Neuroscience Clerkship

     LEARNING OBJECTIVES

Below are the learning objectives for the Neuroscience Clerkship. These are the key points that every medical student needs to master about neurology and neurosurgery, regardless of what specialty they ultimately pursue.

The learning objectives are divided into global learning objectives for the clinical rotations as well as specific learning objectives for neurology and neurosurgery. These learning objectives parallel the weekly didactic teaching sessions. For each learning objective, click the "Acquire Knowledge" button to enter the module for the selected topic.

CLINICAL ROTATIONS              

Gain proficiency and competency in performing the neurologic history and examination

Be able to correlate neuroanatomy with function and clinical neurologic deficits

Gain proficiency and competency in presenting, evaluating and managing patients with a variety of neurologic and neurosurgical disorders

Gain proficiency and competency in identifying basic neurologic structures on CT and MRI imaging

Understand the indications, contraindications and limitations of the commonly used diagnostic tests in neurology, specifically the lumbar puncture, CT and MRI imaging, electroencephalography (EEG) and electromyography (EMG)

Be able to assess the acuteness of a clinical neurologic problem, especially as it relates to the need for immediate management and the requirement for expert assistance

Utilize self-directed learning to gain further knowledge and competence in the area of neurologic disease

NEUROLOGY

     Cerebrovascular Disorders

Be able to differentiate clinically between cortical and subcortical strokes.

Be able to identify common risk factors for stroke.

Know the significance of a TIA and the differential diagnosis of a brief neurologic spell.

Be able to recognize the clinical signs of large vessel anterior circulation stroke, especially infarction of the anterior cerebral and middle cerebral arteries.

Be able to recognize the clinical signs of large vessel posterior circulation stroke, especially infarction of the vertebral, posterior inferior cerebellar, basilar and posterior cerebral arteries.

Know the clinical characteristics that differentiate between thrombotic and embolic stroke.

Know how to manage blood pressure during an acute stroke.

Be able to recognize the common locations and clinical signs of hypertensive intracerebral hemorrhage.

Be able to recognize the clinical presentation, etiology, complications and treatment options of spontaneous subarachnoid hemorrhage.

Know the common locations of saccular aneurysms.

Be able to recognize common lacunar stroke syndromes.

Be able to recognize spontaneous carotid and vertebral artery dissection.

Appreciate the causes of ischemic stroke in the younger patient.

Appreciate the general indication and value of thrombolysis in an acute ischemic stroke.

Know the treatment options designed to prevent stroke in patients with atrial fibrillation.

Know the treatment options designed to prevent stroke in patients with hemodynamically significant carotid stenosis.

Know about the concept of Brain Attack and strategies in the management of acute ischemic stroke.

     Consciousness and Mental State

Know the anatomic structures necessary to maintain consciousness.

Outline the initial steps in the evaluation of a comatose patient.

Know how to perform the neurologic examination on a comatose patient.

Know the differential diagnosis of coma, and know to differentiate structural from metabolic causes.

Be able to recognize transtentorial and foramen magnum herniation syndromes.

Be aware of conversion reactions and appreciate how historical and physical findings may be helpful in suggesting the diagnosis.

Know the difference between delirium and dementia.

Know the differential diagnosis of dementia, especially the reversible causes of dementia.

Know the meanings of aphasia, apraxia and agnosia.

Recognize the clinical presentation of Alzheimer's dementia.

Know the difference between aphasia and dysarthria.

Know the clinical findings and anatomy of Broca's, Wernicke's and conduction aphasia.

     Headache

Be able to recognize classic and common migraine, and tension headaches.

Be able to recognize the headache of subarachnoid hemorrhage.

Be able to recognize the CSF profiles of subarachnoid hemorrhage and meningitis.

Know how to recognize, diagnose and treat temporal arteritis.

Be able to recognize the clinical features that distinguish between benign versus potentially serious underlying causes of headaches.

Be able to recognize the clinical syndrome of trigeminal neuralgia, its evaluation and initial treatment.

     Epilepsy

Know the International Classification System used for classification of common forms of seizures.

Be able to distinguish the ictal and post-ictal patterns of generalized tonic/clonic, partial simple, partial complex, and partial with secondary generalization seizures.

Be able to differentiate between seizure and syncope.

Know the general approach to the evaluation and treatment of status epilepticus.

Know the common causes of seizures as related to age group.

Be able to characterize alcoholic withdrawal seizures.

