GOALS FOR THE NEUROLOGY CLERKSHIP NEUROLOGY CLERKSHIP OBJECTIVES

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1 Specific Learning Objectives for the Neurology Below is a list of the specific neurology objectives (by topic) that we expect you to know by the end of the neurology rotation. The reading list is from Gelb Introduction to Clinical Neurology fourth edition, High Yield Neuroanatomy third or fourth edition by James D Fix, Harrison s Principles of Internal Medicine or from resources posted on Emerge GOALS FOR THE NEUROLOGY CLERKSHIP GOALS - The goal of the Third Year Neurology clerkship is to prepare the student to identify diseases and situations in which neurological evaluation is appropriate so that the student understands as a practitioner when neurological consultation is appropriate and when emergent neurological intervention is needed. Specifically, the overarching goals are to: 1. expose you to bread and butter neurology so you a) are comfortable identifying neurological issues in your field of interest and b) know when to refer to neurology 2. allow you to recognize and manage emergent issues in neurology 3. work on skills that are key to the practice of medicine, regardless of specialty most importantly learning to synthesize and not just gather data, and presenting in a succinct and organized fashion in both oral and written H&Ps 4. become proficient in the neurological exam 5. Allow you to explore the field of neurology to determine if it is an area of interest for you. 6. foster student growth in the areas of communication skills, practice-based learning, medical ethics and moral reasoning, professionalism and social and community context of health care NEUROLOGY CLERKSHIP OBJECTIVES PHYSICIANSHIP OBJECTIVES - Complementary to specific knowledge and skills objectives, students are expected to demonstrate ongoing growth in the area of interpersonal and communication skills, medical ethics and moral reasoning, practice-based learning and improvement and professionalism. During the neurology clerkship, the student will: Participate as members of a health care team and will effectively communicate with members of the team (clinical performance evaluation (CPE)). SATBC-2a, SATBC-2b Participate in one ethics conference and be able to participate in a discussion of ethical principles as they apply to neurology:

2 (attend one conference, complete one write-up) PBMR-1 Demonstrate the ability to acquire and apply scientific knowledge to clinical problem solving: (participation on rounds, CPE, case based didactics, written H&P assignment) PCMC-3, ECIS-2, ECIS-3 Demonstrate professional behavior by attending required conferences and completing electronic clerklog. (Attendance, log records, CPE) PBMR-5 Maintain professional dress and demeanor and develop professional relationships with peers, faculty and staff. (performance evaluations) PBMR-3

3 HISTORY AND PHYSICAL EXAM OBJECTIVES HISTORY and PHYSICAL OBJECTIVES - During the 4 week clerkship students will perform a focused history and physical exam on the specified number of real or simulated patients for the following presenting complaints. At the completion of the clerkship each student will be able to obtain a focused history and perform a focused physical exam for each complaint in a timely manner as assessed by Clinical Performance Appraisals and the OSCE. PCMC-1, PCMC-2 Physical Exams Specific Physical Examination Resources/Where it is Taught in the Demonstrate the ability to perform a screening neurological examination. Perform a focused neurological examination based on the patient s history and initial findings from the screening neurological examination. Objectives Neurology exam perform a cognitive exam including tests to elicit function of all cognitive domains and describe pattern of deficits found on cognitive exam. Demonstrate exam of cranial nerves, identify normal and abnormal cranial nerve findings Demonstrate motor exam, detect abnormalities and describe significance of abnormal patterns of findings such as proximal vs. distal, unilateral vs. bilateral Demonstrate sensory exam, detect abnormalities and describe significance of abnormal patterns of findings such as unilateral vs. bilateral Demonstrate exam of reflexes and describe significance of abnormal findings Demonstrate exam of cerebellar function Identify abnormal gait on exam Understand when special tests are needed and how to perform those, as indicated Neurological examination notes from Dr. Macken and Uchida. Video: NE video: Plea se note you need to be on campus or using an NU VPN in order to view this. Please note there are some minor differences between the notes and video, but that is alright. Neuro exam checklist from orientation Neurology examination demonstration from orientation Physical exam course with Dr. Melen There are many different but correct methods in which the neurological examination may be performed. If you understand the basic principles, you will be able to perform an accurate examination. Neuro observation on Orientation Day (formative) Direct Observation (formative) Standardized Patient on OSCE

