CWRU School of Medicine
Third Year Core Clerkship in Neuroscience

Learning Objectives

Cerebrovascular Disease  |   Disturbances of Consciousness and Mental Status  |   Headache  |  Epilepsy  
Motor System  |  Neuropathy and Myopathy  |  Disorders of Vision, Hearing and Balance  |  Pediatric Neurology
 

Neurology Teaching Sessions:

Cerebrovascular Disease

	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 of subarachnoid hemorrhage.
	Know the common etiologies of spontaneous subarachnoid hemorrhage.
	Know the common locations of saccular aneurysms.
	Know the common complications following subarachnoid hemorrhage.
	Be able to recognize common lacunar stroke syndromes.
	Be able to recognize the signs of arterial dissection.
	Appreciate the differential diagnosis of 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 infarction in patients with atrial fibrillation and hemodynamically significant carotid stenosis.

Disturbances of Consciousness and Mental Status

	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.
	Be able to differentiate structural from metabolic causes of coma.
	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.
	Recognize the clinical presentation of Alzheimer's dementia.
	Know the difference between aphasia, apraxia and agnosia.
	Know the difference between dysarthria and aphasia.
	Know the clinical findings and anatomy of Broca's, Wernicke's and conduction aphasia.

Headache

	Be able to recognize classic migraine, common migraine, cluster 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 among generalized convulsive, generalized non-convulsive, partial complex, partial simple and partial seizures with secondary generalization.
	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.
	Be able to differentiate between an ictal and post-ictal state.
	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.
	Be able to differentiate between chorea, athetosis, hemiballismus, dystonia and tics.
	Know the significance of frontal release signs on physical examination.
	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.
	Be able to recognize the common clinical signs of spinal cord disease, including the classic lesions of cord transection, hemisection (Brown-Sequard), anterior spinal artery infarction, subacute combined systems degeneration (Vitamin B12 deficiency), tabes dorsalis and a central cord syndrome (syrinx).

Neuropathy and Myopathy

	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.
	Recognize the common clinical signs and symptoms resulting from radiculopathies at the C5-6, C7, C8, L3-4, L5 and S1 levels.
	Recognize the pattern of a dystrophinopathy.
	Know the major categories of muscular dystrophies.

Disorders of Vision, Hearing and Balance 

	Understand the neuroanatomy of vision.
	Be able to recognize the common visual field abnormalities and their significance.
	Know that neurologic syndrome, including abnormalities of eye movements, associated with thiamine deficiency.
	Know the clinical signs associated with a lesion of the cerebellar-pontine angle.
	Know the difference between presyncope, vertigo and disequilibrium.
	Understand the difference between peripheral and central vertigo.
	Be able to recognize the syndrome of benign postural vertigo.
	Understand the neuroanatomy of the pupillary light reflex.
	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

	Be able to differentiate between a static encephalopathy (cerebral palsy) from progressive cognitive decline.
	Know the clinical features and differential diagnosis of attention deficit disorder.
	Be aware of the differential diagnosis of a floppy infant.
	Recognize some of the major types of movement disorders in children.
	Know the general differential diagnosis of ataxia in children.
	Know the common neurologic complications of prematurity, including intraventricular hemorrhage.

Revised 12/14/01.
Copyright 2001 Case Western Reserve University School of Medicine.