Universitat Internacional de Catalunya
Neurology
Teaching staff
Teachers responsible for the subject area:
· Dr. Dolores Cocho lolacocho@gmail.com
Medical faculty Associates: PAM
Dr. Jordi Ciurans
Dr Jordi Espinosa
Dra Claustre Pont
Clinical university tutors
· Dr. Jordi Pons Brugada
· Dr. Anuncia Boltes
Professor Lecturer :
· Dra. Analia Elguezabal
· Dr. Paloma Puyaltó
Dr Fernando Muñoz
Introduction
According to the National Commission of the specialty, Neurology is the medical specialty which studies the structure, function and development of the Central nervous system and peripheral, in normal and pathological condition, using all the study, diagnosis and treatment techniques currently in use, or that can be developed in the future.
The Neurology, deals with comprehensive medical care of neurological patient, teaching the areas affecting the nervous system, and both basic research and clinical applications within the field of neuroscience. The medical student must acquire knowledge and special techniques that allow you to carry out assistance and research in Neurology
Pre-course requirements
The student must have basic knowledge on structure and function of the nervous system to understand the pathological situations and therefore, it is required to approve the syllabus of "Structure and function of the nervous system" in the first course.
Objectives
The overall objective of this syllabus is to understand the neurological disease and therefore, the physiopathological mechanisms that occurring in various diseases involving the nervous system, without neglecting a global and systematic vision of the neurological patient.
Specific objectives
• Acquire a global and integrated vision of the mechanisms that alter the normal functioning of the different structures that make up the nervous system.
• Know the physiopathological basis of primary and secondary disorders of the nervous system.
• Train the student in obtaining the medical history, the completion of a full general and neurological examination, and the use and interpretation of diagnostic methodology.
• Identify and interpret the main clinical manifestations indicative of neurological disease, signs, and the complementary tests used to study and differentiate the various diseases that affect the nervous system, whether they are primary or secondary.
• Knowing to make the differential diagnosis of the morbid processes that affect the nervous system.
• Knowledge of different therapies in the treatment and/or prevention of disorders of the nervous system.
Competences/Learning outcomes of the degree programme
- 05 - Recognize own limitations and the need to maintain and upgrade professional skills, with particular emphasis on autonomous learning of new knowledge and skills and motivation for quality.
- 08 - Recognize the basis of normal human behavior and its disorders.
- 09 - Understand and recognize the effects, mechanisms and manifestations of disease on the structure and function of the human body.
- 10 - To understand and recognise the agents and risk factors which determine health status, and learn how they determine the symptoms and natural development of acute or chronic diseases in individuals and populations.
- 11 - Understand and recognize the effects of growth, development and aging on the individual and their social environment.
- 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
- 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
- 16 - Recognize and deal with situations that put life in immediate danger and those that require immediate attention.
- 17 - Establish the diagnosis, prognosis and treatment, applying principles based on the best information possible and safe clinical practice..
- 18 - To indicate the most appropriate (pharmacological, surgical, psychological, social or other) treatments that are pertinent to the most prevalent procedures, in terms of rehabilitation and also terminally ill patients, including an evaluation of their effectiveness.
- 19 - Propose preventive measures appropriate to each clinical situation.
- 25 - Recognize the determinants of public health; genetic and sex-dependent lifestyle, demographic, environmental, social, economic, psychological and cultural determinants.
- 26 - Assume role in the prevention and protection from diseases, injuries or accidents and maintenance and promotion of health, both individual and at the community level.
- 31 - Understand, critically evaluate and know how to use sources of clinical and biomedical information to obtain, organize, interpret and communicate scientific and health care information.
Learning outcomes of the subject
•Recognize the pathophysiological mechanisms and clinical manifestations of neurological diseases .
• Identify the different neurological syndromes and correlate with topographical injury.
• Assess the differential diagnosis
• Ask a correctly argued differential diagnosis
• Understand the evolution and prognosis of neurological diseases .
• Know the different neurosurgical techniques
• Identify key warning signs in different neurological diseases
• Knowing the diagnosis and treatment of neurological emergencies .
• Basic interpretation of neuroradiological studies.
