Neurologic disorders

I. Approach to the patient with a neurologic complaint:

A] Patient history :

1 -key questions: To describe the onset of the symptoms.*

*To explain the progression of the symptoms.*To discuss the features of the disorders.

*To identify any chronic disease or medications are being used.*To report a family history of the disorder or predisposing conditions .

*To recognize habits or toxin exposures .

2 -review of symptoms :* to apply knowledge about presenting symptoms of neurological

diseases ( headache , loss of consciousness , impaired of vision , arm or leg weakness , falling or dizziness, bowel or bladder disturbances ) .

B] Neurological examination:

1 -mental status: *To assess the patient level of arousal , orientation , short-and long- term

memory , affect , concentration and attention. *To examine the comprehension , repetition , fluency , naming , reading

and writing. *To examine the other cortical functions.

2 -cranial nerves : *To examine all cranial nerves.

*To document any abnormalities of ocular motility , including nystagmus and dysmetria .

*To investigate abnormalities of facial sensation and movements.

3 -sensory system: *To define regions of abnormal touch , pain , temperature , vibration and

proprioception .

4-motor system:a)To define the muscle strength grading scale.b)To recognize the presence of atrophy , fasciculation , spasticity and rigidity.

1

c) To determine the ability of patient to perform rapid alternating and other complex maneuvers.

d)To evaluate of patient stance and gait.

5-coordination:*To perform finger to nose and heel to chin test.

*To recognize Romberg ` sign.

6-muscle stretch reflexes : *To determine the activity and symmetry of the brachioradialis, biceps ,

triceps , knee , and ankle reflexes. *To assess the presence of the babinski response with planter

stimulation .

C] Neurodiagnostic studies:

1-cerebrospinal fluid evaluation:a)To recognize the different indications of study of the CSF.b)To list the specific measurements and assays for CSF.

*to determine the opening pressure. *to determine CSF protein level.*to determine CSF glucose level.

*to determine WBC count.*to determine blood in CSF.

*to indicate culture and gram staining to evaluate the possibility of infection.

*to indicate cytology if malignancy is suspected. *to indicate intrathecal immunoglobulin production.

c)To memorize the contraindications to the performance of an LP.

2 -electroencephalography and evoked potentials: a)to indicate EEG in the evaluation of many disorders.b)to indicate EPs in many situations.

3- imagining studies :a) to indicate computed tomography. b) to indicate magnetic resonance. c) to indicate single photon emission computed tomography d) to explain non invasive vascular studies and its indications.e) to indicate angiography .

2

4- nerve conduction velocity studies and electromyography: a) to discuss NCVs indications. b) to list the categories that can be divided by EMG.

2 ] Loss Of Consciousness : A] Syncope:

1 -to define the syncope. 2 -to recognize the clinical signs of the syncope.

3 -to discuss the etiology of the syncope.4 -to demonstrate how to diagnosis of syncope.

5 -to manage patient with the syncope.

B] Coma: 1 -To define the coma.

2 -To classify the causes of coma. 3- To formulate a full history from patients with neurological diseases.4- To demonstrate competency in performing a comprehensive neurological examination.5- to describe the clinical features according to causes of the coma.6- to manage the patient with coma .

C] Vegetative state :1- to define the vegetative state and persistent vegetative state . 2- to determine the level of the treatment.

D] Brain death:1- to define the brain death.2- to explain different investigations for diagnosis.

3] alternation in behavior ;

A] Delirium :1- to define the delirium .2- to classify the etiology of the delirium .3- to manage the delirium .

B] Dementia :1- to define the dementia and be able to distinguish it from delirium .2- to classify the causes of the dementia.

3

3- Alzheimer disease : a) to define Alzheimer disease and identify its genetic factors. b) to recall the prevalence of Alzheimer disease. c) to classify the characteristic pathology of Alzheimer disease. d) to explain different investigations and discuss the differential diagnosis. e) to manage the patient.

4 -normal pressure hydrocephalus: a) to define the NPH.b) to recognize the etiology.

c) to explain the role of imaging studies and ICP in diagnosis of the disease.d) to manage the patient with ventriculoperitoneal shunt.

5 -Creutzfeldt- Jacob disease: * to define the Creutzfeldt- Jacob disease.

* to recognize the causes of this disease and its relation with genetic factor .

* to identify the role of CSF and EEG in diagnosis of this disease. * to recognize the danger of the disease .

