Neurology

Learning objectives:

• Recognise the main anatomic structures of the central and peripheral nervous systems 

• Recall the function and the functional organisation of the key comonents of the peripheral and central nervous systems 

• Demonstrate the ability to select key information in the signalment and history of the patient to support the differential diagnosis 

• Select the steps of the general physical examination to support the neurological examination 

• Identify and reproduce the key steps of and the techiques used for the neurological examination using a systematic approach 

• Interpret the results of the neurological examination showing the ability to identify the neuroanatomical structures tested 

• Summarise the abnormal findings of the neurological examination and use the information to localise the lesion within the nervous system 

• Memorise and apply the sign-time graph and the acronym VITAMIN-D to list the differential diagnoses 

• Use the information collected from the signalment, history and neurological examination to list a differential diagnosis 

Learning objectives

• Identify the main use of survey radiographs of the skull and spine  

• Recognise the limitations of survey radiographs and justify the use of radiographs in the unanaesthetised patient 

• Demonstrate the ability to identify abnormal changes in the images collected and associate them with disease processes 

• Illustrate the technique and the clinical application of contrast radiology (myelography, epidurography, discography) 

• Identify abnormal changes in the images collected and associate them with disease processes 

• Recognise the limitations of contrast radiography 

• Explain the principles and the clinical application of computer tomography (CT) with and without contrast medium 

• Identify the risks and the advantages associated with the use of CT 

• Identify abnormal changes in the images collected and associate them with disease processes 

• Explain the principles and the clinical application of magnetic resonance imaging (MRI) with and without contrast medium 

• Summarise basic MRI physics, MRI sequences and functional imaging 

• Identify the risks and the advantages associated with the use of MRI 

• Identify artifacts and abnormal changes in the images collected and associate them with disease processes 

• Describe the use of ultrasonography in neurology, especially as a supportive diagnostic tool 

Learning objectives:

• Demonstrate how to clinically localise a disease process to the encephalon 

• List differential diagnoses appropriate to lesion localisation 

• Summarise the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the brain, using the acronym VITAMIN-D 

• Establish a protocol for diagnostic tests suitable to each disease process 

• Indicate appropriate treatment options and prognostic factors for common encephalopathies  

Learning objectives

• Recall the neuroanatomical and pathophysiological basis of seizure activity 

• Summarise the classification of seizures and the different stages of a seizure 

• Discuss how to perform a diagnostic evaluation of seizures, including history, general and neurological examination, key ancillary tests and list differential diagnoses based on the clinical findings 

• Explain the main criteria used in the selection of AEDs (antiepileptic drugs) in dogs and cats 

• Explain the contraindications, the side effects and the monitoring of the most common AEDs 

• Illustrate how to manage refractory epilepsy 

• Indicate the pathophysiology, the clinical evaluation and diagnosis of paroxysmal involuntary movement disorders (tremors, myoclonus, dyskinesia, myokymia and neuromyotonia)  

• Discuss the treatment and prognosis of the different paroxysmal involuntary movement disorders 

• Describe the diagnosis and the treatment of narcolepsy 

Learning objectives:

• Explain how to perform a comprehensive cranial nerve assessment 

• Explain how to perform a neuro-ophthalmological assessment (including pharmacological evaluation of pupil function) 

• Distinguish the different neuro-ophthalmic syndromes, their neurolocalisation and causes 

• Review the diagnostic evaluation and treatment of the different neuro-ophthalmic syndromes 

• Identify the pathophysiology and neurolocalisation of the most common disorders of head and face: laryngeal paralysis, masticatory muscles abnormalities, facial paralysis, trigeminal neuropathy, Horner’s syndrome 

• Discuss the differential diagnoses, the neurodiagnostic investigation, the treatment and prognosis of the most common disorders of head and face 

• Illustrate how to evaluate the function of the vestibular system and how to distinguish between central and peripheral lesions 

• Illustrate how to evaluate the function of the auditory system (including BAEP) 

• List the diseases affecting the vestibular system (based on localisation), their diagnostic evaluation, treatment and prognosis 

• List the diseases affecting the auditory system, their diagnostic evaluation, treatment and prognosis 

• Describe the functional neuroanatomy of the key areas of the cerebellum 

• Summarise the clinical signs of cerebellar dysfunction 

• List the diseases affecting the cerebellum, their diagnostic evaluation, treatment and prognosis 

Learning objectives:

• Demonstrate how to clinically localise a disease process to the cervical spinal cord 

• List differential diagnoses appropriate to the localisation 

• Summarise the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the cervical spinal cord, using the acronym VITAMIN-D 

• Establish a protocol for diagnostic tests suitable to each disease process 

• Indicate appropriate treatment options and prognostic factors 

Learning objectives:

• Demonstrate how to clinically localise a disease process to the thoracolumbar spinal cord  

• List differential diagnoses appropriate to the localisation 

• Summarise the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the thoracolumbar spinal cord, using the acronym VITAMIN-D 

• Establish a protocol for diagnostic tests suitable to each disease process 

• Indicate appropriate treatment options and prognostic factors 

Learning objectives:

• Demonstrate how to clinically localise a disease process to the lumbosacral junction and cauda equina 

• List differential diagnoses appropriate to the localisations 

• Summarise the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the lumbar spinal cord and the cauda equina, using the acronym VITAMIN-D 

• Establish a protocol for diagnostic tests suitable to each disease process 

• Indicate appropriate treatment options and prognostic factors 

• Explain the physiology of micturition and the neurolocalisation of the disorders of micturition based on the clinical signs 

