To Neurology: Rini Andriani

INTRODUCTION
TO NEUROLOGY
RINI ANDRIANI
DEFINITION
• Neurology is the branch of medicine
concerned with the study and treatment of
disorders of the nervous system.
• The nervous system is a complex,
sophisticated system that regulates and
coordinates body activities.
• It has two major divisions
Two Major Divisions
Central nervous system: Peripheral nervous system:

the brain and spinal cord all other neural elements:
eyes, ears, skin,
and other "sensory receptors"
Upper Motor Neuron
Lower Motor Neuron

The upper motor neuron (UMN)
• the motor system that is confined to the central
nervous system (CNS) and is responsible for the
initiation of voluntary movement, the
maintenance of muscle tone for support of the
body against gravity, and the regulation of
posture to provide a stable background upon
which to initiate voluntary activity.
• Divided into pyramidal and extrapyramidal
components
Upper Motor Neuron Diseases
• Stroke • Metastases
• Headache • Cerebellar Diseases
• Epilepsy • Myelopathies
• Parkinson Disease • Malformations and
• Multiple Sclerosis Developmental
• CNS Infections Anomalies
• Brain Tumors • Neurodegenerative
Diseases
• Trauma
• Encephalopathies
Lower Motor Neuron (LMN)
• The efferent neuron of the peripheral nervous
system (PNS) that connects the central
nervous system (CNS) with the muscle to be
innervated.
• The entire function of the CNS is manifested
through the LMN.
• The LMN includes two components: the
general somatic efferent system (GSE) and
general visceral efferent system (GVE)
Lower Motor Neuron Diseases
Stroke
• A stroke is an acute focal or global impairment
of brain function resulting from a pathological
process (e. g. thrombus, embolus, vessel
rupture) of the blood vessels
• Ischemia (80%)
• Hemorrhage (spontaneous intracerebral or
intraventricular hemorrhage (15%), and
subarachnoid hemorrhage (5 %))
Brain Vascularisation
Seizure
Epilepsy
Partial (Focal) Seizures
Epilepsy
Generalized Seizures
Headache
CNS Infections
• CNS infection may involve the leptomeninges and
CSF spaces (meningitis), the ventricular system
(ventriculitis), the gray and white matter of the brain
(encephalitis), or the spinal cord (myelitis).
• The clinical manifestations may be acute (purulent
meningitis, herpes simplex encephalitis),
• subacute (cerebral abscess, focal encephalitis,
tuberculous meningitis)
• chronic (tuberculous meningitis, neurosyphilis,
Whipple encephalitis, Creutzfeldt–Jakob disease)
Brain Tumors
• The clinical manifestations of a brain tumor may
range from a virtually asymptomatic state to a
constellation of symptoms and signs that is
specific for a particular type and location of
lesion.
• The only way to rule out a brain tumor for certain
is by neuroimaging (CT or MRI).
• Behavioral changes, headache, nausea, vertigo,
and malaise, epileptic seizures, focal neurological
signs, Intracranial hypertension (elevated ICP)
Brain tumor segmentation and classification from magnetic resonance images: Review of selected methods from 2014 to 2019
ArtiTiwari, ShilpaSrivastava, MilliePant
Traumatic Brain Injury (TBI)
• Primary Injury : affects different parts of the
skull and brain depending on the precipitating
event. The traumatic lesion may be focal
(hematoma, contusion, infarct, localized
edema) or diffuse (hypoxic injury, subarach-
noid hemorrhage, generalized edema).
• Secondary Injury and late sequelae
Lower Motor Neuron Diseases
MUSCLE DISEASES
PERIPHERAL (MYOPATHIES)
NEUROPATHY Inflammatory Myopathies
MOTOR NEURON Bell’s Palsy (PM, DM, IBM)
DISEASES Carpal Tunnel Congenital Myopathies
Amyotrophic Syndrome Muscular Dystrophies
Lateral Sclerosis Peroneal Nerve DISORDERS OF Metabolic Myopathies
Palsy NEUROMUSCULAR
Diabetic JUNCTION
Neuropathies Myasthenia Gravis
CIDP Lambert-Eaton Myasthenic Syndrome
AIDP
Hereditary
Neuropathies
Carpal Tunnel Syndrome
• Paresthesia and pain in the hand and arm
• Worse at night and relieved by rubbing or
shaking the hand
• In the chronic stage, weakness and atrophy
of the thenar muscles may be seen.
•The leading risk factors are female gender
and obesity, follow by occupation
(workplace), and endocrine diseases such as
diabetes, pregnancy, fibromyalgia, and
dialysis
AIDP (GBS)
Anatomic location and pathophysiology