Headach:A) Etiology: To recall and to classify the possible causes of headache in general. To identify and manage the life threatening causes. B) Headache Syndromes: 1\ Migraine: a To recognize the possible causes. b To explain the pathophysiology and focus on the idea that is a neurovascular disturbance based. c To distinguish between different types of migraine syndromes. d To label the causes and try to abort them. To classify management and know how to apply each one.

4

To manage patients and recognize different medications used in the treatment. To appraise between benefits and adverse effects of each drug.

2\ Tension headache: a To describe the clinical features. To distinguish between it and migraine. b To manage the patient.

3\ Chronic daily headache: a To identify cause and to know that positive history of migraine and tension headache can play a role. b To manage patient.

4\ Cluster headache: a To describe the clinical feature. To distinguish between it and migraine. b To manage patient.

5\ Temporal (giant cell ) arthritis: a To describe the clinical feature. To recognize that polymyalgia rheumatica is present in 50% of cases.b To use different types of investigation and to know the diagnostic one.c To use corticosteroid in managing patients.

6\ Benign (idiopathic ) intracranial hypertension (pseudo tumor cerebri): To recognize the associated condition that predispose to the disease.a To describe the clinical feature. To identify the complication.b To indicate that lumber puncture is the diagnostic one and CT or MRI will be normal. To practice lumber puncture procedure and to interpret the results. c To manage the patient. To asses and screen the complication for prevention. To predict and manage the refractory cases.

5

7\ Trigeminal neuralgia (tic douloureux ): To define the disease and it is association.a To describe the clinical feature.b To manage patient and recognize different medications used in the treatment. To discuss the role of surgery and radiation in the management.

8\ Indomethacin – responsive headaches: To Define the condition. To recognize the two different clinical features and to distinguish between them. To identify that the only management is indomethacin. 9\ Low pressure – Volume headache: To define or describe the condition. a To identify the possible causes. b To employ MRI for diagnosis and to interpret the finding. c To manage patient. To describe blood patch as way of management.

Weakness

A) To relate the anatomic classification to clinical feature. To differentiate between each type of weakness.B) Selected disorders characterized by weakness:1\ Facial weakness: To recognize the difference between upper, lower facial weakness

2\ Amyotrophic lateral sclerosis (ALS): a To identify causes and the role of glutamate access. b To describe the clinical feature. To recognize and to discuses the differential diagnosis that may masquerade the diagnosis. c To indicate that there is no definite treatment for this condition and all we have is supportive treatment. To label the role of Riluzole and other glutamate antagonist in slowing the progression.

6

3\ The post polio syndrome:

To identify and to describe the clinical feature and management.

Disequilibrium and dizzinessA) Clumsiness: To classify and discus each cause. To describe clinical feature acute and chronic cerebellar dysfunction.

B) Dizziness:1\Approch to the patient:a\History: To collect a full history from patient complaining of dizziness.

To formulate differential diagnosis of dizziness.b\ Physical examination:

To practice, employ and to interpret several screening techniques to patients. To identify and distinguish different type and directions of nystagmus.

2\ Selected cause of dizziness: To recognize and to identify each one of them. To differentiate between them.

3\ Therapy: To manage the patients starting by treating the cause. To recognize different medications used in the treatment and role of vestibular and gait exercise in the management.

Pain Syndromes

To formulate a full history from patients complaining of pain by asking:Site, onset, duration, progression, intermittent, radiation, severity, aggravating, reliving factors and associated symptoms especially weakness and numbness. To demonstrate competency in performing a comprehensive neurological examination, starting with

7

proper positioning of the patient, to the general appearance, then start with mental status, cranial nerve, sensory and motor examination, skull and spine for local disease and finally check carotid artery for bruits.

A) Pain originating from lower back:1\ Etiology:

To recognize the possible causes.

2\ Disorders associated with low back pain:a\ Sciatica:

To define the condition. To recognize the clinical features. To identify the different modalities used in the diagnosis. To manage the patient. To discus the role of surgery.

b\ Lumber Stenosis: To define the condition. To recognize the clinical features which all depend on prolong standing. To manage the patient. To discus the role of surgery.

B) Pain originating from the neck:1\ Etiology:

To recognize the causes which all hallmark depend on nerve root irritation.

2\ Disorders associated with neck pain: To describe and discus cervical radiculopathy and arthritis as two important disorders.

C) Selected pain syndromes:1\ Herpes zoster: To classify the disease to acute and chronic syndromes. a \ Acute syndrome: To define condition. To recognize clinical features.