• Recognition of the indications of the various tests in Neurology
Syllabus
Master classes (MC)
Theme 1 (Dr. Cocho)
Ischemic cerebrovascular disease. Nomenclature. Epidemiology. Physiopathology of ischemic vascular disease. Semiology of ischemic vascular disease. Pathogenesis of cerebral infarction. Diagnosis of cerebral infarction. Treatment of cerebral infarction
Theme 2 (Dr. Cocho)
Hemorrhagic cerebral disease: parenchymal hemorrhage, epidural, subdural, subarachnoid, Physiopathology, clinical, diagnosis and treatment. Cerebral Vascular malformation. Cerebral venous thrombosis. Neurosurgical vascular pathology
Theme 3 (Dr Cocho)
Brain tumors and Paraneoplastic syndromes. Neurocutaneous syndromes. Classification, description and clinical manifestations of primary brain tumors. Classification, description and clinical manifestations of metastatic brain tumors. Paraneoplastic syndromes: concept, pathogenesis, diagnosis of the primary tumor, clinical subtypes. Neurocutaneos syndromes: tuberous sclerosis, neurofibromatosis, other syndromes.
Theme 4 (Dr. Ciurans)
Epilepsy and epileptic syndromes: concept, epidemiology, physiopathology and classification. Clinical manifestations: seizures, epileptic syndromes, status epilepticus. Etiology. Evaluation and diagnosis of epileptic patients. Epilepsy treatment: therapeutic decision. Types of antiepileptic drugs. Treatment according to type of epilepsy. Treatment of the status. Epilepsy Surgery. Prognosis and basic tips for the epileptic patient
Theme 5 (Dr. Piles)
Demyelinating diseases of central nervous system. Multiple sclerosis: epidemiology. Etiology and pathogenesis, clinical, prognosis, diagnosis and treatment. Other demyelinating disease of central nervous system: acute Sclerosing encephalomyelitis, acute disseminated encephalomyelitis, Devic neuromyelitis, diffuse cerebral sclerosis.
Theme 6 (Dra. Cocho)
Primary headaches. Classification, epidemiology, physiopathology, genetics, manifestations and clinical subtypes, complications, differential diagnosis and treatment. Craniofacial neuralgias.
Theme 7 (Dr Cocho)
Diseases of the spinal cord. Anatomical review, medullary syndromes: hemisction spinal cord syndrome, complete medullar section syndrome, anterior syndrome, post cordonal syndrome, tabet syndrome, syringomyelic syndrome, cone terminal syndrome, cauda equine syndrome. Diagnosis and treatment of the myelopathy due to extrinsic or intrinsic cause, localized or multifocal: Syringomyelia, intramedullary tumors, spinal cord vascular disease, acute transverse myelitis, polio, subacute combined degeneration due to deficiency of B12, tabes dorsalis.
Tema 8 (Dr Ciurans)
Hydrocephalus and other disorders of the circulation licuoral. Congenital malformations of the central nervous system. Physiology of spinal fluid. Intracranial hypertension. Hypertensive hydrocephalus syndrome:physiology, clinical syndromes (congenital hydrocephalus, benign intracranial hypertension, or normal pressure hydrocephalus), treatment. Licuoral hypotension: mechanism and treatment . Microcephaly and craniostenosi. Defect of the closing of the neural arch. Spinal malformations: spina bifida, meningocele and myelomeningocele.
Theme 9 (Dr. Pont)
Primary degenerative dementia. Concept and classification: Alzheimer's disease, Lewy body dementia, fronto-temporal degeneration, focal onset dementia. Diagnosis of primary dementia. Pharmacological treatment. Non-pharmacological treatments.
Theme 10 (Dr. Pont)
No degenerative cognitive disorders: vascular, infectious, by dynamic alteration of the cerebrospinal fluid, due to nutritional, or metabolic disorders of toxic origin. Prion diseases. Alcohol and central nervous system
Theme 11 (Dr. Pont)
Movement disorders. Parkinsonisms. Basal ganglia functional organization. Classification. Parkinsonisms. Parkinson's disease: epidemiology, pathogenesis and genetics, diagnostic techniques, clinical manifestations, treatment. Other parkinsonisms: cortico-basal syndrome, progressive supranuclear palsy, multiple system atrophy, not degenerative parkinsonism.
