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O. I. Kolenko neurology: general neurology




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O.I. Kolenko


NEUROLOGY:

GENERAL NEUROLOGY


Educational book


O.I. Kolenko


Neurology:

General Neurology


Educational book


Recommended by the Ministry of Education and Science of Ukraine


Sumy

“Sumy State University Publishers”

2010

УДК [611.8+612.8](075.8)

ББК 56.12я73

K 60


Reviewers:

Mishchenko T.S. – Doctor of Medicine, professor of the Institute of Neurology, Psychiatry and Narcology of Academy of Medical Sciences of Ukraine;

Morozova O.G. – Doctor of Medicine, professor of Kharkiv Medical Academy of Postgraduate Education;

Dubenko E.G. – Doctor of Medicine, professor of the Kharkiv National Medical University


^ Recommended by the Ministry of Education and Science of Ukraine

as educational book for the students of higher medical

educational institutions of IV accreditation level

(letter № 1/11 – 8009 of 19.08.2010)


Kolenko O.I.

K 60 Neurology: General Neurology: educational book / O.I. Kolenko. – Sumy : Sumy State University Publishers, 2010. – 169 p.

ISBN 978 – 966 – 657 – 315 – 8


The main principles of anatomy and physiology of nervous system are reviewed, basic syndromes of nervous system affection are represented. Basic disorders and diagnostics fundamentals of neurological diseases are reviewed.

У навчальному посібнику висвітлені головні принципи будови та фізіології нервової системи, наведені основні синдроми ураження нервової системи, а також основи діагностики нервових хвороб.


УДК [611.8+612.8](075.8)

ББК 56.12я73



ISBN 978 – 966 – 657 – 315 – 8


© Kolenko O.I., 2010

© Sumy State University Publishers, 2010

CONTENTS

Contents……………………………………………………3

Preface……………………………………………………..4

1 Chapter I. Short history review of neurology. Main foundations of structure and functioning of nervous system………………………………………………………5

2 Chapter II. The physiology and pathology of motor function……………………………………………….......13


2.1 Main principles of structure and functioning of nervous system. Neuron – the functional unit of nervous system. Reflexes……………………………………….....13

2.2 Basic motor pathway. Examination of motor functions. Lesions of pyramidal tract at multiple level…..26


2.3 The Subcortical structures. Extrapyramidal system (anatomy, functioning and disorders)…………………….43

2.4 Cerebellum. Conduction Pathways. Signs of lesions……………………..…………………………….56


3 Chapter III. Sensation and its disorders (anatomy of sensory pathways. syndromes of sensory system lesion on different levels)…………………………………………...64

4 Spinal cord syndromes…………………………………80

5 Chapter V. Short review of cranial nerves. Signs of lesions……………………………………………………..92


6 Chapter VI. Clinical anatomy of the brainstem. Signs of lesions. Bulbar and pseudobulbar palsy…………………108

7 Chapter VII. Autonomic nervous system. Methods of investigation, signs of lesion…………………………….122

8 Chapter VIII. Cerebral cortex. Affection and irritative signs of cerebral cortex. Cerebrospinal fluid. Meningeal syndrome………………………………………………..142

9 Chapter IX. Methods of investigations in neurology………………………………………………..156

Referenses……………………………………………….168


PREFACE


to my tutors


Diagnostic skill in neurology is quite a complicated process, which requires high level of basic training. That is why, publishing of text-books from this division of neurosciences is a very actual problem. This text-book was worked out for overseas english-speaking students according to educational program of our country. Its contaent covers a wide range of issues that are not logically enough represented in similar foreign manuals.

The presented text-book includes selected lectures on topical diagnostic and investigation methods for medical students but may be of use of lecturers and English-speaking residents. The main data about anatomy, physiology of central and peripheral nervous system, syndromes of nervous system lesion at multiple levels are presented in this issue in a condensed form. There is a sufficient number of tests questions examples.

The text-book can be of use for homework, clinic and test check in neurology and is a the good addition to the course of lectures on neurology.
^

1 CHAPTER I

SHORT HISTORY REVIEW OF NEUROLOGY.

MAIN FOUNDATIONS OF STRUCTURE AND FUNCTIONING OF NERVOUS SYSTEM.


it is true that those who ignore the lessons of history are likely to repeat the mistakes of earlier generations.

