Course Title: ANAT 6310, Fundamentals of Structure and Function in the Human Nervous System (4 credits) Course Timeframe: March 17- May 2, 2014 Co-Course Directors: John Caldwell, Ph.D Professor, Cell and Developmental Biology Email: John.Caldwell@ucdenver.edu; Phone: 303-724-3190; Office: RC1-North, room 7105. W. Frank Hughes, Ph.D. Adjunct Associate Professor, Cell and Developmental Biology Email: f.hughes@live.com ; Phone: - - - - Office: Building 500, room N5209F I. Course Description: This course stresses neural systems organization in the central nervous system (CNS) in relation to the peripheral nervous system (PNS) and as substrates for higher order brain function and cognitive processing. Exposure to cellular neurobiology reviews critical aspects of the electrical and synaptic functions of the neuron, neuronal architecture, and microenvironment. Topographic and vascular anatomy of the spinal cord, brainstem and cerebrum in lecture and laboratory sessions build the foundations for understanding CNS structure and function at a systems level. Dissections and sections of human brain specimens are instrumental in helping students build 3-dimensional mental constructs of central neural systems and their functional topography. The goal is to have students use their knowledge of systems topography to localize lesions responsible for particular neurologic signs and symptoms. Problem-oriented case studies are used to 1) emphasize strategies for anatomical localization of neurological defects, 2) provide exposure to disease-related pathobiology, and 3) to profile technological developments used in clinical as well as research settings to evaluate and to study brain function. II. Class Format, Class Decorum, and Resources. Lecture, laboratory, and case study sessions are to be held in the same classroom. Flexible seating in groups of 5-7 students at tables will be used to foster discussion and teamwork for various assignments. Behavioral objectives, outlines, and appropriate illustrations for each session will be provided as handouts as the course progresses. Students are encouraged to bring laptops/tablets to class for note-taking and Internet access minus the distractions of e-mail, phones, or texting. You can expect to do a fair amount of
doodling in the form of anatomical diagrams or circuits, or other pertinent illustrations of your own creation. You will find a set of colored pencils/pens to be most helpful! Recommended Textbook: Class discussions, Internet resources, and guidance from your instructor and classmates should be sufficient to pass this course often dependent on adapting your own learning style and background to the task at hand. The text recommendation is made for use as a reference resource to clarify or to explore particular topics in more depth. This particular text is well written with clinical and contemporary basic science perspectives and has the benefit of excellent illustrations and photographic specimens. John Nolte, The Human Brain: An Introduction to its Functional Anatomy ( 6 th Edition), 2009, Mosby/Elsevier Many other excellent neurological anatomy texts and atlases have been published over the years, each with special advantages. We will make some of these available to you on reserve, including the recommended text. Learning Perspectives: The course is taught from an integrated systems approach, meaning that the neuroanatomy is presented with functional highlights that touch upon physiology, pharmacology, clinical neurology and pathophysiology. This course is unlike histology or regional gross anatomy where you can complete a unit and put it behind you. It is cumulative and a building process such that content in one part of the course is revisited and often necessary for understanding in another part of the course. Hence, we will have a comprehensive final examination. Case Studies. Students often get lost in the details of neuroanatomy without the case focus. Cases force you to work with the big picture that we will continue to build as we proceed through the course. The comprehensive element of the course is a challenge you will encounter immediately with the case exercises. You are compelled to address points from entirely remote elements of the course. All of a sudden you realize your patient has sensory deficits, a particular visual problem, and motor signs or paralysis... not any one single problem that came from last week s content. Cases are the single most powerful tool for integrating your learning process in this course. They provide a super opportunity to put your knowledge of basic neuroanatomy to work in localizing lesions and to gain exposure to a diversity of diseaserelated mechanisms. We expect you will not have a particular comfort level with the cases at first. Then... as we work through a number of these, you will see how they can become the centerpiece for your learning... and the detective work is fun!! Keep the faith and by the end we believe you will feel pretty amazed and confident about your foundations in neurological science!
