Department of Neurology

Neurology Clerkship
4th Year Student

Goals and Objectives of the Clinical Neurology Clerkship

Goals: To learn the principles and skills underlying the recognition and management of neurologic diseases that a general practitioner is most likely to encounter in practice, with special emphasis on the neurologic emergencies.

Objectives:

To learn the following procedural skills: the ability to obtain a complete and reliable history:

the ability to perform a complete and reliable neurologic examination
the ability to deliver a clear, concise, and thorough oral presentation of a patient’s history and examination
the ability to prepare a clear, concise and thorough written presentation of a patient’s history and examination (Ideally) the ability to perform a lumbar puncture

To learn the following analytical skills:

the ability to recognize symptoms that may signify neurologic disease, including disturbances of consciousness, cognition, language, vision, hearing, equilibrium, motor function, somatic sensation, and autonomic function
the ability to localize the likely site or sites in the nervous system where a lesion could produce a patient’s symptoms and signs
the ability to formulate a differential diagnosis based on lesion localization, time course, and relevant historical and demographic features
an awareness of how to use and interpret common tests used in diagnosing neurologic disease
an awareness of the principles underlying a systematic approach to the management of common neurologic diseases, including the recognition and management of situations that are potential emergencies.

Content of subjects to be taught:

The neurologic examination (as an integral component of the general medical examination):

how to perform a complete neurologic examination
how to perform a screening neurologic examination
how to recognize and interpret abnormal findings on the neurologic examination

Localization – general principles differentiating lesions at the following levels:

cerebral hemisphere
posterior fossa
spinal cord
nerve root/plexus
peripheral nerve (mononeuropathy, polyneuropathy, and mononeuropathy multiplex)
neuromuscular junction
muscle

Disease Management – general principles governing (urgent and non-urgent) evaluation and management of:

acute mental status changes
strokes
seizures
chronic mental status changes
headaches and facial pain
low back pain
peripheral neuropathies (especially subacute toxic and metabolic neuropathies and Guillain-Barre syndrome)
cranial neuropathies (notably Bell’s palsy, third nerve palsy)
common movement disorders (notably Parkinson disease, essential tremor, tardive dyskinesia)
meningitis and encephalitis
multiple sclerosis
myasthenia gravis
polymyositis
primary and metastatic CNS tumors
sleep disorders (notably obstructive sleep apnea, narcolepsy)
developmental delay and developmental regression

Identify the following normal anatomy on a CT or MR scan:

frontal, parietal, temporal and occipital lobes
sylvian fissure
caudate and putamen
globus pallidus
substantia nigra
thalamus
pituitary gland
cerebellum and cerebellar peduncles
midbrain, pons and medulla
corpus callosum
spinal cord
intervertebral disc and nerve root
cauda equina

Identify the following types of pathology on a CT scan or MR scan:

subarachnoid hemorrhage
intracerebral hematoma
brain abscess
infarct (hemorrhagic vs bland)
glioma, meningioma and metastatic brain tumor
subdural and epidural hemorrhage
Arnold-Chiari malformation
hydrocephalus
multiple sclerosis
herniated intervertebral disk
cerebral edema

Identify the following normal anatomy on a conventional cerebral angiogram or MR angiogram:

common, internal and external carotid arteries
vertebral and basilar arteries
anterior, middle and posterior cerebral arteries

Using angiography, recognize

atherosclerotic stenosis and occlusion of a major vessel
arteriovenous malformation
cerebral aneurysm