many stimuli have receptor alone. Neuroglias divide to 3 parts: astrocyte, oligodendroglia and microglia. The CNS have special characteristic on base vascularisation.
Spinal cord is part of CNS located in vertebral canal have cervical, thoracal, lumbal, sacral and coccygeal parts. Superficial part is white matter consist nerve fibers: tracts (ascending, descending and intersegmental tracts), deep/profundus part cosist cell bodies of neuron: nucleus/nuclei. The tract have origin/source, route/journey, function and purpose alone. From spinal cord come out average 31 couple spinal/segmental/
or intervertebral nerves, its have supply qualities: general somatic sensory and motor, symphathetic fibers (Th. 1-L2/3) and parasymphathetic fibers (S 2 3 4) at addition.. Innervation to skin knows by skin segmental innervation or dermatome innervation. Spinal cord receive blood from ventral and dorsal spinal arteries branches of vertebral arteries, and radicular arteries branches of intercostal/ subcostal arteries.
Brainstem (truncus encephalicus) have 3 parts: medulla/medulla oblongata, pons, midbrain/mesencephalon is very important because have center of cardiovascular, respiratory system and primary conciousness. The brainstem also pass through by ascending, descending tracts and filled in most of the nuclei of cranial nerves. Cranial nerves may contribute by the qualities: general somatic efferent, general visceral efferent, general visceral afferent, general somatic afferent, special somatic (branchial) efferent (special visceral/branchial efferent-in American and England library), special somatioc afferent, special visceral afferent. Motor nuclei of cranial nerves innervate by UMN (upper motor neuron-corticonuclear/corticobulbar fibers) divide manner: bilateral, homolateral or contralateral and with or without intercalate neuron. UMN (upper motor neuron-corticospinal/pyramidal tract) also innervate nuclei in ventral corn of spinal cord. LMN (lower motor neuron): origin in ventral corn of spinal cord and motor nuclei of cranial nerves. Clinical sign and sympthom lesion of UMN compare with LMN are different, and very important and routine examine in neurology clinic. Lesion on some cranial nerves are routine examine in neurology clinic, by examination the receptors or effectors each innervations.
qualities. UMN innervate motor nuclei by homolateral, bilateral or contralateral manner, with or without intercalate neuron.
LMN innervate the effector by homolateral or contralateral manner.
Generally the spinal nerves have two kinds of qualities: general somatic afferent andefferent, but from the thoracal 1 to Lumbal 2 or 3 there are addition of [presynaptic symphathetic fibres which go directly to paravertebral or prevertebral ganglia except the fibers which go to adrenal medulla. In sacral segment (S 2 3 4) There are presynaptic/prganglionic fibres that going intrinsic parasympathetic ganglia supplying mainly genitalia organs. The parasympathetic centers are also found incranial nerves nuclei that why it is called craniosacral nerve, and the sympathetic nerve is called thoracolumbal nerve. In cervical 5 6 7 8 thoracal 1 the spinal cord compose of widening segment it called intimescentia, as the origin of motor neuron for anterior rami to form brachial plexus ( 5 rami 3 trunks 6 devisions 3 fasciculus/cords) 5 main nerves for the upper limbs. Lumbosacral plexus (divide to lumbar and sacral plexuses) formed by ventral rami of (L1) L2 to S 4 innervate lower limbs, internal organs in pelvis including genital organs.
TRIGGER/SCENARIO: Case 1:
A man 35 years old who had a stab trauma on spinal cord. After CT scan he had hemisectio/half lesion left spinal cord on thoracal 10. He had hospitalization in neurology department. Two week after to hospital a neurologist take examination the patient: a. power, b. trophy, c. tone of muscles, d. stretch, pathological and superficial reflex, e. clonus. e.sensibility.
LEARNING TASK:
1. Describe the power of muscles on: left and right upper limbs and lower limbs?
2. Describe the muscle tone of: left and right biceps brachii, left and right quadriceps femoris, left and right triceps surae?
3. Describe the the trophy of each muscles above?
4. Describe the pain and temperature sensation on: left and right upper limbs, left and right lower limbs, left and right the body?
5. Describe special sensation on left and right upper limbs, left and right lower limbs, left and right the body.
6. Describe the Babinski reflex? Where that reflex examine by doctor? Why the manner /method. 7. Describe the route, purpose, main purpose, last purpose of lateral spinothalamic and gracile,
cuneate tracts.
8. Describe the route, parts, purpose of pyramidal tract (cortico spinal, corticobulbar tracts), and how the innervation manner to the motor nuclear of cranial nerves.
9. Please list the other tracts: routes and purposes (homo, contra or bilateral).
Case 2:
Child, male 10 years old had fever 7 days. After go and examine in hospital has found the child suffering poliomyelitis. Left lower limb can not movement.