Tema 12 (Dr Pont)
Movement disorders, hyperkinetic disorders: Korea: Huntington's disease. Dystonia. Seizures. Myoclonus. ICT: Gilles de la Tourette disease. Stereotypies. Paroxysmal Entacapone. Late syndromes. Tremor.
Theme 13 (Dr Pont)
Hereditary ataxias. Diseases by deposit. Inherited metabolic diseases. Spinocerebellar degeneration: cerebellar ataxias: inheritance and clinical subtypes. Wilson's disease and other disorders by deposit. Accumulation Lysosomal diseases. Adrenoleukodystrophy. Amino acid disease. Mitochondrial diseases.
Theme 14 (Dr. Piles)
Diseases of the peripheral nerves. Classification. Mononeuropathy. Cranial Neuropathies. Polyneuropathies. Multiple neuropathy. Radiculopathy. Plexopathy.
Theme 15 (Dr. Piles)
Myopathies. Acquired myopathies: inflammatory, induced by drugs, endocrine, neglect, infectious, of the critical patient, sarcoidosis. Muscular Dystrophies. Myotonic myopathies. Distal myopathies. Myofibrillar myopathies. Myopathies and Dystrophies congenital. Periodic paralysis. fibrodysplasia ossificans progressiva disease. Acquired neuromyotonia
Theme 16 (Dr Alameda)
Neuropathology: Anatomic Pathology of demyelinating , neurodegenerative diseases and myopathies
Methods of the case (MC)
01 Diagnostic methods in Neurology (Dra Cocho). Neurological examination. Lumbar puncture and cerebrospinal fluid study. Neuroradiological study. Neurophysiological techniques. Extra and Transcranial Doppler. Functional neuroimaging techniques.
02. Neurosurgery
Neurosurgical basic techniques : PIC sensor, trepanation , ventricular drainage, craniotomy and laminectomy.
• tumor surgery: skull base endoscopy , brain mapping.
• Vascular Surgery : aneurysms and arteriovenous malformations
• Surgery of Chiari malformation
• Surgery of cerebrospinal fluid; hydrocephalus and ventricular peritoneal valve
• Functional neurosurgery : epilepsy , movement disorders , pain and psychosurgery
• Spinal Surgery.
03 Primary and Secondary headache (Dr. Cocho) Secondary headaches: headache by trauma, headache by vascular disorder, headache by intracranial disorder, headache due to consumption of substance or deprivation, infection headache, headache by alteration in homeostasis, headache by alteration of facial skull structures. Craniofacial pain.
04 Phathology of the cranial nerves. (Dr. Cocho). Oculomotor syndromes. Facial paralysis. Jugular foramen syndrome. Dizziness and pathology of VIII cranial nerve. Cavernous sinus syndrome.
05. Head trauma and acquire encephalopathy (Dr. Ciurans)
Classification of secondary injuries due a head trauma. Management of the head trauma: related complications. Cerebral herniation: subtypes, clinical and treatment. Acquire encephalopathy: clinical subtype. Deficiency pathology. Avitaminosis. Endocrinological disorders. Iatrogenesis by radiation
06 Disorders of consciousness and sleep (Dr Ciurans)
Anatomy of consciousness and awakening. Exploration of consciousness. Disorders of consciousness: subtypes. Coma. Insomnia, Hypersomnia and parasomnias. Respiratory sleep disorders. Disturbances of the circadian rhythm of sleep. Abnormal movements associated with sleep, isolated symptoms, and other disorders.
07 Motor neuron diseases and neuromuscular junction (Dr. Piles). Motor neuron disease: amyotrophic lateral sclerosis; spinal atrophy. Pathology of neuromuscular junction: myasthenia gravis; Eaton Lambert syndrome; Botulism; congenital myasthenic syndromes.
Laboratory skills
01 Neuroradiology (Dr. Puyaltó)
Title: Imaging techniques in the study of the pathology of neurological and neurosurgical.
Content: The main techniques of image review: simple radiology, computed tomography, magnetic resonance, conventional angiography and nuclear medicine scans.
Objetives: at the end of the lab the student should be able to identify the major radiological technical of the central nervous system, know the indications and limitations.
02 Neuroradiology (Dr. Puyaltó)
Title: Algorithm of reading radiological scans that study the SNC.