III. Course Objectives The student should be able to: 1. Describe functions of different cell types in the central and peripheral nervous system. For neuronal function note: a) mechanisms of the action potential and conduction; b) regulatory aspects of synaptic and neurotransmitter function; and c) contributions of neuronal structure and architecture to integration and dissemination of information. 2. Develop a comfort level with the external topography of the CNS, i.e. brain, brainstem, and spinal cord and be able to describe the following, using diagrams where appropriate: The meninges, compartmentalization of the cranial cavity, and dural venous sinuses. The ventricular system, CSF production and outflow. major external features of the spinal cord, brainstem, and cortex. the blood supply and territories supplied by major named vessels, noting: relationships of the vertebral-basilar (posterior) and carotid (anterior) circulations to the brain and brainstem and the importance of the Circle of Willis. relationships of the peripheral nervous system to the CNS denoting contribution of spinal cord segment to spinal nerve and plexus organization. cranial nerve components and their origins of cranial nerves in relation to brainstem levels. reflexes and their pathways in the cord and brainstem; autonomic sympathetic and parasympathetic outflow and distribution. 3. Describe the internal topography of the brain, brainstem, and spinal cord in crosssections, identifying the major structures at selected levels. Indicate the terminology for various planes of section (axial, horizontal, coronal) and radiologic vs. anatomical conventions. 4. List the major systems of the central nervous system designating their principal structural elements, their connectivity, and functional attributes. Do this for the following: ascending somatosensory systems special sensory systems (visual, auditory, vestibular, olfactory and taste) corticospinal and bulbar motor outflow cerebellum and basal ganglia limbic and paralimbic visceromotor systems substrates for memory cortical association areas, higher order cognitive functions and behavior 5. Localize lesions in the nervous system based on particular signs and symptoms or elements of the neurological exam including neurologic or other special testing. And conversely -- given a description or image demonstrating a patient s lesion, be able to predict the appropriate signs and symptoms. 6. Demonstrate familiarity with the pathobiology of lesions in the central and in the peripheral nervous systems.
IV. Examinations and Grading The course grade will be based on the following components (%): 1) Five Topical Exams : 15% each = 75% of total grade 2) Cumulative Final: 25% Exam Formats. Various question formats will be employed with opportunities to practice these along the way. Questions will consist of single-answer multiple choice questions, extended matching, and short answer/simple narrative types. Many questions will be based on images, lab-derived materials, and case vignettes. Case-based questions are likely to be the most challenging in testing your ability to apply your neuroanatomy skills. These will entail assessment of patient data in the form of a clinical presentation that may include a presentation, history, and neurological exam findings, images or lab results. You will be asked to localize lesions based on the clinical assessment; or, otherwise, to predict neurological signs and symptoms from diagrams or images depicting the lesion site. If you are having problems at any point in this course don t hesitate to talk to us. The cumulative nature of this material makes this most important. Often a simple stumbling block, easily fixed, can help you move forward with confidence. Focus on details often keeps students from building the big picture which for most, does not come together until a few aha moments help connect things toward the end of the course. Course Letter Grades comply with the guidelines set by the MSMHA Curriculum Committee as follows: A = 90-100; B = 80 89.5; C = 70 79.5; D = 60 69.5; F = < 59.5 At the end of a course, a student who has a grade of C or below will be given one chance at remediation by re-taking one or more written exams to replace a previous score(s) and raise their grade to a B (but not higher than a B). No re-examination will be offered for pre-lab or laboratory quizzes or laboratory exams. Remediation must be completed prior to the due date when the course director must submit semester grades. Disability Services If you have documented disabilities, please inform the course director as soon as possible to arrange necessary accommodations
