神经病学教学大纲(供八年制)

1、 神经病学教学大纲（供八年制）Syllabus of Neurology (for 8-year Medical Students)（2008.4 修订）一、课程基本信息（basic information of this course）课程名称(name of the course)：神经科学模块2（neuroscience unit 2）课程号（代码）(code)：502146030课程类别(type of the course)：（专业与服务课程）学时(time)：48 学分(score)：3二、教学目的及要求神经科学模块2是整合了神经病学、神经外科学及精神疾病相关知识。根据培养目标，通

2、过教与学，使学生能够掌握神经系统疾病学的基本知识、基础理论和基本技能以及神经系统常见病与多发病的诊断与防治知识。在教学中，采用以问题为基础的教学方式，充分发挥教师的主导作用，由浅入深，重点突出，适当介绍本学科的新进展。充分调动学生的积极性，独立思考，提倡积极讨论问题，理论联系实际，培养他们的自学能力及分析解决问题的能力。将神内、神外与精神科相结合，可使学生掌握知识更加全面。本大纲按自编讲义内容并参考认知领域和临床技能考试大纲的内容编写，并提供参考书。在教学目的要求方面用“掌握”、“熟悉”、“了解”来说明不同程度的学习要求。Objective and requirements:Neuroscie

3、nce unit 2 is a combination of neurology, neurosurgery and psychology. All medical students should acquire and maintain some basic knowledge, theories and skills of neuroscience, and master the diagnosis, treatments and prevention of common neurological disorders. In the class, teachers should play

4、a key role, introduce the knowledge step by step with the problem-based model, emphasize the keystones, and present the students with the new improvements on neuroscience. Teachers should enlighten students to think independently, discuss actively and to combine the theories with practice so that th

5、ey can improve their abilities of self-study and solving problems. The conjunction of neurology, neurosurgery and psychology makes the students more deeply and comprehensively to grasp the knowledge. This syllabus based on self-compiled teaching materials, bombing with the outline of test of clinica

6、l skills and knowledge. It uses master, familiarized with and generally understand to show the different requirements.三、教学内容（表1）含各章节主要内容、学时分配，并以下划线或*等方式注明重点、难点。表1 教学内容章节题目课时1总论42缺血性脑血管病43出血性脑血管病44癫痫、帕金森病45脊髓疾病46中枢神经系统感染、脑器质性精神障碍、周围神经疾病、肌肉疾病47神经变性疾病、神经遗传性疾病、脱髓鞘疾病48头痛、颅内压增高及脑疝49颅脑外伤、肿瘤4合计36Table 1 Lec

7、turing contentschaptertitleTime (class)1Introduction42Ischemic Cerebrovascular Diseases43Hemorrhagic Cerebrovascular Diseases44Epilepsy , Parkinsons disease45Spinal cord diseases46Infections of CNS, psychology associated due to brain disease, Peripheral Neuropathy, muscular diseases47Neurodegenerati

8、on and neurogenetic disease, Multiple sclerosis48Headache, Intracranial Hypertension and Brain Herniation49craniocerebral trauma; brain tumor4sum36四、教材（名称、作者、出版社、出版时间）自编讲义五、主要参考资料1MERRITTS Neurology2、实用神经病学 主编:史玉泉 2003.7. 3、神经外科手术学 主编：王忠诚4、Oxford Textbook of Psychiatry六、成绩评定（注明期末、期中、平时成绩所占的比例，或理论考核、

9、实践考核成绩所占的比例）: 期末理论考核成绩备注：1、 各学院可根据参考格式，结合本学科课程的特点，另行规范教学大纲的格式，但本学院所开各门课程的教学大纲必须统一格式。2、 每门本科课程都必须有教学大纲。 教学大纲的内容要符合培养目标要求，服从课程体系结构及教学安排的整体需要。教学大纲由教研室组织有关教师编写，经学院或教研室认定后施行，并注意根据每轮教学的具体情况及时更新、修订大纲内容。教师在教学过程中原则上应当严格执行教学大纲。3、 学院开出的各门本科课程的教学大纲均应上网（学院网页），并在上第一次课时就告诉学生，以便于学生查询。总 论（Introduction）（神经系统解剖、生理、定位诊