LEARNING TASK:
1. Describe main deficit the movement on left lower limb? 2. Describe the part of nuclei of spinal cord attack? 3. Describe the sensibilities senses on left lower limb? 4. Describe the reflex, tone and trophy of left lower limb?
Case 3:
A man 65 years old, 80 kgs body weight, 160 cm of height. He very busy, can not exercise, a smoker average15 of cigaretes a day from 20 years ago. He have hypertension: T: 190/90 mm Hg. Three days ago he can not movement left lower limb, and his right eye adduct.
LEARNING TASK:
1. Describe the lower limb can not movement? What tract affected, and where the location lesion affected.
2. Describe the route of corticospinal tract, and route of tract and nerve that innervate lateral rectus muscle of eye?
3. Describe the others cranial nerves nucli innervate by corticonuclear tract? 4. Describe the other muscles of orbita innervate by Cranial nerves III, IV and VI? 5. Describe The others cranial nerves nuclei innervate by cortico-nuclear tracts. 6. Describe the foramen/fissure as the ways of cranial nerves.
7. Describe the formation of brachial plexus, and at last 5 main peripheral nerves innervate upper limbs? Please make a diagram of plexus brachialis!
8. Describe the lumbosacral plexus, and mention 4 main peripheral nerves from lumbosacral plexuses!
9. Describe are the qualities of peripheral nerves from lumbosacral plexuses!
Case 4:
A craftsman of metals 45 year old, until one month his hand lost of heat sensation.Neurologist examine him with CT scan. He affected the syringomyelia on cervical 5678 thoracal 1.
LEARNING TASK:
1. Describe the tract affected?
2. Describe the part of spinal cord route of the tract above?
3. Describe the formation of the brachial plexus? Please make the diagram. 4. Describe the qualities of plexus to innervate the upper limbs?
5. Describe the differences lesion of: rami anterior and posterior, lesion in dorsal radices, anterior radices, all of dorsal division, one of fascicle/cord?
Day 4th
NEUROANATOMY
dr. I Wayan Suarya, PAK.
AIMS:
Describe the structure FR (formatio reticularis), cerebellum and telencephalon.
LEARNING OUTCOME:
1. Describe the parts, structures of cerebellum.
2. Describe the connection of brainstem and cerebellum.
3. Describe of the intrinsic structure, cytoarchitectonic of cortex cerebellum. 4. Describe the tracts to and out of cerebellum, and each route.
7. Describe architectonic structure, and interconnection of neuron in isocortex (cerebral cortex), and functional areas of cerebral cortex.
CURRICULUM CONTENTS:
1. Components, borders, and surface features of the brainstem. 2. Topography cranial nerves nuclei in brainstem.
3. Come out of the cranial nerves from ventral aspect of the brainstem. 4. The structure of fourth ventricle.
5. Functional structure and clinical aspect of cranial nerves
6. The parts, intrinsic structure, cytoarchitectonic of cortex cerebellum. 7. The connection cerebellum with: brain, brainstem, spinal cord. 8. Structure of pedunculi, corpus medullare of cerebellum. 9. Functional Clinical aspect of cerebellum.
10. Cerebrum or hemispherium cerebri: parts, sulcus, gyrus.
11. Architectonic structure, interconnection of neuron in cerebral cortex and its funtional areas. ABSTRACT OF LECTURE:
FR (formation reticularis) in neruoanatomi is the term that include brainstem substance filled in the space between specific nuclei and tracts in the brainstem. FR sophisticated structure that consist many kind of neurons.
Obey Cajal, the neurons in FR consist orde III of sensory fibers. Obey Brodal (1957) that are consist specific area and have cytoarchitectonic and have specific intrinsic organization.
Intrinsic Organization:
1. In medulla (medulla oblongata) have 5 nuclei, and have each connection (afferent and efferent) of each nucle.
2. In Pons (FR Pontis): have 3 parts of nuclei.
3. In midbrain (FR mesencephali): have 3 nuclei. Sukardi, E., Chapter 15. The neurotransmitter and FR:
Monoamine fibers build by the axons that have monoamine: nore-adrenaline, serotonin and dopamine. The research indicate most of its source from special area of the FR. The broad lined mono-amine fibers consist 5: noradrenergic descending, noradrenergic ascending, noradrenergic from locus ceruleus, serotonergic ascending and dopaminergic fibers. Except dopaminergic fiber, the fibers from the FR of brainstem. Please look at the table on Sukardi, E., page: 191-192.
Many functional aspect of FR: - facilitation area, inhibition area, respiratory center, cardiovascular center, Primary consciousness center, On these had many research: Torvik and Brodal (1957, Brodal and Rossi (1955) Kuypers (1958).
The corticonuclear fibers consist 2 parts: 1), direct and 2) indirect fibers.