8

To manage the patient and recognize different medications used in the treatment.

b\ Chronic syndrome: To discus the chronic phase and to manage the patient. To recognize different medications used and the role of surgery in the treatment.

2\ Complex regional pain syndrome: To define the condition. To recognize clinical features. To choose and apply the most diagnostic investigation. To practice the paravertebral nerve block for the diagnosis. To manage the patient and to recognize the different medication used. To discus the role of paravertebral sympathetic ganglion block and physical therapy as a way of management.

D) Chronic pain syndromes: To recognize that is difficult to treat these condition. To discus the management and drugs used for treatment.

StrokeA) Introduction: To discus the pathogenesis of stroke. To classify and explain the optimal management.

B) Ischemic stroke: 1\ Introduction: To discus the different possible causes of ischemic stroke. To classify and describe the clinical signs. To define the therapeutic window and it's importance. To discus the management and different thrombolyic agents used. To identify and recognize the contraindication for starting thrombolytic agents.

9

To describe the new mechanical technique the intra-arterial thrombolysis.

2\ Transient ischemic attack: a To define condition. b To discus the causes. c To recognize and use different diagnostic studies. d To manage the patient and to identify the risk factors to prevent them. To evaluate for coronary artery disease. To recognize different medication used for treatment. To select and choose carotid endarterectomy in appropriate cases. 3\ Cardiogenic embolic stroke: a To indicate for the most common cause; that is non valvular atrial fibrillation. To discus and explain other causes. b To formulate a good history and find out the predisposing risk factors. To use different diagnostic techniques like angiography. c To indicate that cardiogenic embolus may develop hemorrhagic infraction. To relate that the management depend on the embolus size. To recognize that heparin and anticoagulant are first line of treatment.

4\ Large artery disease: To recall different important large arteries diseases. a To define condition and to manage patients. b To identify etiology. To discus diagnostic techniques. To label risk factors and try to avoid them. To manage patients and recognize different medication used. To indicate the role of carotid endarterectomy in managing the patients.

10

c To identify etiology. To discus diagnostic techniques and role of CTA, MRA, carotid duplex, TCD and angiography in the diagnosis. To manage the patients and to classify them as extrcrinal and intracrinal. To choose carotid endarterectomy superior to medical therapy in extracrinal carotid diseases. To recognize the role of aspirin in the treatment of intracrinal diseases.

5\ Small artery disease: To define the condition. a To discus the causes and to know that hypertension – associated lipohylinosis as the most important cause. b To formulate a full history taking and perfume a good physical examination. To order most diagnostic tests and to interpret the results. c To mange the patients and to controlled hypertension. To review other causes and to treat them. To recognize the role of antiplatelet medication in management.

6\ Hematologic and systemic conditions: To recognize and discus the associated condition and causes.

7\ The young ischemic stroke patients: To recognize the possible causes.

8\ The deteriorating ischemic stroke patients: a To describe and discus the pathophysiology. b To formulate a full history and find out risk factors. To report BP and the degree of hydration. To review coagulation profiles, platelet count and hematocrit. To describe and report the obtained CT. c To manage the patients and try to keep good hydration and avoid extremes of blood pressure.

11

To discus the interventional neuroradiological techniques .

Skills competencies in stroke:

To formulate a full history from patients with stroke. To apply knowledge about presenting symptoms of stroke (loss of consciousness, convulsion, mood alternation, facial numbness or weakness, arm or leg weakness, slowness in movement and altered limb sensation) while obtaining history from patients.

To formulate differential diagnosis for presenting symptoms of stroke.

To demonstrate competency in performing a comprehensive neurological examination, starting with proper positioning of the patient, to the general appearance, then start with mental status, cranial nerve, sensory and motor examination, skull and spine for local disease and finally check carotid artery for bruits.

12

D – Selected Syndromes :

1 - compression neuropathies : -to describe the pathophysiology of compression

neuropathies. -to name the common sites of compression.

-to discuss the etiology of carpal tunnel syndrome. -to describe how the compression neuropathies are

diagnosed. -to manage patients with compression and recognize the

role of surgical decompression. -to describe the selected types and causes of neuropathy

classified by other features .

2 - Guillain – Barre Syndrome : -to define and recognize the etiology of Guillain – Barre

Syndrome. -to describe how the patients with this syndrome present

clinically. -to identify the diagnostic studies can be used in this

syndrome. -to discuss the role of plasmapheresis and intravenous

immunoglobulin in treatment of Guillain – Barre Syndrome .