10、断与神经系统检查、辅助检查）【目的要求】一、掌握内容：1、意识障碍的分类2、运动性、感觉性、命名性及混合性失语3、感觉、运动系统的定位诊断及感觉障碍与瘫痪的类型4、脑不同部位损害的临床表现5、脑脊液各项指标的正常值二、熟悉内容：1、特殊类型的意识障碍及脑死亡2、视、动眼、三叉、外展、面、舌咽、迷走神经和舌下神经受损时的主要症状体征，特别是眼肌麻痹的分类与表现3、常见不自主运动及共济失调类型4、深、浅及病理反射的临床意义5、神经系统疾病的病史采集和临床常规检查方法以及与各论中疾病有关的定位诊断三、了解内容：神经电生理、影像学检查的意义及基因学诊断技术【Objectives】After compl

11、eting of this chapter, you should have achieved the following goals:1、Master classification of consciousness disorder2、Master the motor aphasia, sensory aphasia, amnesic aphasia and total aphasia3、Master the topographic diagnosis of motor and sense lesions, types of paralysis and sensory disorders.4

12、、Master the symptoms and signs of lesions of different part of the brain5、Master the normal values of cerebral spinal fluid (CSF) inspection6、Familiar with: special types of conciousness and brain death7、Familiar with the main manifestations of lesions of optic nerve、oculomotor nerve、abducent nerve、

13、trigeminal nerve、facial nerve、glossopharyngeal nerve、vagus nerve and hypoglossal nerve; especially the manifestations of ophthalmoplegia8、Familiar with the frequent types of involuntary movements and ataxia9、the clinical importances of superfacial reflexes, deep reflexes and abnormal reflexes10、Fami

14、liar with: The method of history collection and routine clinical examination, relative topographic diagnosis11、Knowing the electrophysiology, imaging studies, and genetic investigations in neurology【教学时数】 4课时【lecturing time】 4 class 【教学内容】一、意识障碍的分类及特殊类型的意识障碍、脑死亡二、常见的失语（运动、感觉及混合性失语）及构音障碍的解剖基础与临床表现三、视

15、、动眼、滑车、外展、面、舌咽、迷走、舌下等颅神经损害的主要症状、体征, 核上、下型眼肌麻痹表现四、感觉系统1、感觉的分类：特殊感觉、一般感觉、复合感觉2、深浅感觉的传导通路、主要节段支配3、感觉障碍的几种类型4、各种感觉障碍的临床表现和感觉障碍的定位诊断（皮质、内囊、脑干、脊髓、周围神经损害的特点）。五、运动系统1、运动系统包括的范围（随意运动、锥体外系统及小脑系统），随意运动系统的传导解剖通路2、随意运动障碍及上、下运动神经元瘫痪的鉴别3、瘫痪的定位诊断（皮质、内囊、脑干、脊髓及损害表现）4、锥体外系统运动障碍，不自主运动、肌张力变化（1）不自主运动：震颤、痉挛、抽搐、舞蹈样动作、手足徐动症

16、及扭转痉挛（2）肌张力变化：强直性增高、变型性肌张力障碍、肌张力降低。5、小脑系统运动障碍：共济失调的临床表现及检查方法六、反射系统深、浅反射的改变，病理反射的临床意义，常见几种病理反射七、大脑、小脑、脑干的解剖及各部位损害的临床特点。八、辅助检查1、脑脊液：压力及各项指标正常值、电生理（脑电图、肌电图、诱发电位）、组织显像（CT、MRI、同位素等）等项检查的临床意义，组织活检（肌肉、神经、脑）的临床意义。2、神经电生理、影像学检查的意义及基因学诊断技术（自学）【lecturing contents】1、Classification of conscious disturbance, spec

17、ial types of conciousness, brain death2、Manifestation of different aphasia and their localization; the anatomy and manifestation of dysphasia3、the main manifestations of lesions of: optic nerve、oculomotor nerve、abducent nerve、trigeminal nerve、facial nerve、glossopharyngeal nerve、vagus nerve and hypog

18、lossal nerve; the manifestations of upper and lower motor neuron paralysis of extraocular muscles4、Sensory system:（1）classification of sensation: special sensation, common sensation, complex sensation（2）the conducting contract pathway of superfacial and deep sensation; mian spreading section（3）class

19、ification of sensational disorders（4）manifestation of each kinds of sensation and the topography diagnosis of sensational disturbances (cortex, internal capsule, brain stem, spinal cord, peripheral nerve )5、Movement system:（1）Aspect of movement system (voluntary movement, extrapyrimidal system and c

20、erebellar system), the conduct tract pathway of voluntary movement system（2）Disturbances of voluntary movement; differentiation of the upper and the lower motor neuron paralysis（3）topography diagnosis of palsy(cortex, internal capsule, brain stem, spinal cord)（4）Disturbances of extrapyrimidal system

