1. Clinical Anatomy of the Nervous System Prof. Abdelmoniem Sahal

2. Issues  Introduction  Background knowledge  Imaging Anatomy  Interviewing  Physical examination

3. Introduction  Relating structure to applications is called Correlational Anatomy  Includes developmental anatomy, functional anatomy, imaging anatomy, surgical anatomy & clinical anatomy  This correlation can be exercised through seminars (topic-based & case- based), and practical (clinical) sessions

4. Issues  Introduction  Background knowledge  Imaging Anatomy  Interviewing  Physical examination

5. Background knowledge  Knowledge of the basic neuroanatomy and physiology is the cornerstone of neurologic diagnosis  The knowledge is used to understand the pathoanatomy & pathophysiology of the features of clinical problems  Most important aspects are developmental anomalies, functional anatomy of the various areas of the nervous system  Details of the blood supply are most important

6. Issues  Introduction  Background knowledge  Imaging Anatomy  Interviewing  Physical examination

7. Imaging anatomy  The various imaging modalities used to investigate the nervous system  How normal structures appear in these images  How do abnormalities appear in these images and how are they interpreted  Usually for confirmation & to investigate the extent of the lesion  Include plain & contrast radiography, CT, PET & MRI

8. Issues  Introduction  Background knowledge  Imaging Anatomy  Interviewing  Physical examination

9. Interviewing  Part of the consultation framework  Has two purposes  The establishment & building of rapport  Information gathering  Has agreed upon content & techniques  Practitioners need to acquire certain communication skill to apply the techniques  Include interpersonal skills & language skills (e.g. active listening)

10. Clinical Encounters  Primary health care facilities  Hospitals  Casualty (A & E – ER)  Outpatient clinics  Wards  Private clinics

11. The first encounter  In the health centre  In the A & E  in the outpatient clinic  In the ward  In the private clinic

12. The clinical workup  History taking (interviewing)  Physical examination  Investigations  Management  Diagnosis  Intervention (therapeutic & non-therapeutic)

13. Important Concepts  The patient-doctor relationship  The patient-centered approach  The illness-centered approach

14. The Patient-centred/illness-centred Focuses on:  Their ideas about what is wrong with them  Their feelings, especially fears about being ill  The impact of their problems on functioning  Their expectations about what should be done

15. About the Encounters  The content (what you should do)  The process (how to do)  The rationale (why)  The skills & the protocols

16. The framework  Initiating the session  Gathering Information  Physical examination  Explanation & planning  Closing the session

17. The framework  Providing structure  Building the relationship

23. The Communication Skills

25. Issues  Introduction  Background knowledge  Imaging Anatomy  Interviewing  Physical examination

26. The balance Neurological examination by the internist 1 General examination by the neurologist 2

27. Neurological Examination  Mental status  Sensory examination  Motor examination  Examination of the cranial nerves