Neurology is a science about the development and functioning of the nervous system (NS) in norm and pathology. The problem of research of human brain, the problem of the ratio between the brain and mentality are the most important tasks which were considered by the science.

Modern neurology (neuropathology) as an independent science was established in the second half of the 19th century and it is a result of thousand-year work of many talented observers of antiquity; namely doctors, biologists, physiologists, morphologists, who studied the role of the NS in normal and unhealthy conditions of an organism.

An ancient Egyptian treatise concerning trauma surgery, the Edwin Smith papyrus, contains descriptions and suggests treatments for various injuries, including some of neurological nature. They describe the meninges, the external surface of the brain, the cerebrospinal fluid and the intracranial pulsations. The Sumerians illustrated paraplegia caused by physical trauma. In the Ayurvedic text Charaka Samhita (ancient India) discusses epilepsy, its symptoms and possible treatments.

Slightly later, the ancient Greek physician Hippocrates was convinced that epilepsy had a natural cause, not a sacred one. The ancient Greeks also dissected the nervous system. For example, Aristotle (although he misunderstood the function of the brain) describes the meninges and also distinguishes between the cerebrum and the cerebellum. More lately, in Rome, Galen performed many dissections of the NS in a variety of species, including the ape. One particular discovery he made was of the importance of the recurrent laryngeal nerves. Originally, he cut through them accidentally while performing an experiment

Neuropathology (neurology) as an independent clinical science appeared in 1862 when the department for patients with diseases of the NS in Salpetrier hospital near Paris was opened. Jean-Martin Sharko (1835-1893) whom we quite often we name the father of neuropathology headed it.

The first Kiev Department of neurology was founded in 1884 by M.M. Lapinsky. The first Kharkiv Department of neurology was founded in 1884 by P.I. Kovalevsky (S.M. Davidenkov, K.I. Platonov, O.M. Grinshtein, G.D. Leshchenko their mantle had fallen). In 1922 Ukrainian Research Institute of psychiatry and neurology was founded in Kharkiv by G.I. Geimanovitch. In 1926 the Ukrainian Institute of Clinical Psychiatry was founded by V.P. Protopopov. Now its headed by professor P.V. Voloshin.

The first Russian neurologic department was opened in 1869, on the base of Catherine’s hospital. The initiator of its creation and its first head was A.J. Kozhevnikov (1836-1902). Under his initiative the first clinic of nervous diseases was constructed in Russia in 1890. Kozhevnikov is the founder of Moscow school of neuropathologists, which was represented by such famous scientists such as L.O. Darshkevitsh, G.I. Rossolimo, S.S. Korsakov and others.

In St. Petersburg neurological science began to develop on the basis of the Department of mental diseases of Medical-surgical academy created in 1857 (since 1881- Military Medical Academy). From the end of the 80s of the 19th century the course of nervous diseases at this chair was given by Merezhkovskiy (1838-1908). In 1932 a surgeon N.N.Burdenko together with a neurologist V.V.Kramer created independent institute of neurosurgery in Moscow, where such scientists as Irger, Arutjunov worked and also there were representatives of new fields in neurology such as neurophthalmology, otorhinoneurology, and neuroradiology. In 1944 the research institute of neurology was founded in Moscow.

The new stage of the development of neurology was opened by Marushi. He described the reaction of the activation of the brainstem through the implanted electrodes. Academician Anochin described the theory of functional system.

The newest period has been since the 60s-70s of the 20th century. The ultra structure of synapses has been discovered, the theory of ligand-synaptic communications has been specified. In peripheral NS albuminous or axonal transport has been found.


^ SOME SIGNIFICANT DATES ABOUT NEUROLOGY

2700 B.C. - Shen Nung originates acupuncture.


1700 B.C. - Edwin Smith surgical papyrus is written. First written record about the NS.


460-379 B.C. - Hippocrates discusses epilepsy as a disturbance of the brain. 460-379 B.C. - Hippocrates states that the brain is involved with sensation and is the seat of intelligence.


^ 387 B.C. - Plato teaches at Athens. Believes brain is a seat of mental process.

335 B.C. - Aristotle writes about sleep; believes heart Is a seat of mental process.


^ 1000 - Al-Zahrawi (also known as Abulcasis or Albucasis) describes several surgical treatments for neurological disorders.


1025 - Avicenna writes about vision and the eye in The Canon of Medicine.

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