21、; involuntary movement, changing of musclar toneInvoluntary movement: tremor, spasm, tic, and so onChanging of muscular tone: rigidity, and so on（5）Disturbances of cerebellar system: manifestation and examination of ataxia6、Reflex system Changing of superficial, deep reflex, clinical importance of p

22、athological changes, pathological reflexes found often in clinic 7、The anatomy and the manifestation of lesions of the Cortex、Cerebellum、Brain stem: anatomy, signs and symptoms8、Investigative studies:（1）CSF: pressure, normal values. Electrophysiology(EEG, EMG, EP); Tissue imaging(CT, MRI, and so on)

23、; Tissue biopsy( muscle, nerve, brain)（2）electrophysiology, imaging studies, and genetic investigations in neurology ( studying by students themselves)缺血性脑血管疾病（Ischemic Cerebrovascular diseases）【目的要求】一、掌握内容：掌握脑动脉血栓形成和脑栓塞的临床表现、诊断、鉴别诊断和治疗原则二、熟悉内容：熟悉短暂性脑缺血发作的概念、特点及治疗措施三、了解内容：1、了解缺血性脑血管疾病的分类，危险因素和预防2、了解

24、腔隙性及分水岭脑梗死的概念，临床特点及治疗措施3、了解静脉窦血栓形成的定义、病因、分类及诊断与治疗原则4、了解缺血性脑血管病的外科治疗【Objectives】1、Master: the clinical manifestation, diagnosis, differential diagnosis and treatment principle of cerebral infarction, apoplexy and subarachnoid hemorrhage2、Familiar with: the conception, manifestation and treatment of t

25、ransient ischemic attack.3、Knowing: classification, risk factor and prevention of ischemic cerebrovascular disease. Kowning：conception, cause, ,classification, diagnosisand treatment of cerebral venous thrombosisKnowing: conception, clinical manifestation, treatment of lacunar infarction,cerebral wa

26、tershed infarctionKnowing: the surgical treatment of ischemic cerebrovascular disease【教学时数】 4课时【lecturing time】 4 classes【教学内容】1、脑血管应用解剖2、缺血性脑血管疾病的分类，危险因素和预防2了解急应用解剖、3、动脉血栓性脑梗死的病因和发病机制、病理、临床表现、诊断和鉴别诊断、治疗原则3、脑栓塞的病因和发病机制、病理、临床表现、诊断和鉴别诊断、治疗原则4、短暂性脑缺血发作的病因、临床特点、诊断、治疗5、腔隙性脑梗死的定义，病因、临床表现、诊断和治疗6、分水岭脑梗死的定义，

27、病因、临床表现、诊断和治疗。7、静脉窦血栓形成的定义、病因、分类及诊断与治疗原则8、缺血性脑血管病的外科治疗：颈内动脉内膜切除术，恶性大脑中动脉综合征的外科治疗【lecturing contents】 1、Blood supply of the brain 2、Classfication, risk factors and prevention of ischemic cerebrovascular disease3、The etiology, pathogenesis, clinical manifestation, diagnosis, differential diagnosis and

28、 treatment principles of cerebral thrombosis3、The etiology, clinical manifestation, diagnosis, differential diagnosis and treatment principles of cerebral embolism4、The etiology, clinical manifestation, diagnosis, and treatment principles of transient ischemic attack.5、Conception, cause, manifestati

29、on, diagnosis and treatment of lacunar infarction6、Conception, cause, manifestation, diagnosis and treatment of cerebral watershed infarction7、Conception, cause, manifestation, diagnosis and treatment of cerebral venous thrombosis 8、the surgical treatment of ischemic cerebrovascular disease: Carotid

30、 Endarterectomy; the surgical treatment of malignant MCA syndrome .出血性脑血管病（Hemorrhagic Cerebrovascular diseases）【目的要求】1、掌握脑出血和蛛网膜下腔出血的临床表现、诊断、鉴别诊断和内、外科治疗原则3、了解出血性脑血管疾病的分类，危险因素和预防【Objectives】1、Master: the clinical manifestation, diagnosis, differential diagnosis and medical and surgical management pr

31、inciple of cerebral hemorrhage and subarachnoid hemorrhage2、Knowing: The classification, risk factors and prevention of hemorrhagic cerebrovascular diseases【教学时数】 4课时【lecturing time】 4 classes【教学内容】1、出血性脑血管疾病的分类，危险因素和预防2、脑出血的病因、发病原理、病理、临床表现、诊断和鉴别诊断、治疗原则、外科手术指征、预防。3、蛛网膜下腔出血的病因、病理、临床表现、辅助检查、诊断、鉴别诊断和内科