3 - Diabetic neuropathy : -to explain how diabetes mellitus cause neuropathy.

-to list the types of Diabetic neuropathy. -to define the role of blood glucose control in managing a

Diabetic neuropathy.

4 - Chronic Inflammatory Demyelinating Polyneuropathy ( CIDP ) :

13

-to define the causes of ( CIDP ). -to describe how the ( CIDP ) is diagnosed. -to discuss how the( CIDP ) is managed .

& Disorder Of The Neuromuscular Junction :

A) Myasthenia Gravis : -to discuss the etiology of Myasthenia Gravis.

-to recognize the clinical signs associated with Myasthenia Gravis.

-to define values obtained from the intravenous edrophonium and acetylcholine receptor antibodies and

other studies in diagnose Myasthenia Gravis. -to manage patients with cholinesterase inhibitor and

recognize the role of thymectomy in Myasthenia Gravis. -to discuss the role of corticosteroids ,

immunosuppressive agents , intravenous immunoglobulin and plasma pheresis in patients with refractory disease.

B) Eaton – Lambert Myasthenic Syndrome : -to describe the pathophysiology of Eaton – Lambert

Myasthenic Syndrome.-to recognize the clinical signs of this syndrome.

-to discuss the diagnostic studies used in this syndrome. -to manage patients with Eaton – Lambert Myasthenic

Syndrome .

& Disorders of Muscle :

A) Muscular dystrophies : -to list the types of muscular dystrophies.

-to identify the cause of Duchenne Muscular Dystrophy ( DMD ).

-to recognize the pattern of muscles affected in ( DMD ). -to discuss the role of prednisone in treatment of ( DMD ).

-to discuss the occurrence of death with ( DMD ). -to identify the cause of Becker's Muscular Dystrophy

( BMD ) and how it differs

14

from ( DMD ). -to identify the cause of Myotonic Muscular Dystrophy.

-to define the clinical signs associated with Myotonic Muscular Dystrophy.

-to discuss the occurrence of death with Myotonic Muscular Dystrophy.

-to identify the cause and the pattern of weakness in Facioscapulohumeral Muscular dystrophy.

-to identify the cause of Limb –girdle Muscular Dystrophy. -to recognize the role of serum CK level , EMG , muscle

biopsy and genetic studies in diagnosis of Limb –girdle Muscular Dystrophy.

B) Acquired Myopathy : -to discuss the etiology of acquired myopathy.

-to identify the clinical signs of acquired myopathy . -to recognize the diagnostic studies used in acquired

myopathy. -to list selected syndromes in acquired myopathy.

-to describe the cause , pattern of weakness and diagnostic studies used in corticosteroid myopathy .

-to identify the cause of myopathy acquired with polymyositis.

-to define inclusion body myositis. -to recognize how to diagnose the inclusion body

myositis. -to recognize that there is no accepted treatment in

inclusion body myositis. -to describe the clinical signs of polymyalgia rheumatica

( PMR ). -to recognize the diagnostic studies used in polymyalgia

rheumatica ( PMR ). -to define the role of NSAID or corticosteroid therapy in

managing the ( PMR ) .

C ) Nondystrophic myotonias (channelopathies ):-to define Nondystrophic myotonias (channelopathies).

-to recognize the different clinical features of Nondystrophic myotonias (channelopathies) including sodium channel diseases ( hyperkalmic periodic paralysis , paramyotonia congenita) and chloride channel diseases ( myotonia congenita "Thompsens ,beckers " ).

15

-to manage patient with Nondystrophic myotonias .

D) metabolic myopathies : -to recognize metabolic disorders that cause myopathies.

E) Myoglobinuria : -to list the different causes of Myoglobinuria.

-to recognize how Myoglobinuria can be diagnosed. -to manage patient with Myoglobinuria.

F) Acute quadriplegic myopathy : -to explain how Acute quadriplegic myopathy can develop

and how manage them.

& Infection :

A) Meningitis , encephalitis , and neurologic complaints associated with HIV infection

B) Brain abscess : -to discuss the etiology of brain abscess.

-to recognize the clinical signs of brain abscess. -to identify the role of CT and MRI scanning in the

diagnosis of brain abscess. -to discuss antibiotic therapy and the role of surgery ,

biopsy and drainage in managing the brain abscess .