The Cerebellum is suprasegmental part of CNS, located dorsal of brainstem filled in posterior of cranial cavity and connect with brainstem by three couples of structure called: pedunculi cerebelli (superior/anterior/brachium conjunctivum, medius/brachium pontis, posterior/inferior/corpus restiforme), its function is pass by afferent and efferent fibers. Cerebellum divide to 3 parts: archeocerebellum, paleocerebellum, and neocerebellum. Archeocerebellum is the oldest part had functional connection with vestibular nuclei, paleocerebellum receive impulses from spinal cord through the spinocerebellar tracts (ventral and dorsal) and cuneocerebellar tract (fibrae arcuatae externae), conduct proprioceptive impulses. In medial part have vermis and lateral part have hemispherium.
dorsal and dorsolateral of fourth ventricle of brain (ventricle IV / ventriculus quartus). The cortex of cerebellum have 3 layers: molecular, piriform, granular layers/stratum.
Afferent fibers divide divide to 2 parts: Climbing and mossy fibers. All of impulses to the cerebellum are excitation to neuron of cortex and nuclei of cerebellum. But, Purkinje cells inhibition, connection with the nuclei of cerebellum, lateral vestibular nucleus, basket cells and all of the interneurons in cerebellar cortex. Efferent impulses can reach to red nucleus, thalamus area 4 Brodmann by thalamo-cortical fibers. By these tracts (Rubro-spinalis, rubroreticularis-reticulospinalis tracts) cerebellum can coordinate the motoric reaction ( in a reflex, automatic and aware manner). Muscle tone controlled by cerebellum through reticulospinal tract (alpha and gamma motoric neurons).
White matter of cerebellum divide to 2 parts: intrinsic (cortico-nuclear, association fibers) and extrinsic fibers( in the corpus restiforme, brachium pontis and brachium conjunctivum). In caudal cerebellar peduncle had 8 tracts, medial cerebellar peduncle had 1, in cranial cerebellar [peduncle had 2 tracts/fibers.
Functional aspect of cerebellum: 1. Controlled the tension of muscles in equilibrium and posture; 2. Guarantee on fast and regulated contraction group of muscles.
Neocerebellum lesion mainly have sympthom, smooth action disorders: 1. Hippotoni and asthenia, 2. Asinergi, 3. Nystagmus.
Telencephalon have 2 parts: telencephalon impar, and a couple cerebral hemisphere. Cerebral hemisphere left and right connect with caloosal body (corpus callosum). Cerebral surfaces showed out : sulcus or fissurae and gyrus; most of cerebral cortex hidden in sulcus or fissurae. One hemisphere have 4 lobe, and each lobe have gyrus. Cerebral cortex divided to 3 parts: neocortex/ neopallium/ isocortex, paleocortex/ paleopallium, archicortex/archipallium. Koniocortex applied to sensory part of cortex: optic area, auditory area and somesthetic area. Isocortex had 6 layers, had many connections of each neurons in each layers. Lorente de No (1949) had studied main connections neuron to neuron in the isocortex. Brodmann (1909) had studied functional area in cerebral cortex. Most of the cerebral cortex had studied, numberized and had studied each fuction. That are primary, assosiation, integrated, ideomotor area in cerebral cortex.
Structure of white matter of cerebral hemisphere; this substance filled in between cerebral cortex and subcortical substance. Fibers of the white matter cerebral hemisphere divide ti 3 main parts: Projection (afferent and efferent), assossiation and commissural fibers. Projection fibers divided 2 parts: source from cerebral cortex and from subcortical center.
From corona radiatacapsula interna/ internal capsule (crus anterior, genu, crus posterior). Each parts of capsula interna filled in (arranged) by each tract alone.
Commissural fibers mainly connection same center to the other hemisphere, but assosiation fibers connection the other cortex in same hemisphere. Commissural fibers divide to 3 parts, association fibers to 4 parts.
Case 1:
A man 65 years old had a progressive headache since 3 month ago. He have examination in hospital: the intracranial tension increase, tremor, ; The CT Scan: Tumor on the cerebellum.
LEARNING TASK:
1. Describe the FR (Formatio Reticularis) in medulla, pons, and midbrain. 2. Describe the connections (afferent and efferent) of each fibers.
4. Describe of many functionaspecty of FR, locus ceruleus.
5. Describe the positions of: LM (lemniscus medialis), Lemniscus trigeminalis, Tractus spinothalamicus lateralis, fibrae corticonuclearis, fasciculus pyramidalis, rubrospinalis, vestibulospinalis, tectospinalis, and assossiation fibers in midbrain.
6. Describe the prediction of neurologic manifestation result the lesion on paramedian or lateral of midbrain.
7. Describe the position and connection of cerebellum to the brainstem.
8. Describe the afferent, efferent connections and functions of archi-, paleo-, neo-cerebellum. 9. Describe the projection from cortex of cerebellum to the nuclei.