4 KNOWLEDGE OBJECTIVES KNOWLEDGE OBJECTIVES -At the completion of the 4-week Neurology clerkship, the student should be have studied the following material at least ONCE via clinical encounter, didactic sessions, simulation OR through self-study from recommended texts MKS-1b, MKS-1d, MKS-1e Localization Epilepsy Stroke CNS infections Neuromuscular disorders Altered Mental Status with Special Emphasis on Head Trauma Demyelinating Illnesses Sleep disorders Dementing Illnesses Movement Disorders Brain tumors Headaches Dizziness Neurological Manifestations of systemic disease Side effects of psychiatric medications Neurology Knowledge Objectives Localization Describe the blood supply of the various parts of the High Yield Neuroanatomy by James D Fix brain and spinal cord. Describe the neurological deficits Aids to examination of the peripheral nervous that may occur with vascular compromise related system, damage of the various arterial territories such as middle Dr. Perkin s notes from SBM

5 cerebral artery territory. MKS-1a Describe the blood brain barrier and the resulting changes seen when there is a breakdown of blood brain barrier (vasogenic edema, enhancement seen on CT or MRI when a study with contrast is performed).mks-1a, 1d List the cranial nerves, their function and deficits resulting from their lesions.mks-1a List the functions of the cerebellum MKS-1a Describe the clinical findings produced by lesions of the cerebellar vermis (trunk and gait ataxia) vs. the cerebellar hemispheres (limb dysmetria). MKS-1d Describe the deficits in transection of the cord at different levels, including brown sequard syndrome, anterior cord syndrome, cauda equina syndrome and central cord syndrome (cervical level).mks-1d Identify functional areas of the cerebral cortex, particularly the primary areas of the brain including: primary motor, sensory, olfactory, taste, auditory and visual areas. Describe the function of these areas and the deficits seen when they are damaged. MKS-1a,1d Draw the visual pathway and describe the visual deficits along different parts of the pathway.mks-1a,1d List the language areas of the brain including Broca, Wernicke, arcuate fasciculus. Compare and contrast features of the various aphasias resulting from lesions of these areas including: Broca s, Wernicke s, Conductive aphasia transcortical sensory and motor aphasias. MKS- 1d, 3a Describe the motor pathway starting from the cerebral cortex and ending above the anterior horn cell in the spinal cord. Also describe the path of the motor nerve from the anterior horn cell to the neuromuscular junction. MKS-1a Explain what the upper and lower motor neurons are. Case based didactics You can also refer to chapter 1 in Gelb pages: This chapter is lengthy and if you feel you are short of time, you can skip this.

6 Compare and contrast the features of upper motor neuron and lower motor neuron lesions.mks-1a,1d, 3a Explain how to localize hemiparesis. Compare and contrast distinguishing features of hemiparesis due to lesion in the cortex, subcortical region, brainstem or high cervical cord. MKS-1d Describe the anatomy of the neuromuscular junction and the pathophysiology of myasthenia gravis. MKS-1a,1b,1d Describe the sensory pathways starting at the peripheral nerve and ending in the primary sensory cortex. MKS-1a Identify the various dermatomes. Compare and contrast sensory deficits that follow a peripheral nerve vs. dermatomal vs. plexus vs. cord distribution. MKS-1a,1d Describe the features of the most common peripheral nerve injuries such as median, ulnar and peroneal (fibular) nerve palsies. MKS-1d Explain how to localize peripheral nerve lesions such as: radiculopathy, plexopathy, mononeuropathy, diffuse peripheral nerve involvement, neuromuscular junction and muscle disease. MKS-1d, Explain when to suspect multifocal lesions of the central nervous system. MKS-3a Be able to describe the direct and indirect pathways in the basal ganglia and the deficits arising from dysfunction of each, such as parkinsonism and chorea. MKS-1a,1d Neurology Knowledge Objectives