C) A spinal epidural abscess : -to define the causes , symptoms and signs associated

with a spinal epidural abscess. -to recognize the role of spinal MRI or CT scan and

myelography in the diagnosis of spinal epidural abscess. -to manage spinal epidural abscess by surgical drainage

along with antibiotic therapy.

D) neurosyphilis : -to list the stages of neurosyphilis including

( asymptomatic disease , acute syphilitic meningitis , cerebrovascular " meningovascular " syphilis , general

16

paresis and tabes dorsalis .)and recognize the clinical signs of each stage.

-to discuss the role of reactive serum fluorescent treponemal antibody (FTA-ABS) , CSF VDRL and other CSF

finding in the diagnosis of neurosyphilis. -to manage neurosyphilis with penicillin.

& Primary CNS Tumors : A) Astrocytic neoplasms :

-to define the morphology of Astrocytomas and Anaplastic astrocytomas.

-to identify the typical clinical signs of Astrocytomas and Anaplastic astrocytomas.

-to manage Astrocytomas and Anaplastic astrocytomas and assess the role of surgery , radiotherapy and

chemotherapy. -to identify the prognosis of Astrocytomas and Anaplastic

astrocytomas-to define the morphology of Glioblastoma multiforme. -to assess the clinical signs of Glioblastoma multiforme.

-to indicate the role of corticosteroid therapy , surgical debulking , radiation therapy and chemotherapy in

managing Glioblastoma multiforme. -to identify the prognosis of Glioblastoma multiforme.

B) Oligodendrogliomas : -to describe the clinical signs associated with

Oligodendrogliomas. -to indicate the role of radiation therapy , chemotherapy

and surgery in managing Oligodendrogliomas. -to identify the prognosis of Oligodendrogliomas.

C)Meningiomas :-to define Meningiomas and clinical signs associated with

it. -to assess the role of surgical resection and radiation

therapy in managing Meningiomas. -to identify the prognosis of Meningiomas.

17

D) Schwannomas : -to define Schwannomas and discuss clinical signs

associated with it. -to recognize the diagnostic studies used in Schwannomas

.-to indicate the role of surgical resection or stereotactic

radiation therapy in managing Schwannomas. -to identify the prognosis of Schwannomas.

E)Primary CNS lymphoma : -to recognize the increasing incidence of CNS lymphoma in

immunocompromaized patient. -to discuss the imaging studies in the diagnosis of CNS

lymphoma. -to manage the primary CNS lymphoma.

-to identify the prognosis of primary CNS lymphoma.

& Hereditary Disorders :

A) Wilson's disease ( hepatolenticular degeneration ) : -to define Wilson's disease ( hepatolenticular degeneration

).-to discuss the clinical signs associated with Wilson's

disease. -to recognize how to diagnose Wilson's disease.

-to manage patient with copper chelation in Wilson's disease.

B) Neurofibromatosis (NF) : -to define Neurofibromatosis type 1 (NF 1 , von

Recklinghausen's disease). -to list the criteria can be used to diagnose

Neurofibromatosis including ( Neurofibromas , café-au-lait macules , Freckling in axillary or inguinal areas , optic glioma , iris hamartomas " lisch nodules " , sphenoid dysplasia or thinning of the cortex of the long bone and an

immediate relative with NF 1 ) .. -to identify the complications associated with

Neurofibromatosis. -to manage patient with Neurofibromatosis. -to define Neurofibromatosis type 2 (NF 2 )..

18

C) von Hippel –Lindau disease : -to define von Hippel –Lindau disease.

-to recognize cerebellar , retinal and other hemangioblastomas associated with von Hippel –Lindau

disease.

D) Osler – Weber – Rendu disease ( hereditary hemorrhagic telangiectasia ) :

-to define and recognize characteristic abnormalities associated with Osler – Weber – Rendu disease.

E) Tuberous sclerosis : -to define Tuberous sclerosis.

-to discuss the criteria for diagnosis of Tuberous sclerosis. -to recognize some associated features with Tuberous

sclerosis.

F) Down syndrome (trisomy 21 ) : -to define the characteristic clinical features associated

with Down syndrome (trisomy 21 ).

G) Huntington's disease : -to define Huntington's disease and abnormalities

associated with it.

H) Cerebellar atrophies : -to define Cerebellar atrophies.

-to discuss the etiology of Cerebellar atrophies. -to identify the types of Cerebellar atrophies.

-to recognize associated conditions with Cerebellar atrophies.

I) Peroxisome disorders : -to define Peroxisome disorders.