10. Describe the projection of olivary nuclei to cortex of cerebellum. 11. Describe the excitation, inhibition fibers in cerebellum.
12. Describe the kinds of circuit in cortex of cerebellum.
13. Describe the pedunculi of cerebellum and the fibers throw in.
14. Describe some disorders in cerebellum: nystagmus, hippotoni, asteni, asinergi. 15. Describe the sulci, gyri, on brain: from medial and lateral aspect.
16. Describe the areas of brain, and each function of its. 17. Describe the allocortex, sensory and motor homunculus.
18. Describe the term: alexia, agraphia, apraxia, and limbic system.
19. Describe the location and representation of learning, memory functions. 20. Describe the projection, commissural and association fibers of the brain.
DAY 5th
NEUROANATOMY dr. Wayan Suarya, PAK.
AIMS:
1. Describe the structure of: telencephalon, cerebral cortex, white matter of cerebral hemispheres and diencephalon., its connection with the other parts of CNS, and ganglia basalia.
2. Structure and route of visual and olfactoric system, intracranial meninges ventricle of CNS, vascularisation, general development, evolution of CNS.
LEARNING OUTCOME:.
1. Describe the limbic system, emotion and high function of CNS.
2. Describe composition of white matter of cerebral hemispherium: projection fibers, internal capsule, commissural fibers, and assossiation fibers.
3. Describe structure, each connections and clinical aspect of ganglia basalia. 4. Describe differentiation of pyramidal and extrapyramidal system.
5. Describe structure of of olfactory nerve, rhinencephalon.
6. Describe composition of intracranial meninges, ventricle system of brain.
7. Describe general and regional vascularisation, arterial circle, and venous system of the brain. CURRICULUM CONTENT:
1. Limbic system and other structure in emotional reactions, memory and learning.
2. Composition/structures of white matter of the cerebral hemispherium: projection fibers, internal capsule, commissural fibers, and assossiation fibers.
3. The structure/component of the ganglia basalia, the connections and clinical aspect of ganglia basalia disorders.
4. Differentiations of pyramidal and extrapyramidal systems.
5. Structure of olfactory nerve and the other parts of brain involve in smell process.
7. General and regional vascularisation of brain, arterial circle, and venous system of the brain.
Abstracts of lectures:
Diencephalon and ganglia basalia constitute subcortical nuclei (gray matter) of the cerebral hemisphere together. Diencephalon divided to: Thalamus, metathalamus,hypothalamus, subthalamus, epithalamus. Thalamus oval shape of gray matter, have average long: 3 cm, lateral to ventricle III. Thalamus have many group of nucleus, but functionally divided to 3 parts:Specific/ relay connection, association nuclei and subcortical projection nuclei. Functional and clinical aspect of thalamus: except olfactory impulse, all of the impulses send to the nuclei of thalamus. Olfactory fibers have not synapse in thalamus, but projection directly to the rhinencephalon. Structure and orgization of thalamus just not only relay station of the sensory impulses send to the cerebral cortex, but so far complex. Many function commonly connected to thalamus: main sensory integration, part of thalamus regulate conciousness and alertness, connect in emotion aspect, integrated center of motoric function ( because it receive main efferent projection from cerebellum and striatum body/corpus striatum).
Hypothalamus and hypophysis cerebri: hypothalamus most ventrally parts of diencephalon. In man slightly over than 4 gram, take place very important nerve mechanisms. So that hypothalamus divided to 3 parts: supraoptic, tuberal, mammillary parts. Hypothalamus have wide and complicated connection to the other nervous center. Hypothalamus have afferent, efferent connections. Main functions of hypothalamus to a).endocrine and b).to ANS in brainstem and spinal cord (autonomic descendens fibers), and c). Center of expression of emotion,d) correlation the visceral and olfactory impulses.
Hypothalamus connect to brainstem by: 1). Periventricular fibres, 2). Hypothalamoreticular fibers, 3). Mammillotegmental fascicles/fibers.
Rhinencephalon only included CNS structure its receive nerve fibres from olfacfory bulbs. Another meaning rhinencephalon included: olfactory bulbs, olfactory tracts, olfactory striae, anterior perforate substance, part of amygdaloide body, and part of prepiriform cortex, ( it is appropriate to paleopallium). The conduction machanism of olfactory impulse: olfactory cells in nasal mucosafila olfactoria (foramina in cribriform/crbrose lamine at ethmoidal bone dendrite of mitral cells in olfactory bulbs (its take place upper than roof nasal cavity).Amount of olfactory cells there are synaptic connection with one mitral cell. These synaptic knows glomerulus. Axons of mitral cells formed olfactory tracts, and there are have collateral fibres and formed synaptic connections with granular cells in olfactory bulbs, and axon of granular cells formed synaptic connections dendrite of same mitral cells form feedback arc (circuit). To posterior part the olfactory tracts have three branches;stria olfactoria (lateralis, medialis and intermedia). These cortex are the primary center of olfactory, the function is olfactory perseption. Area 28 and 33 there are a higher center of olfactory, functionally for olfactoric gnosia, identification of smell.