Course Schedule * subject to change at course director s discretion 3/17 M 9-10 Ch 1 Introduction to the Nervous System (CNS/PNS; overview and terminology) Ch 3 Gross Anatomy and General Organization of the CNS 1-3 3/18 T Ch 1 Lab 1: Gross external structures and Coronal and Horizontal sections of the brain (Caldwell, Finger and Restrepo) Neurons and Glia: cellular components of the brain WEEK 1 1-2 3/19 W 9-10 Ch 7&8 Ch 2 Action potentials / synaptic transmission: electrical and chemical signaling Brain Model and Brainstem Model: Lab Development: neural tube and neural crest; vesicles to ventricles Ch 6 Blood supply of the brain and spinal cord (internal carotid, vertebral; Blood Brain Barrier; veins) 3/20 Th 9-10 Ch 5 Meninges, CSF, Ventricles, and clinical consequences of obstruction of CSF compartments 3/21 F 9-11 Review for exam
WEEK 2 3/24 M 3/25 T 8-10 Ch 9 Ch 9 EXAMINATION 1 (MC, Short Answer, and Projection Exam) Somatosensory System: Receptors and dermatomes Spinal cord organization and major axon tracts Autonomic Nervous system (sympathetic and parasympathetic) 1-4 Ch 10 Lab 2 Spinal Cord: three major pathways - on computers in class (in groups): 3/26 W 8-9 Lesions - PNS & Spinal Cord Cases 3/27 Th 9-11 Lesions : Case Workshop (cont) 3/28 F 10-12 Review for second exam WEEK 3 3/31 M 9-11 EXAMINATION 2 4/1 T 10-12 Ch 11 Discussion of exam and introduction to Brainstem 8-9 Cranial nerves: Anatomy and Function 4/2 W 9-10 4/3 Th 9-12 Ch 11 & 12 Brainstem organization I (including external anatomy review) Brainstem organization II Lab 4 (Computer in class) - Brainstem: three major pathways and cranial nerve nuclei 4/4 F 9-11 Practice Questions and Review
4/7 M - Systems and Connectivity: Overview from schematics to topography Diagnostic Strategy and the Neurological Exam BRAINSTEM (cont.) 4/8 T Brainstem III: Using Brainstem Internal Topography Ch 11 & 12 & Blood Supply to Diagnose Lesions. - Cranial Nerves - Pathways - Brainstem Reflexes WEEK 4 Brainstem IV: Summary of Brainstem Functions: integration, sensory, motor and visceromotor systems, RF & ARAS, monoaminergic pathways. 4/9 W 1-3 - Preparation for afternoon workshop Lab 5: Brainstem Case Workshop Study Day: Q/A Session 4/10 Th 10-12 Practice Questions and Review for Exam #3 (address case challenges) 4/11 F 9-11 EXAMINATION 3 (MC, Short Answer, and Projection Exam)
CEREBRUM: Cortex & Cortical Infrastructure 4/14 M Ch 22 Cerebral Cortex I : Introduction - Architecture and Microstructure Cerebral Cortex II: Functional Domains and Connectivity Introduction to Multimodal & Higher Order Functions. 1-3 Lab 6: Classical Imaging and Review of Horizontal and /Coronal Sections WEEK 5 4/15 T 4/16 W 8-9 9-11 Ch 22 - Cerebral Cortex III: Higher Order Functions (con t) - Language Gnosis - Praxia Cerebral Cortex IV: Sleep and Consciousness Advances in Neuroimaging: (CT, MRI, MRA, f-mri/bold, PET, SPECT) + Multimodal Applications Lab 7 (Case Workshop): Cortex Cases I Stroke & Tumor 4/17 Th 9-10 10-12 Ch 23 Limbic System: Components, Pathways & Functions Lab 8 (Case Workshop): Cortex Cases II Epilepsy & Dementia 4/18 F :30 12-1 Q/A Session and Review for Exam #4 Possible: Neuroradiology Seminar (+ lunch)
EXAMINATION 4 (MC, Short Answer, & Projection Exam) 4/21 M Ch 23 MOTOR SYSTEMS Highlights: Hypothalamus and the Visceromotor System 4/22 T Ch 18 Somatomotor System Overview: Reflexes, Component Subsystems, Connectivity, and Function WEEK 6 9-10 Ch 20 Cerebellum Ch 19 Basal Ganglia 4/23 W SPECIAL SENSES: 1-2 Ch 17 The Eye and Retina 2-3 Ch 17 Central Visual Pathways and Lesions 4/24 Th Ch 14 Ch 21 Ear I: Vestibular System Oculomotor system and gaze 4/25 F :30 Q/A Session and Review for Exam #5
EXAMINATION 5 (MC, Short Answer, & Projection Exam) 4/28 M 1-2 Ch 14 Ear II: Auditory System & Pathways 2-3 Ch 13 Highlights of Olfaction and Taste WEEK 7 4/29 T 1-3 Lab 9: Content Review for Final Specimen & Image Review for Final 4/30 W 9-11 Lab 10: Q&A and Discussion Session 5/1 Th Study Day 5/2 F 9-12 FINAL EXAMINATION COMPREHENSIVE - MC and Projection Exam