7 Epilepsy Define seizure and epilepsy and explain the difference between them. MKS-1d Describe the difference between provoked and unprovoked seizure. MKS-1b Explain the pathophysiology of epilepsy. MKS-1b Discuss the classification of seizures and epilepsy: focal vs. generalized. Old terminology (partial and complex partial seizure) is still commonly used by neurology residents and faculty and may be seen in textbooks. MKS-1d, Describe the clinical characteristics of different seizure types, eg. Focal seizure arising in the motor cortex will produce rhythmic (clonic) shaking of the body part represented by the involved motor cortex. MKS-1d Explain the various causes of epilepsy: genetic, structural, metabolic and unknown. MKS-1b Describe various epilepsy syndromes such as juvenile myoclonic epilepsy and childhood absence epilepsy, including the prognosis and treatment. MKS-1d, 3a, MKS- 1e, MKS-3b Describe the features of temporal lobe epilepsy. MKS-1d Compare and contrast features of temporal lobe epilepsy and absence seizures. MKS-1d, 3a Discuss the differential diagnosis of epilepsy including: syncope, cardiac convulsions, TIA, aura without migraine, metabolic disturbances (hypoglycemia), cataplexy and non-epileptic events. MKS-1d, 3a Formulate the diagnostic evaluation of seizures/ epilepsy, including CT (if needed emergently)/ MRI and EEG. List work-up of potential underlying cause of the event (such as reduced sleep, alcohol, etc.). Discuss when epilepsy monitoring may be helpful.mks-1d, MKS- 3a Explain whether a first-time unprovoked seizure should Gelb chapter 5 Alternatively you can also read Dr. VanHaerent s lecture notes from SBM For a better understanding of AEDs, read AED notes (emerge)- Read about how to initiate therapy in Gelb. New concepts in classification of the epilepsies: Entering the 21st century. Special attention to table 1 (right hand side of the table discussed the new terminology (emerge). Case Based Didactics

8 be treated. MKS-3a, 3b Identify topics of patient education after first seizure, including driving restrictions, regardless of whether an AED (antiepileptic medications) is started.mks-1c, 3b Discuss the process in how an AED is selected based on type of seizure, gender and potential for child bearing, other comorbidities and side effect profile of the medications. MKS-1c,1e, 3b Define status epilepticus (SE) and discuss the potential causes. MKS-1d, Outline the treatment algorithm for SE, including concurrent diagnostic work-up. MKS-1d, MKS-1e MKS- 3a,3b

9 Neurology Knowledge Objectives Stroke Describe the classification of stroke by etiology, including thrombotic, embolic, lacunar and hypercoaguable states. MKS-1b, 1d Distinguish the difference between ischemic and hemorrhagic strokes. MKS-1b, 1d Discuss typical syndromes produced by occlusion of various arteries, such as symptoms due to MCA infarct, ACA infarct, or symptoms found in posterior circulation (i.e. basilar, vertebral and posterior cerebral arteries) infarcts. MKS-1d List typical location of lacunar infarcts and risk factors for lacunar infarcts such as diabetes, hypertension, hyperlipidemia and smoking. MKS-1b,1d Discuss immediate evaluation of an acute stroke patient including the role and choice of appropriate cerebral, cardiac, and vascular imaging. MKS-1d, 3a Identify laboratory testing (e.g. glucose, platelets, coagulation profile-pt, PTT and INR) that is needed acutely in the management of a stroke patient. MKS-1d Identify what criteria are used to determine if a patient is a tpa candidate. Also discuss contraindications for tpa in an acute stroke as well as the risks associated with tpa administration. MKS-1e Discuss evaluation of a stroke patient beyond the emergency room setting. This includes appropriate brain and vascular imaging as well as cardiac evaluation. Also recognize appropriate laboratory studies needed in the evaluation of stroke patients (e.g. including but not limited to lipid profiles, hypercoaguable studies). Explain how each test will influence patient management. MKS- Discuss how evaluation will differ based on the stroke Gelb chapter 4 Dr. Caprio s notes from Scientific basis of Medicine Can refer to American academy of neurology guidelines for stroke management Case based didactics

10 subtype. MKS-1d, 3a Discuss secondary stroke prevention based on various subtype, (e.g. risk factor modification such as treatment of hyperlipidemia and hypertension; antiplatelet therapy for lacunar infarcts and anticoagulation for patients with embolic disease due to atrial fibrillation). MKS-1e, MKS- 1f, MKS-3b Discuss the work up needed to determine whether a patient has symptomatic vs asymptomatic carotid artery stenosis (ultrasound, MRA, CT angiogram). MKS-1d, 3a Recommend whether someone is a candidate for carotid endarterectomy based on NASCET criteria for symptomatic and asymptomatic carotid stenoses. MKS- 3a,3b