Intracranial meninges, like in spinal cord, duramater, arachnoid and piamater. Arachnoid and piamater layers knows leptomeninx, and duramater knows pachymeninx. Duramater divided to 2 layers: outer layer rich with blood vessels and nerves and lining inner surface of cranial bone and constitute periost layer, and inner layer, thinner, and linning with a layer of thin cells. Generally two these layers adhering to the other except in certain places: duramater sinuses (sinus duramateris). These sinuses filled in venous blood ( from superficials cerebral veins.
veinsophthalmic veins, so that duramater sinuses had connection with extracranial veins. Posterior direction cavernous sinussigmoid sinus by (through) superior and inferior petrosus sinuses. Two main function of CSF are: (1) as venous system in brain, (2) location of absorption of Th CSF through arachnoidal villimainly to superior sagittal sinus.Cerebral ventricles there are: lateral, tertius (III), mesencephalic aquaduct, quartus (IV) and central canal.
Brain vascularisation there are depend on aerobicglucose metabolism. In brain cells or tissue be found a small amount of glucose and oxygen. Brain is 2 % of body wight, purpose 17 % of cardiac output, may be 20 % of gas oxygen of body purposes.
Many main factors the circulation of the brain are: blood gases, brain metabolism, otoregulation. Many pathological disorders are result of circulation of the brain. The brain receive blood from two couple of ateries: internal carotis and vertebral arteries. Internal carotis artery beside participate in arterial circle it give branches: ophthamic, posterior communicans, anterior choroid, anterior cerebral and medial cerebral arteries. Vertebral arteies beside serve to spinal cord, brainsten and cerebellum, it follow give its terminal branches to form arterial circle (circulus arteriosus): posterior cerebral arteries.
Regional vascularisation: the parts of the brain there are had each arteries and its branches. The venous blood circulation of the brain: veins of the brain had qualities: (1) Not follow the artery, (2) had thin of the wall, (3) deep veins of the brain not have a wide anastomosis, (4) most of superficial cerebral veins pour blood to superior sagittal sinus, and many pour to tranverse sinus, in the contrary direction to blood flow in duramater sinus relevant. Venous system in the brain divide to 2 group: superficial and deep veins.
Case 1:
A man 50 years old affected Diabetes mellitus until 10 years ago. The diabete is not controll carefully. Three days ago he had strok affected on branches of vertebral artery: left posterior inferior cerebellar artery and left posterior cerebral artery. The arteries lesion to knows by CT scan.
LEARNING TASK:
1. Describe the corona radiate in internal capsule, afferent and efferent projection fibers.
2. Describe the position of the fibers in the internal capsule, and to predict the neurological symptoms and signs of one side internal capsule lesion.
3. Describe the thalamus with the others components of diencephalon. 4. Describe the position of thalamus concerning third ventricle.
5. Describe the connections of the thalamic nuclei. 6. Describe the main function of thalamus.
7. Describe the signs on the upper case.
8. Describe the nuclei of hypothalamus, and each functions of its. 9. Describe the connection of each parts of ganglia basalia.
10. Describe the control mechanism of hypothalamus to pituitary gland, brainstem, ANS (autonomic nerve system), hunger and thirsty center.
11. Describe the connection of ganglia basalia to control the skeletal muscle movements.
Case 2:
A Man 50 years old affected Diabetes mellitus until 10 years ago. He is not control be carefully. Three days ago he had stroke, affected on branches of vertebral artery: left anterior cerebellar artery (by CT-Scan).
1. Describe the left posterior inferior cerebellar artery, left cerebral artery joins to forming arterial circle (circulus arteriosus), and the athers arteries forming it.
2. Describe the lobe, area on the brain serve by: posterior, medial, anterior cerebral arteries.
3. Describe the area Broca, precentral, poscentral, internal capsule, thalamus, hypothalamus, pituitary gland, serve by………..arteries.
4. Describe the differencies venous system on brain compare with the common venous system in the body.
5. Describe the intracranial meninges to built the sinus duramateris, and where the liquor cerebrospinalis to produce.
6. Describe the oxygen comsumption of the brain.
Case 3:
A Physician work in forensic department, after autopsy he had bad smell until 2-3 days, where as he have taken a bath and wash cloth and his hair.
LEARNING TASK:
1. Describe the physician have bad smell until 2-3 days after autopsy. 2. Describe the components to forming the circle the nerve of bad smell. 3. Describe the parts of brain involve in olfactory system, and the receptor. 4. Describe the receptor, route, stria of the olfactory system.