Appreciate the various types of behavior and movements that occur during complex partial seizures.

Appreciate the concept of a post-ictal (i.e., Todd's) paralysis and similar deficits.

Appreciate the significance of focal onset vs. generalized onset seizures.

Know the routine evaluation of new onset of seizures.

     Motor System

Recognize the clinical signs of an upper motor neuron lesion.

Recognize the clinical signs of a lower motor neuron lesion.

Recognize the different types of increased tone, including spasticity, rigidity and paratonia.

Recognize the clinical signs and symptoms of common spinal cord syndromes.

Be able to recognize the clinical appearance of Parkinson's disease.

Be able to recognize the clinical signs of disease in the cerebellar vermis and in the cerebellar hemispheres.

Be able to recognize the clinical syndrome of alcoholic cerebellar degeneration.

     Peripheral Nerve and Muscle

Recognize the clinical signs, symptoms, evaluation and treatment of myasthenia gravis.

Recognize the clinical signs, symptoms, evaluation and treatment of Guillain Barré syndrome.

Recognize the clinical signs and symptoms of a generalized peripheral neuropathy.

Understand the significance and differential diagnosis of mononeuritis multiplex.

Recognize the clinical signs, symptoms, evaluation and treatment of polymyositis and dermatomyosits.

Recognize the clinical symptoms and signs resulting from common cervical and lumbosacral radiculopathies.

     Vision, Hearing and Balance

Understand the neuroanatomy of vision.

Be able to recognize the common visual field abnormalities and their significance.

Understand the neuroanatomy of the pupillary light reflex.

Know the neurologic syndrome, including abnormalities of eye movements, associated with thiamine deficiency.

Know the clinical signs associated with a lesion of the cerebellopontine angle.

Be able to differentiate between the different types of dizziness, including vertigo, presyncope and disequilibrium.

Understand the difference between peripheral and central vertigo.

Be able to recognize the syndrome of benign paroxysmal postural vertigo.

Describe the common signs and symptoms of multiple sclerosis, its pathogenesis and treatment.

Be able to recognize papilledema and know its significance.

Be able to recognize the common disorders that result in anisocoria, especially a third nerve palsy and Horner's syndrome.

     Pediatric Neurology

Overview of Pediatric Neurology Learning Objectives

Know the basics of how to perform a neurologic examination of an infant and child.

Be able to differentiate between a static encephalopathy (cerebral palsy) from progressive cognitive decline.

Know the clinical features and differential diagnosis of attention deficit hyperactivity disorder.

Be aware of the differential diagnosis of a floppy infant.

Recognize some of common causes of ataxia in children.

NEUROSURGERY

     Hydrocephalus

Understand the CSF circulation

Know the definition of hydrocephalus

Distinguish between communicating and non-communicating hydrocephalus

Estimate the incidence of uncomplicated hydrocephalus

Describe non-surgical treatments of hydrocephalus

Discuss techniques for ventricular shunting and associated complications

Explain alternative surgical treatments, specifically endoscopic third ventriculostomy

     Brain Tumors

Describe the clinical presentation of brain tumors

Recognize the WHO grading scheme for gliomas

Recognize the common brain tumors in adults

Recognize the common brain tumors in children

Contrast the indications for biopsy, surgical resection, radiation and chemotherapy for brain tumors

     Spine and Peripheral Nerve

          Surgery

Differentiate lesions of the conus medullaris from the cauda equina

Discuss the indications and surgical work-up for surgery for disorders of the spinal cord, spinal roots, and peripheral nerves

Identify the major mixed nerves

Locate the major entrapment sites

Relate the major causes of acute peripheral nerve injury

     CNS Trauma

Discuss the epidemiology of brain trauma

Know how to determine the Glasgow Coma Scale

Distinguish among mild, moderate and severe brain injury

Contrast cerebral concussion from cerebral contusion

Describe the presentations of traumatic epidural hematoma vs. traumatic subdural hematoma

Relate the prognosis of gunshot wounds of the brain

Distinguish between primary and secondary insults in the pathophysiology of traumatic brain injury

Discuss the importance of the Monro-Kellie Doctrine

Know the importance of intracranial pressure (ICP) monitoring, and when it is indicated

Describe the calculation of the cerebral perfusion pressure

Distinguish first tier and second tier strategies for treating elevated ICP

Recognize the different types of shock, including spinal shock and brain shock