32、及外科治疗原则。 【lecturing contents】 1、The classification, risk factors and prevention of hemorrhagic cerebrovascular diseases2、The etiology, pathogenesis, clinical manifestation, diagnosis, differential diagnosis ，treatment principles，the surgical indications and prevention of cerebral hemorrhage3、The eti

33、ology, pathogenesis, clinical manifestation, laboratory investigation, diagnosis, differential diagnosis ，medical and surgical treatment principles of subarachnoid hemorrhage.癫 痫（Epilepsy）【目的要求】三熟悉辅助检查方法和治疗方法临床表现、诊断标准 1、掌握癫痫的治疗原则与癫痫持续状态的抢救2、熟悉癫痫的分类、临床表现、诊断、鉴别诊断及外科治疗（手术指征、术前准备）3、了解癫痫的病因与发病原理和预防措施【Obj

34、ectives】1、Master: （1）treatment of epilepsy（2）Emergency rescue of epileptic state2、Familiar with: the classification, clinical manifestation, diagnosis differential diagnosis and surgical treatment of epilepsy(surgical indication, preoperative preparation) of epilepsy3、Knowing: etiology, pathogenesis

35、 and prevention of epilepsy【教学时数】1+2/3课时【lecturing time】 1+2/3classes【教学内容】1、定义2、病因 3、发病机制：介绍癫痫病灶的异常放电与传播4、分类5、临床表现：讲解痫性发作各种类型临床表现6、诊断和鉴别诊断：确诊癫痫依据，脑电图的诊断价值，与假性发作、TIA、晕厥、偏头痛等的鉴别，症状性癫痫者的病因寻找7、防治：病因治疗、预防致病因素；痫性发作时的处理，药物治疗原则，药物副作用8、癫痫持续状态的处理9、癫痫外科治疗：手术指征和术前准备【lecturing contents】 1、Conception: introduce

36、the conception of epilepsy and epileptic seizure, briefly lecturing the epidemiological character of epilepsy2、Etiology: introduce primary and secondary epilepsy; localization of epileptic lesion; classification of seizure and the diagnostic method of epilepsy3、Pathogenesis: introduce the abnormal d

37、ischarge and conduction of epilepsy4、Classification of epilepsy5、Clinical manifestation: explain the manifestation of different kinds of seizure6、Diagnosis and differential diagnosis: evidences for confirm epilepsy, EEG, different from pseudoepilepsy, TIA, vertigo, migraine. Finding causes of sympto

38、matic epilepsy7、Prevention and treatment：treatment of causes, prevention of causes, treatment of seizure, principle of how to use antiepileptic drugs, side effects og antiepileptic drugs8、Treatment of status epilepticus9. surgical treatment of epilepsy(surgical indication, preoperative preparation)

39、of epilepsy帕金森病（Parkinson Disease）【目的要求】1、掌握帕金森病的临床表现 2、熟悉帕金森病的诊断、鉴别诊断、内科及外科治疗方法（深部脑刺激）3、了解帕金森病的病因【Objectives】1、Master: the clinical manifestation of Parkinson disease2、Familiar with: diagnosis，differentiation and medical and surgical treatment (DBS) of Parkinson disease3、Knowing: etiology of Parkin

40、son disease【教学时数】 1+1/3课时【lecturing time】 1+1/3 classes【教学内容】1、帕金森病的病因2、帕金森病的临床表现症状：震颤、肌强直、运动障碍三大表现3、诊断与鉴别诊断：与继发性帕金森病综合征，多系统萎缩，肝豆核变性4、治疗方法5、外科立体定向治疗和脑起搏器植入治疗【lecturing contents】 1、The etiology of parkinsonism2、The clinical manifestation of Parkinsonism: tremor, rigidity, and dyskinesia3、Differentiat

41、ion: distinguish from secondary PD, multiple atrophy and Wilsons disease4、Treatment 5、surgical treatment :stereotaxis treatment and DBS脊髓疾病（Myelopathy）压迫性脊髓疾病（compressive myelopathy）【目的要求】一、掌握内容：掌握压迫性脊髓疾病的临床表现，纵向和横向定位二、熟悉内容：1、熟悉压迫性脊髓疾病的病因2、熟悉压迫性脊髓疾病的内外科治疗【Objectives】1、Master: clinical manifestation,