Case 4:
A neonatal baby have congenital anomaly on his back; and he had diagnosed by the physician: Spina bifida. On the skin of head the child had pyodermia. Also diagnosed: had meningitis, spread from piodermia.
LEARNING TASK:
1. Describe the piodermia may spread to the intracranial meninx. 2. Describe the components of meninges, and sinus duramateris.
3. Describe the CSF: produce, flow from plexus choroideus right atrium of the heart. 4. Describe the subarachnoidal space filled in.
5. Describe general development of brain.
6. Describe some development disorders, and the level of main organization in nervous system.
DAY 6th
HISTOLOGY
HISTOLOGICAL STRUCTURE OF NERVOUS SYSTEM dr. Wayan Sugiritama, M.Kes
ABSTRACT:
Anatomically, the nervous system is divided into the central nervous system (CNS), consisting of the brain and the spinal cord; and the peripheral nervous system(PNS), composed of nerve fibers and small aggregates of nerve cells called nerve ganglia. Structurally, nerve tissue consists of two cell types: nerve cells, or neurons, which usually show numerous long processes; and several types of glial cells, which have short processes.
occupied by neuroglia which have short processes, support and protect neurons, and participate in neural activity, neural nutrition, and the defense processes of the CNS
Brain and spinal cord are covered by three layers of connective tissue, meningens. The outermost layer is the dura mater, the innermost is the pia mater, and an intermediate layer between these is the arachnoid.
The nerve of PNS consists of varying numbers of myelinated and unmyelinated axons originating from neurons located in the brain, spinal cord, or ganglia. Functionally, the PNS is divided into a sensory (afferent) component, which receives and transmits impulses to the CNS for processing, and a motor (efferent) component, which originates in the CNS and transmits impulses to effector organs throughout the body. The motor component is further subdivided as: somatic system and autonomic system.
A major function of the CNS is to receive sensory stimuli from various parts of the body and to analyze this information and respond by generating signals that are transmitted over PNS to initiate and integrate muscular, secretory, and other activities in the body. The function of the CNS is not limited to integration of information from the periphery, it is also engaged in less well understood endogenous neural activity that underlies consciousness, memory, reasoning, and regulation of behavior.
Case 1:
A 22-year-old male had a severe, traumatic injury on his head and lower back after a motorcycle accident. He referred to the hospital in unconscious state. There was large hematoma on his head and abrasion on lower back. A CT-Scan was done and found subdural hematoma and brain edema. The surgical was done to safe his life. When the patient conscious he cannot feel and move both of his leg. Neurological examination found there was decreased of motoric and sensory function on his leg.
LEARNING TASKS:
1. On the above case, the patients had cerebral edema, please explain the microscopic structure of the brain and find the differences between the cerebrum and the cerebellum!
2. When the accident occurred, meninges is one structure that protects the brain from injury. Please explain the structure of the meninges and it’s clinical importance!
3. Decreased of motoric and sensory function on patient’s leg may caused by spinal cord injury, please explain its structure !
4. On the accident, peripheral nerve system (PNS) may have injured, explain the microscopic structure of Peripheral Nervous system (PNS), and its classification!
5. After an injury is usually followed by a healing process, please explain the healing process in the central nervous system and peripheral nervous system
Case 2:
A one-year-old boy referred to the neurologist with enlargement of the head, vomiting and fatigue. On examination the doctor found decreased of muscular function. A lumbar puncture was done to measure the intracranial pressure and collect the sample of cerebrospinal fluid (CSF). There was an increase of intracranial pressure and the composition of CSF was normal. He was diagnosed with hydrocephalus.
LEARNING TASKS:
1. On the above case, the patients had increased of intracranial pressure that may be caused by the accumulation of CSF, please explain the structure that produces CSF, the CSF production process and it’s absorption .
3. Describe the structure of neuroglial cell which is have a role in circulation of CSF!
Case 3
A two-year-old girl admitted to the hospital with high body temperature followed by seizures and decrease of consciousness. A CSF examination found a sign of infection and the working diagnosis is encephalitis.
LEARNING TASKS:
1. Brain tissue is protected from harmful microorganisms and hazardous materials by the Blood -Brain Barrier, please explain the components of Blood-Brain Barrier and describe its microscopic structure
2. Please explain the clinical importance of blood-brain barrier in the development of disease in the brain and its treatment
SELF ASSESSMENT
1. Explain the general structure of neuron!
2. Mention and explain classification of neuron according to their structure and their function! 3. Explain the Nisll’s Bodies!
4. Mention the type and explain the function of neuroglial cells! 5. Mention and explain various types of synapses between neuron! 6. Brain consist of...and...
7. White matter is composed mostly by..., and Gray Matter is composed mostly by...
8. Differentiate the histological structure between cerebrum and cerebellum
9. Connective tissue that covered the brain and spinal cord is called by…………, its outermost layer is…... intermediate layer is………., and the innermost layer is………..