• Differentiate between upper motor neuron and lower motor neuron bladder dysfunction 

• List the most common differentials for the disorders of micturition, their treatment and the important prognostic factors 

Learning objective:

• Demonstrate how to clinically localise a disease process to the PNS 

• List differential diagnoses appropriate to the localisation 

• Summarise the key aspects (signalment, history, pathophysiology) of the most common diseases affecting the PNS, using the acronym VITAMIN-D 

• Establish a protocol for diagnostic tests suitable to each disease process 

• Indicate appropriate treatment options and prognostic factors 

Learning objectives:

• Define status epilepticus and cluster seizures and describe their aetiology and pathophysiology 

• Illustrate the appropriate at home and in hospital emergency treatment of status epilepticus and cluster seizures 

• List the supportive care needed by a patient with status epilepticus and cluster seizures 

• Explain the diagnostic procedures required in case of status epilepticus and cluster seizures 

• Recognise prognostic factors and possible complications in a patient with status epilepticus and cluster seizures 

• Discuss the pathophysiology of head trauma (primary and secondary brain injury, raised ICP) 

• Illustrate how to assess the patient with head trauma (primary and secondary assessment) and the appropriate emergency treatment 

• Choose the necessary diagnostic procedures and select appropriate treatment for the patient with head trauma (medical and surgical) 

• Appraise the importance of ICP monitoring and of the modified Glasgow coma scoring system in a patient with head trauma 

• Recognise prognostic factors and possible complications in a patient with head trauma 

• Discuss the pathophysiology of spinal trauma and the possible causes 

• Illustrate how to assess the patient with spinal trauma and the appropriate stabilisation and emergency treatment 

• Choose the necessary diagnostic procedures and select appropriate treatment (for primary injury and secondary injury) for the patient with spinal trauma including principle and indications for surgical vertebral stabilisation 

• Recognise prognostic factors and possible complications in a patient with spinal trauma 

Learning objectives:

• Estabilish a list of the appropriate clinical parameters and and blood tests needed to safely anaesthetise a patient with a neurological condition 

• Summarise the key aspects of the physiology and pathophysiology of anaesthesia, relevant to the neurological patient 

• Choose the appropriate protocol, drugs and anaesthetic agents to safely anaesthetise a patient with an intracranial disease 

• Illustrate a suitable monitoring for the anaesthesia of a patient with an intracranial disease 

• Summarize the protocol needed for a safe recovery and analgesia of a patient with an intracranial disease 

• Choose the appropriate protocol, drugs and anaesthetic agents to safely anaesthetise a patient with a spinal disease 

• Illustrate a suitable monitoring for the anaesthesia of a patient with a spinal disease 

• Summarize the protocol needed for a safe recovery and analgesia of a patient with a PNS disease 

• Choose the appropriate protocol, drugs and anaesthetic agents to safely anaesthetise a patient with a PNS disease 

• Illustrate a suitable monitoring for the anaesthesia of a patient with a PNS disease 

• Summarise the protocol needed for a safe recovery and analgesia of a patient with a PNS disease 

• Describe the essential physiology of pain (including transduction, transmission and perception) and the mechanism of neuropathic pain 

• Appraise the importance and the limitations of pain scoring a patient with a neurological condition  

• Plan the most suitable analgesic protocol for the most common neurological disorders and surgical procedures, listing indications, contraindications, side effects, interactions 

• Describe the use of fluid therapy in neurological patients during the pre operative, intraoperative and post operative periods: indications, protocols, monitoring 

• Explain how to evaluate and manage blood loss in the neurological patient 

Learning objectives:

• Review the principles of physical rehabilitation, their indications, contraindications and benefits for the neurological patient  

• Discuss initial assessment of the patient and demonstrate its value in physical rehabilitation 

• Evaluate the physical modalities of rehabilitation indicated for the neurological patient (physiotherapy, hydrotherapy, massages, passive range of motion, laser therapy, heat and cold, electrotherapy). 

• Suggest therapeutic exercises for particular neurological diseases and justify the recommendations 

• Indicate the risks, benefits, therapeutic time frames and monitoring of the therapeutic plans recommended 

• Explain the modalities for the management of the bladder and bowel functions in the neurological patient and analyse their indications, possible complications and appropriate monitoring 

• Recognise how to care for the respiratory system in the neurological patient and how to monitor function and possible complications  

• Appraise the importance of appropriate nutrition in the neurological patient and indicate its specific needs 

Learning objective:

• Summarise the anatomy and the physiology of CSF production and drainage 

• Illustrate suitable techniques to collect CSF from the cisterna magna and the lumbar spinal area and the risks involved 

• Identify the contraindications of CSF sampling 

• Identify the advantages and disadvantages of each type of CSF collection and their sutability to the different diease processes 

• Illustrate the suitable tests and techniques to analyse CSF after collection 

• Show how to interpret the results of CSF analysis and how to relate them to the disease processes  

• Identify the principles of electrodiagnostic evaluation of the neuromuscular system and the most appropriate technique to the clinical presentation 

• Show how to interpret the results of electrodiagnostic tests and how to relate them to the disease processes and clinical presentation 

• Evaluate the use of muscle and nerve biopsies in the neurodiagnostic evaluation of a neuromuscular disease: indications, limitations and contraindications 

• Show how to interpret the results of muscle and nerve biopsy analysis and how to relate them to the disease processes and clinical presentation