Fauci AS, DL Kasper, DL longo, et al. Harrison’s principles of internal medicine 19th Ed. New York: McGraw-Hill,
2012
Myasthenia Gravis
Myasthenia Gravis
• Myasthenia gravis (MG) is the most well-known
autoimmune disease in humans.
• The onset is often acute or subacute and may be triggered
by stress, infection, surgery, pregnancy, drugs, and other
unknown environmental factors.
• The disease has two peak onsets: age 20–30 in women and
50–60 in men.
• The clinical hallmarks of MG are fluctuating muscle
weakness and fatigue.
• The most typical presentation is weakness in distribution of
ocular (ptosis, diplopia) and bulbar muscles (dysphasia,
dysphonia, and dysarthria). The limb muscles are less
affected. Onset of MG with proximal limb and respiratory
muscle weakness is less common.
Diagnostic Tests for Patients
With Lower Neuron Disease
Blood work: •Electrophysiological •Imaging:
Blood cell count, tests: •Chest X-rays,
Chemistry profile, •Nerve conduction •Chest computed tomography (CT)
Serum creatine kinase studies (NCS), scan
(CK), •Needle •Positron emission tomography
Sedimentation rate, electromyogram scan,
Thyroid function tests, (EMG), •Magnetic resonance spectroscopy,
Serum •Repetitive nerve •Magnetic resonance imaging
autoantibodies, stimulation, [MRI]
DNA analysis •Single-fiber EMG
(SFEMG).
•Spinal tap in selected cases. •Muscle, nerve, or skin biopsy in selected cases.
The history is usually the single most
important tool in obtaining a diagnosis
Basic Information:
• Age: Some conditions are more common at certain
ages; for instance, forgetfulness is more likely to be
caused by dementia in an elderly patient than in a
teenager.
• Gender: Some disorders are more common in men
such as cluster headaches. In contrast, women more
commonly have migraine headaches.
• Ethnicity: Some disease are more common in certain
ethnic groups (such as type 2 in Hispanic pts)
Four main parts in taking history
1.The chief complaint and history of present
illness.
2. The past medical history.
3. The family history.
4. The social history
The discipline of neurology illustrates the importance of
understandinghow to correlate the neuroanatomical
defect to the clinical manifestation
• Chief complaint: What is it that brought the

patient into the hospital? Has there been a
change in a chronic or recurring condition or is
this a completely new problem?
• History of present illness
• Associated symptoms
Chief complaint, history of present
illness and associated symptoms
• Time of onset.
• Mode of onset, acute or gradual.
• Character and severity.
• Location, extension, and radiation.
• Precipitating or exacerbating factors
• Course: Progression or remission
Seizure Disorders
• Description of the mode of onset of the generalized
seizure and a careful description of the partial
seizure.
• The patient should be questioned closely & required
to define terms with as much care as possible
• Too often the patient uses vague and generalized
terms, such as dizziness, forgetful spells, little spells,
etc.
• Warning symptoms and precipitating factors should
clearly be emphasized.
Special History: Headache or
Seizure Disorders
• Severity of pain.
• Temporal onset.
• Duration.
• Location.
• Quality.
• Associated symptoms, including physical changes.
• Presence of any warning minutes or hours before
• Factors relieving or aggravating the pain
Past medical history
• This assumes particular importance in the
setting in the list of disorders that can play a
• role as risk factors for neurological problems.
• Such as diabetes, hypertension, heart disease,
polio as a child, or alcohol/drug abuse.
Family History & Social History
• Questions regarding other family members
and relatives are particularly pertinent in the
context of seizure disorders, headache,
movement disorders, and muscle disease
• Social history is important in the context of
alcohol and drug abuse and its complications,
smoking, and other such factors

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INTRODUCTION

Central nervous system: Peripheral nervous system:

Lower Motor Neuron

Anatomic location and pathophysiology

• Chief complaint: What is it that brought the

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