10. Blood-brain barrier is composed by...
11. Cerebro spinal fluid (CSF) is produced by...
12. Connective tissue which covers a nerve is..., covers each bundle of nerve fiber is..., and covers a nerve fiber is...
13. Myelin sheath in CNS is produced by...and in PNS by... 14. Explain the classification of the nerves!
15. Differentiate the structure of somatic and autonomic nervous system!
16. Ganglia are..., there are two types of ganglia :...and...
NEUROPATHOLOGY
dr. Ni Putu Sriwidyani, Sp.PA
ABSTRACT
The principal function unit of the central nervous system is the neuron. Of all the cells in the body, neurons have a unique ability to receive, store, and transmit information. Neurons of different types and in different locations have distinct properties, including functional roles, distributions of their connections, neurotransmitters used, metabolic requirements, and levels of electrical activity at a given moment. A set of neurons may thus show selective vulnerability to various insults because it shares one or more these properties.
Case 1
A 30 year old women sees the Gynecologist because of amenorrhea since 1 year and infertility. On physical examination found galactorrhea and hemianopsia bitemporal.
LEARNING TASK
1. Elaborate sign and symptom of this patient with anamnesis and physical examination. 2. Laboratory and imaging method should be performed
3. What is the possible diagnosis of this tumor.
Case 2
A 45 year old, previously healthy man has developed headaches over the past month. There are no remarkable findings on physical examination. A cerebral angiogram shows a 7 mm saccular aneurysm at the trifurcation of the right middle cerebral artery.
LEARNING TASK
1. What is the abnormal vascular disease found in this man? 2. What is the complication of this abnormality
Case 3
A 72 year old woman falls down the stairs. She does not lose consciousness. About 36 hours later, she develops a headache and confusion and is taken to the emergency department. On physical examination, she is conscious and has a scalp contusion on the occipital.
LEARNING TASK
What is the most likely location of an intracranial hemorrhage in this patient?
SELF ASSESMENT
Describe and give some example of:
1. Cerebral edema, hydrocephalus, and raised intracranial pressure. 2. Malformation and developmental disease
3. Trauma affecting CNS 4. Cerebrovascular disease 5. CNS Infection
6. Demyelinating disease
DAY 7th
Clinical Pathology
dr. I Nyoman Wande, SpPK TOPIK : Cerebrospinal analysis
AIMS:
To discribe the kind of CSF test how to interprete the test.
LEARNING OUTCOMES:
To discribe the interpretation of test.
CURRICULUM CONTENTS: a. Production of CSF. b. Spicemen collection.
c. CSF examination and interpretation of test.
ABSTRACT OF THE LECTURE:
Lumbar puncture is frequently performed in primary care. Properly interpreted tests can make cerebrospinal fluid (CSF) a key tool in the diagnosis of a variety of diseases. Proper evaluation of CSF depends on knowing which tests to order, normal ranges for the patient’s age, and the test’s limitations. Protein level, opening pressure, and CSF-to-serum glucose ratio vary with age. Xanthochromia is most often caused by the presence of blood, but several other conditions should be considered. The presence of blood can be a reliable predictor of subarachnoid hemorrhage but takes several hours to develop. The three-tube method, commonly used to rule out a central nervous system hemorrhage after a “traumatic tap,” is not completely reliable. Red blood cells in CSF caused by a traumatic tap or a subarachnoid hemorrhage artificially increase the white blood cell count and protein level, thereby confounding the diagnosis. Diagnostic uncertainty can be decreased by using accepted corrective formulas. White blood cell differential may be misleading early in the course of meningitis, because more than 10 percent of cases with bacterial infection will have an initial lymphocytic predominance and viral meningitis may initially be dominated by neutrophils. Culture is the gold standard for determining the causative organism in meningitis. However, polymerase chain reaction is much faster and more sensitive in some circumstances. Latex agglutination, with high sensitivity but low specificity, may have a role in managing partially treated meningitis. To prove herpetic, cryptococcal, or tubercular infection, special staining techniques or collection methods may be required.
TRIGGER SCENARIO:
1. A girl one years old taken by her father to emergency department with chief complained convulsion. Her father also complained about rhinitis, productive cough and fever since 5 days.
LEARNING TASK:
1. Mention the kind of CSF test should be done!
2. Described the location of CSF puncture in this patient! 3. Mention the differential diagnosis of this patient!
4. Mention the indication and contra indication of lumbal puncture! 5. What are the CSF findings in bacterial meningitis?