11 Neurology Knowledge Objectives CNS Infections Explain the pathogenesis of meningitis and encephalitis. Dr. John Flaherty s scientific basis of MKS-1b medicine notes are excellent. List the common organisms that cause acute, aseptic and 2 articles: community acquired bacterial subacute or chronic meningitis. MKS-1b meningitis in adults and nosocomial Distinguish the microorganisms causing communityacquired and post-neurosurgical meningitis. MKS-1b the tables on antibiotic therapy in these infections are present in emerge. Review Compare and contrast classic clinical presentation of articles. bacterial, aseptic and subacute or chronic meningitis and You can also read selectively in Harrison s meningoencephalitis.mks-1d, 3a for a better understanding of certain Interpret CSF findings in bacterial, viral and TB/ fungal topics. meningitis.mks-1d, 3a Case based didactics Discuss the differential diagnosis of CNS mass lesion in patients with HIV/ AIDs. MKS-1b,1d, 3a Recognize the role of diagnostic testing including CT/ MRI and LP in patients with suspected CNS infection and the importance of early diagnosis and treatment. MKS-1d, 1c Discuss antibiotic therapy and the role of steroids treatment of the different types of meningoencephalitis. MKS-1e, 3b

12 Neurology Knowledge Objectives TOPIC Specific Knowledge Objectives Resources/Where it is Taught in the Neuromuscular Conditions Describe the clinical features which localize a lesion to the following anatomic areas: anterior horn cell, nerve root, plexus, peripheral nerve, neuromuscular junction, and muscle. MKS-1a, 1d, 3a Discuss the common clinical symptoms and signs of polyneuropathy. Identify common causes of length-dependent polyneuropathy such as diabetes, vitamin B12 deficiency, hypothyroidism and medications. MKS- 1b, 1d Outline the clinical presentation, work-up, treatment and prognosis of Guillain-Barre syndrome (acute inflammatory demyelinating polyneuropathy-aidp). MKS-1d, 1e,3b Describe the clinical features of Amyotrophic Lateral Sclerosis (ALS). MKS-1d Describe clinical features of Myasthenia Gravis. Discuss the ancillary testing that is useful in confirming the diagnosis. MKS-1d Discuss the different therapies of myasthenia gravis including acetylcholinesterase inhibitors, immunomodulation and thymectomy.mks-1e, 3b Discuss when electromyography (EMG) and nerve conduction studies (NCS) are useful in evaluating neuromuscular disorders. MKS-1d, 3a Explain neuromuscular emergencies (Guillain-Barre and myasthenic crisis). Discuss what defines an emergency and the immediate workup is necessary including: respiratory parameters and management Gelb chapter 6 Case based didactics

13 of these crises. MKS-1d, 3a,3b Neurology Knowledge Objectives Altered Mental Status with Special Emphasis on Head Trauma Grade concussions based on AAN guidelines.mks-1d Outline the evaluation of a patient with acute change in mental status MKS-1d Discuss various types of traumatic brain injury including subdural hematoma, epidural hematoma, subarachnoid hemorrhage, diffuse axonal injury, and intraparenchymal hemorrhage, Gelb chapter 11 Can also refer to Harrisons chapters 15 and 16 for reference Case Based Didactics

14 including the pathophysiology. MKS-1b, 1d Describe the lucid interval, which is most commonly seen with epidural hematoma, and its mechanism. (it may also be seen with acute subdural hematoma). MKS-1b,1d Identify subdural hematoma, epidural hematoma, subarachnoid hemorrhage and intraparenchymal hemorrhage on CT brain. MKS-1d Discuss the various herniation syndromes, including: transtentorial, subfalcian and cerebellar tonsillar. MKS-1d Identify structures involved in transtentorial/uncal herniation. MKS-1b Discuss acute management of elevated intracranial pressure and brainstem herniation, including the role of hyperventilation, hypertonic solution, head elevation MKS-3a, 3b Discuss the indications and role of neurosurgical intervention in a patient with a traumatic brain injury- (large subdural or epidural hematoma, patients at risk of brain herniation. MKS-3b Describe how to perform a brain death evaluation PCMC-2 Neurology Knowledge Objectives Demyelinating Illnesses Describe the typical presenting symptoms of multiple sclerosis Gelb chapter 10 including optic neuritis and transverse myelitis. MKS-1d Case based didactics Discuss the diagnostic criteria for multiple sclerosis (Macdonald s criteria). MKS-3a, MKS-1d Compare and contrast four general categories or types of MS including: relapsing-remitting, primary-progressive, secondaryprogressive and progressive-relapsing. MKS-1d, 3a List diagnostic tests used to support the diagnosis of multiple