-to define Adrenoleukodystrophy and Adrenomyeloneuropathy and recognize the role of CT and

MRI scan and the cause of both.

19

-to define Refsum disease and clinical features associated with it.

-to describe the pathophysiology of Refsum disease. -to manage patient with Refsum disease.

J) Mitochondrial disorders : -to describe Mitochondrial disorders and how can be

inherited . -to name the Mitochondrial disorders including ( Kearns-

Sayre syndrome , Myoclonic epilepsy with ragged red fibers (MERRF) , Mitochondrial encephalopathy with lactic acidosis and stroke like events ( MELAS ) and Leber's hereditary optic neuropathy ) and recognize the

manifestation of each.

& Toxic And Metabolic Disorders :

A) Vitamin B12 deficiency : -to describe the pathophysiology of Vitamin B12 deficiency

.-to discuss the clinical signs of Vitamin B12 deficiency.

-to explain how to diagnose Vitamin B12 deficiency. -to manage Vitamin B12 deficiency with cobalamin.

B) Acute intermittent porphyria : -to describe the pathophysiology of Acute intermittent

porphyria. -to discuss the clinical signs of Acute intermittent

porphyria and the role of Watson Schwartz test in the diagnosis.

-to recognize the role of Hematin administration in managing Acute intermittent porphyria and identify the precipitants which should be avoided in susceptible

individuals.

C) Complications of alcohol abuse : 1 - Complications from intoxication , addiction and

withdrawal : -to discuss the complications of alcohol intoxication ,

addiction and withdrawal on nervous system.

20

-to recognize the clinical manifestations associated with acute alcohol intoxication.

-to discuss the symptoms associated with alcohol withdrawal and recognize the role of Benzodiazepines to

treat this symptoms. -to describe alcohol- related seizures ("rum fits") and how

to manage them. -to memorize the abnormalities associated with alcohol

abuse including cerebral atrophy , cognitive impairments , stroke , myopathy and Rhabdomyolysis.

2 - Complications related to nutritional deficiencies : -to list Complications related to nutritional deficiencies

including (Wernicke's encephalopathy, Korsakoff psychosis , sensory neuropathy and cerebellar degeneration )

-to discuss Wernicke's encephalopathy associated with alcoholic patients and other conditions due to thiamine

deficiency. -to define clinical signs associated with Wernicke's

encephalopathy. -to manage patient with thiamine administration in

Wernicke's encephalopathy . -to discuss Korsakoff psychosis associated with alcoholic

patients. -to define clinical signs associated with Korsakoff

psychosis. -to manage patient with Korsakoff psychosis.

-to describe sensory neuropathy associated with alcoholics .

-to discuss cerebellar degeneration associated with alcoholics.

D)Drug abuse : -to discuss the abnormalities can result from using cocaine

or " crack. " -to discuss the abnormalities can result from using heroin.

-to discuss the abnormalities can result from ingestion of phencyclidine (PCP).

-to discuss the abnormalities can result from ingestion of " ecstasy."

21

& Sleep Disorders : A) Narcolepsy :

-to describe the character of Narcolepsy.-to discuss the etiology of Narcolepsy.

-to recognize the clinical signs associated with Narcolepsy including cataplexy , sleep paralysis and vivid dreams.

-to identify the management of Narcolepsy.

B) Sleep apnea : -to define sleep apnea and discuss the causes of it.

-to discuss the clinical signs of sleep apnea. -to identify the treatment options of sleep apnea.

C) Periodic movements in sleep : -to describe abnormalities in Periodic movements in

sleep. -to discuss the clinical signs in Periodic movements in

sleep . -to identify the treatment options in Periodic movements

in sleep .

& Trauma :

A) Brain injury : 1 - concussion :

-to define a concussion associated with brain injury. -to discuss the clinical signs of brain injury.

-to recognize the duration of symptoms and discuss the development of postconcussion syndrome and post-

traumatic migraine.

2 - sever head trauma : -to discuss what can cause sever head trauma.

-to identify the clinical signs associated with sever head trauma.

-to locate the diagnostic studies can be used in sever head trauma.

22

-to discuss how to manage sever head trauma.

3 - A subdural hematoma : -to define the causes of subdural hematoma.

-to recognize the role of CT scan in diagnosing subdural hematoma .

-to discuss the role of surgery in managing subdural hematoma.

B) Spinal cord injury : -to describe the abnormalities associated with Spinal cord

injury. -to discuss diagnostic studies used in Spinal cord injury.

-to manage patient with Spinal cord injury .

23