SELF ASSESSMENT:
1. How is CSF product ?
2. What is the indication and contraindication of lumbar puncture ? 3. How to normal value CSF analysis?
4. How to interprete the result of each test ?
5. How to differentiate the red colour of CSF due to the artificial bleeding and the subarachnoidal bleeding ?
6. Procedure collection of CSF?
PHARMACOLOGY
DRUGS USED FOR SEIZURE DISORDERS Dr. dr. I Made Jawi, M.Kes
AIMS :
1. Describe the rationale drugs used to treat each type of seizure 2. Describe the desired therapeutics outcomes for seizure disorders 3. Develop a education plan for people diagnosed with a seizure disorder
LEARNING OUTCOMES :
Apply concepts and principles of drugs used for seizure
CURRICULUM CONTENT
1. Basic pharmacology of anti seizure drugs
- Drugs used in partial seizures & generalized tonic-clonic seizures
- Drugs used in generalized seizures
- Other drugs used in management of epilepsy
2. Clinical pharmacology of anti seizure drugs
- Management of epilepsy
- Special aspect of the toxicology of anti seizure drugs
ABSTRACT
SCENARIO
Mr X, 45 years old, suddenly had a tonic clonic seizure while attending a seminar. When his family notified of this and his need for transportation home, his wife tells you he has not been taking his medications regulary.
LEARNING TASK
1. Describe how you as a doctor would address this situation ? 2. Describe anti seizure drugs using in seizure patients ?
3. Describe adverse effect of anti seizure drugs using in seizure patients ?
SELF ASSESMENT
1. What is the definition of fetal hydantoin syndrome ?
2. Which one of antiseizure drugs can cause gingival hyperplasia ?
3. Can you describe the interaction of antiseizure drugs with the other drugs ? 4. What is the treatment of patient with status epilepticus ?
PHARMACOLOGY MANAGEMENT OF PARKINSONISM & OTHER MOVEMENT DISORDERS
Dr. dr. I Made Jawi, M.Kes
AIMS :
1. Describe the rationale drugs used to treat parkinson’s disease 2. Describe the desired theraupetic outcomes for parkinson’s disease 3. Develop a education plan for people diagnosed with parkinson’s disease
LEARNING OUTCOMES :
1. Apply concepts and principles of drugs used for parkinson’s disease
CURRICULUM CONTENT
Drug therapy for Parkinson’s Disease
- Drug class : Dopamine Agonists
- Drug class : COMT Inhibitor
- Drug class : Anti cholinergic Agents
- Drug Class : Miscellaneous Anti parkinsonism Agents
ABSTRACT
excess of acetylcholine in the brain. The goal of treatment is to restore dopamine neurotransmitter function as close to normal as possible and relieve symptoms caused by “excessive” acetylcholine. Therapy must be individualized, but selegiline therapy is often started first to slow the development of symptoms. As selegiline becomes less effective, levodopa is started with or without selegiline. Dopamine agonists (amantadine, bromocriptine, pergolide, ropinirole, pramipexole) may be added to directly stimulate dopamine receptors. Entacapone may be added to levodopa therapy to reduce the metabolism of levodopa, prolonging its action. Anti cholinergic agents may be added at any time to reduce the effects of the excessive acetylcholine. Non pharmacologic treatment (e.g., diet, exercise, physical therapy) of Parkinson’s disease is equally important in maintaining the long-term well being of the patient.
SCENARIO
Mrs X, 55 years old, is being started on an anti cholinergic drug as part of the treatment plan for Parkinson’s disease.
LEARNING TASK
1. What symptoms can be expected to improve ?
2. What problems could also arise from starting this medication ?
3. Discuss the normal course of progsession of Parkinson’s disease and include the rationale for drug therapy to alleviate the symptoms
4. List drugs which will give to the patient who has parkinsonism ?
5. Explain why do you choose l-dopa and not dopamine to treat Parkinson’s disease ? 6. Explain why levo-dopa could not be combined with pyridoxine?
7. Describe the benefit combination of levodopa with carbidopa in the treatment od Parkinsonism ?
8. Describe why dipenhydramine used to treat Parkinsonism caused by neuroleptic ?
SELF ASSESMENT
1. Describe the rationale drugs used to treat parkinson’s disease 2. Describe the side effect of drugs that used for parkinson’s diseas
3. Develop an education plan for people diagnosed with parkinson’s disease
LEARNING PROGRAM CLINICAL NEUROSCIENCE
DAY 1st
April 9th 2015.
VERTIGO, MENIERE DISEASE AND BELL’S PALSY dr. IA Sri Wijayanti, M.Biomed, Sp.S
VERTIGO Aims:
Describe diagnosis, initial management and/ or referral patients with vertigo Learning outcome:
2. Differentiation between peripheral vestibular vertigo and central vestibular vertigo 3. Differentiation between vestibular vertigo and non vestibular vertigo
4. Examinations of dizzy patients
5. Initial management principle for vertigo
6. Evaluation the need for urgent investigations and referrals
Curriculum contens:
1. H