15 sclerosis including: MRI, CSF studies and evoked potentials. MKS- 1d Discuss the disease-modifying agents used to treat multiple sclerosis, including when they are indicated and major drug side effects. MKS-1e, 3b Discuss the differential diagnosis of multiple sclerosis including other multifocal diseases of the CNS. MKS-3a Neurology Knowledge Objectives Sleep Disorders Describe the difference between comorbid and primary Gelb chapter 9 insomnia. MKS -1b, 1d Alternatively you can also read List the various causes of comorbid insomnia including: Harrisons chapter 13, or use this underlying medical, psychiatric conditions, primary sleep chapter as a reference. disorders and medications. MKS-1b You can also refer to notes from Describe the clinical presentation, pathophysiology and the scientific basis of medicine treatment of the various primary sleep disorders that may cause notes (Dr. Coleman) insomnia including: obstructive sleep apnea, restless legs Case based didactics syndrome and circadian rhythm sleep disorders. MKS-1b, 1d, 3a, 3b Identify the various causes of daytime sleepiness or hypersomnia including insufficient sleep, disturbed nocturnal sleep and primary disorders of daytime sleepiness. MKS-1b Discuss the various causes of disturbed nocturnal sleep that result in daytime sleepiness including: medical and psychiatric conditions, medications, poor environment and primary sleep disorders as mentioned in c. MKS-1b Outline the clinical manifestations and treatment of the primary hypersomnias: narcolepsy and idiopathic hypersomnia. MKS-1d,

16 3a, 3b, MKS-1e Be familiar with the various diagnostic tests that are used to evaluate sleep disorders including sleep diary and nocturnal polysomnography. MKS-1d, 3a Neurology Knowledge Objectives Dementing Illnesses Define dementia and explain the difference between mild Gelb chapter 7 cognitive impairment (MCI) and dementia. MKS-1c, 1d Dr. Bornakdapour s notes from Define Alzheimer s disease according to the DSM IV. MKS-1d SBM Outline the differential diagnosis including vascular dementia, Case Based Didactis mass lesion, metabolic and endocrine and nutritional deficiencies, depression and other types of dementias such as Diffuse Lewy Body Disease (DLD) and Frontotemporal Dementia (FTD) MKS-1d, 3a List workup for the reversible causes including B12, folate, TSH, CT or MRI to look for structural causes, depression screening, and if applicable screening for syphilis and HIV. MKS-1d, 3a Discuss the medications that are currently available and FDA approved for use in patients with AD, including: donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne) and memantine (Namenda). MKS-1e, 3b Explain evaluation of the patient s social environment, ability to care for themselves, safety, advanced directives and caregiver burden issues, including the role of patient and family counseling. MKS-1c, 3b

17 Neurology Knowledge Objectives Movement Disorders Discuss the pathophysiology of parkinsonism. MKS-1b Gelb Chapter 8 Recognize the cardinal features associated with parkinsonism Can also refer to SBM lectures including: tremor, rigidity, akinesia/bradykinesia. MKS-1d Case based didactics Discuss the differential diagnosis of parkinsonism including Parkinson s disease, drug induced parkinsonism, vascular parkinsonism. MKS-1d, 3a Compare and contrast atypical parkinsonian syndromes such as progressive supranuclear palsy, multiple system atrophy, and Diffuse Lewy Body Disease (DLD) MKS-1d, 3a Discuss the diagnostic evaluation of Parkinsonism and when testing is necessary. MKS-1d, 3a List the medications use to treat Parkinson s disease (including carbidopa/levodopa, dopamine agonists and MAO-B inhibitors) and the most common side effects associated with each of them. MKS-1e Discuss the complications which arise from long standing disease and its treatment (such as motor fluctuations including wearing off and dyskinesias and hallucinations). MKS-1c, 3b Recognize when deep brain stimulation is indicated in the treatment of Parkinson s disease. MKS-3b Discuss the key clinical features and examination findings of essential tremor (ET) and how to distinguish it from Parkinson s disease MKS-1d, 3a Identify the most common medications used to treat essential tremor such as propranolol and primidone. MKS-1e Discuss the evaluation of essential tremor and when testing is necessary. MKS-1d, 3a