Content: Semiology of the lesions intra and extraaxiales and their location in the different spaces (subdural, epidural, subarachnoid and intraventricular). Evaluation of the radiological characteristics of occupying lesions of space in different techniques - therapeutic in neuro-Radiology.
Objectives: at the end of the lab the student must be able to perform a systematic interpretation of the findings found in tests of image according to the procurement guidelines of basic radiological semiology, once all the pathology has been studied during the course.
Learning based on problems (LBP)
01 (LBP Clinical-radiologic) (Dr Cocho)
02 LBP Neuromuscular clinical cases. (Dr. Piles)
Research Project
Literature review on a neurological diseases proposed by the tutors of the course. The work will be optional and will serve up note on all those students with final grade for the course of 5 or higher.
Teaching and learning activities
In person
The master class is the scenario in which a teacher transmits knowledge in a virtual classroom to the entire group of students. The format allows the introduction of activities within the virual classroom and the deployment of strategies that promote the active participation of the students.
The case method is the process of resolving cases clinical or inherent to the profession. They are group activities that are resolved with the active participation of the teacher after the deliberation of the students.
Problem-based learning has similarities with the case method but differs in that is responsible for students searching for the solution to the problem. The teacher serves as tutor which facilitates the process of learning. It is also performed in groups.
Laboratory practice is done with groups of 20 to 40 students according to the practice and consists of practical observation of individual cases sent to student/group of students beforehand, as well as the discussion on set of findings and issues raised by each of the students in relation to the proposed cases.
The research project is carried by the student, as an introduction in the search, and review of the literature. It will at the end of the course and will have an optional character. The project will be evaluated by the responsible teachers, and will have potential value on the final grade for the course.
-Will be to carry out a summary of the literature review of a topic proposed by the tutors, with a maximum of two pages. Especially the final conclusions obtained by the student will be valued. it shall deliver before the 15th of May at 21:00 h.
Evaluation systems and criteria
In person
Theoretical exam: 75% of the global note.
Partial examination. Represents 15% of the note. The note will count for the final examination of first and second examination.
Final examination (first and second examination). Represents 60% of the global note. Where a student is presented to the second examination, the final note will be calculate with the one obtained in the second examination.
For average, will be essential to pass the final exam (for any examination) with a note equal or higher than 4. Students with less than 4 notes in the test, may not average and therefore will have no option to pass the course.
Examinations ( partial ,final and competency test) with multiple choice section, where the wrong answers deducted 1/3 of the value of the response.
Competency test: it will be an examination with clinical cases and radiological studies, and they will represent 25% of the final grade
Final note:To pass the subject of Neurology the final average grade must be 5 or higher.
On the second examination
- It is possible to save the note of the competency test of the first examination and only to perform the final exam if you wish.
- If you want to improve the grade in any of these sections (competency or final test) of the first convocatory, you must notify the responsible teacher in advance.
Research at the end of the course project: optional . Delivery deadline May 15 at 21:00 p.m.
It will serve to raise grade (maximum 1 point) in the case of having obtained a final grade equal to or greater than 5. Therefore, it will not serve to pass the course.
The work will fundamentally assess the quality of the bibliographic review, and the student's conclusions opening new lines of future research.
In the case of students who repeat the subject, the note of the research work, will be saved if so desired.
Bibliography and resources
- Pascual Gómez, Julio. TRATADO DE NEUROLOGÍA CLÍNICA. 1ª Ed. Ars Médica 2009. ISBN: 9788497513951
Other recommended texts:
- Zarranz, J.J. NEUROLOGIA. 4ª ed .ELSEVIER 2007. ISBN: 978-84-8086-228-8
- Ropper, A. ADAMS & VICTOR'S PRINCIPLES OF NEUROLOGY. Edición: 9/2009. ISBN: 9780071499927
- Seth Love, David N Louis, David W Ellison. GREENFIELD'S NEUROPATHOLOGY. 8th Edition (2 Volume Set & CD-ROM)
- Gaensler, Erik H.L. NEURORRADIOLOGÍA FUNDAMENTAL. 1ª ed. Marban Libros. ISBN: 9788471012487
- Harrison's. Principles of Internal Medicine, 17th ed. Mc Grau-Hill. ISBN: 978-0-07-159990-0