18 Neurology Knowledge Objectives Brain Tumors/Cancers Recognize the most common clinical presentations of brain Gelb Chapter 10 tumors (e.g. headache, focal neurological signs and seizures). Harrison Chapter 25 MKS-1d Dr Kumthakar s notes from SBM Describe unique features of headache due to elevated Case based didactics intracranial pressure (e.g. the headache worsens with: valsalva maneuver, when lying down and may wake the patient up in the middle of the night). MKS-1d Discuss acute management of complications related to brain tumor, including role of steroids and antiepileptic medications. MKS-1e,3b Be familiar with the most common cancers that metastasize to the brain including lung, breast cancer and melanoma. MKS-1b, MKS-1d

19 Neurology Knowledge Objectives Headaches Compare and contrast clinical features of the primary headache Gelb chapter 12 disorders including migraine, cluster and tension headache. Dr. Macken s notes from MKS-1d, 3a Scientific Basis of Medicine Discuss how to differentiate a primary vs. secondary headache Case based didactics disorder (including but not limited to subarachnoid hemorrhage, pseudotumor cerebri, temporal arteritis). MKS-1d, 3a List the commonly used prophylactic and abortive treatments for migraine as well as the nonpharmacologic approaches.mks- 1e,, 3b Understand how side effect profile and pertinent medical history guide choice of medications used to treat headaches in the acute and chronic setting MKS-1e, 3b Discuss the clinical features and management of medication overuse (rebound) headache. MKS-1d, 3b Outline the prophylactic and abortive treatments for cluster headache. MKS-1e, 3b Neurology Knowledge Objectives Dizziness Describe the clinical features which distinguish central from Gelb chapter 14

20 peripheral vertigo. MKS-1d, 3a Discuss the pathophysiology of the two most common types of peripheral vertigo including benign paroxysmal positional vertigo (BPPV) and acute labyrinthitis. MKS-1b Be familiar with how to perform and interpret the Dix-Hallpike maneuver. MKS-1d, PCMC-4 Discuss use of the Epley Maneuver for the treatment of BPPV. MKS- 3b Describe the clinical features of Meniere s disease. MKS-1d Define and perform HiNTS criteria MKS-1d, PCMC-4 Dr. Cherchi s notes from scientific basis of medicine Case based didactics Neurology Knowledge Objectives Neurological Manifestations of Systemic Disease List the most common neurological manifestations of various vasculitides (e.g. temporal arteritis, Polyarteritis nodosa) MKS-1d List the most common neurological manifestations of connective tissue disorders (e.g. lupus) MKS-1d Describe the pathophysiology of amarosis fugax. MKS-1b Outline the work up and treatment of amarosis fugax. MKS-1d, 3a, 3b List the most common chemical abnormalities associated with neurological manifestations (e.g. hyponatremia) and identify what those neurological manifestations are. MKS-1b, 1d Gelb chapter 14 Dr. Cherchi s notes from scientific basis of medicine Case Based Didactics

21 Neurology Knowledge Objectives Side Effect of Psychiatric Medications List the major neurological side effects of various drugs commonly used to treat psychiatric diseases, including dopamine antagonists, valproic acid, and lithium MKS-1e Case based didactics Neurology Knowledge Objectives Neuroradiology Identify various anatomical structures from the various cross Introduction to Head sections on brain CT. List the structures that are hyperdense vs. hypodense. MKS-1a,1b, 1d Identify various anatomical structures from the different cross CT: dct/ sections on brain MRI. MKS-1a,1b, MKS-1d Introduction to Neuroimaging Identify the different MRI sequences including: T1, T2, Flair, slides (emerge) diffusion weighted, gradient echo and post contrast. MKS-1d Image card (emerge) Understand which structures or lesions are bright vs. dark Neuroradiology lecture from (increased or reduced intensity) in various sequences. Eg. CSF is orientation bright on T2, but dark on T1. MKS-1a,b,d Be able to identify the following on CT: subdural hematoma, epidural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage, obstructive and nonobstructive hydrocephalus, stroke, and mass effect due to tumor or stroke. MKS-1d, 3a Be able to identify the following on MRI- all of above, plus lesions consistent with multiple sclerosis, brain tumor MKS-1d, 3a