42、 transactional longitudinal topographic diagnosis of compressive myelopathy2、Familiar with etiology of compressive myelopathy 3、Familiar with: the medical and surgical treatment of compressive myelopathy【教学时数】2 课时【lecturing time】2 class【教学内容】1、脊髓解剖2、病因：压迫性脊髓疾病的常见病因3、临床表现：压迫性脊髓疾病的临床表现4、诊断：压迫性脊髓疾病的横向纵

43、向定位诊断和定性诊断5、内外科治疗原则 【lecturing contents】1、Anatomy of Spinal Cord2、Etiology: common causes of a compressive myelopathy3、Clinical symptoms and signs: the manifestation of compressive myelopathy 4、Transactional longitudinal topographic diagnosis 5、The principle of medical and surgical treatment 急性脊髓炎（A

44、cute myelitis）【目的要求】一、掌握内容：掌握急性脊髓炎的临床表现二、熟悉内容：1、熟悉急性脊髓炎的鉴别诊断2、熟悉急性脊髓炎治疗【Objectives】1、Master: manifestation of acute myelitis2、Familiar with differentiation of myelitis.3、Familiar with: the treatment and nursing of myelitis【教学时数】2学时【lecturing time】 2 classes【教学内容】1、病因和病理：简述急性脊髓炎的一般病因2、临床表现：重点讲述脊髓炎的急性

45、休克期、恢复期及并发症的临床表现3、诊断：与急性硬膜外脓肿，脊髓出血，脊髓压迫症、视神经脊髓炎等进行鉴别4、治疗与护理：急性期治疗及护理；恢复期处理【lecturing contents】1、Etiology and pathology: Introduce the general causes of acute myelitis2、Clinical symptoms and signs: Lecture the manifestation of acute myelitis in spinal shock and complexes3、Diagnosis and differentiatio

46、n including spinal epidural abscess, spinal hemorrhage, compressive spinal diseases, optic myopathy4、Treatment and nursing中枢神经系统感染（Infection of CNS）【目的要求】1、掌握单疱病毒性脑炎的病因、临床表现、诊断及鉴别诊断2、熟悉辅助检查方法和治疗原则3、了解CNS感染的分类和生物源性感染源【Objectives】1、Master: the cause, manifestation, diagnosis and differential diagnosis

47、 of herpes simplex virus encephalitis.2、Familiar with: the methods of investigation and treatment.3、Understanding of: category of central nervous system infection and infectious origin.【教学时数】1课时【lecturing time】 1 class【教学内容】1、简介中枢神经系统感染的定义2、简介CNS感染的生物源感染原3、简介感染途径，血行、直接感染、经神经干感染4、单疱病毒脑炎（herpes simple

48、x encephalitis，HSE）（1）病因（2）病理改变：颞叶，额叶脑组织水肿、软化、出血性坏死（3）临床表现（4）实验室检查：脑脊液、脑电图、MRI、活检, 病原学检测（5）诊断及鉴别诊断（6）治疗原则【lecturing contents】 1、Introduce briefly the conception of central nervous system infection2、Introduce briefly the biological infectious origin of central nervous system infection3、Introduce brie

49、fly pathway of central nervous system infection4、HSE（1）Etiology（2）Pathology（3）The clinical manifestation of herpes simplex virus encephalitis（4）Investigation: CSF, EEG, MRI, biopsy, investigative studies for infectious origin（5）Diagnostic and differential diagnosis of HSE（6）Treatment of HSE脑器质性精神障碍(

50、Mental Disorders due to brain diseases)【目的要求】1、掌握脑器质性疾病所致精神障碍的概念、分类和诊治原则2、熟悉谵妄的概念 3、了解谵妄病理机理 【Objectives】1、master the definition of mental disorders due to brain diseases and the principals of diagnosis and treatment.2、master the definition of delirium .3、Familiar with the pathological mechanism of

51、delirium.【教学时数】 1学时【lecturing time】 1 class【教学内容】1、脑器质性精神障碍的概念 2、脑器质性精神障碍的常见症状和综合征3、脑器质性精神障碍的诊治原则4、谵妄的概念5、谵妄的病理机理【lecturing contents】 1、The concepts of mental disorders due to brain diseases2、The common syndromes and their symptoms of mental disorders due to brain diseases3、the principals of diagnos

52、is and treatment of mental disorders due to brain diseases4、The conception of delirium 5、The pathological mechanism of delirium 周围神经病（Peripheral Neuropathy）急性炎症性脱髓鞘性多发性神经病（Guillain-Barre综合征, GBS）【目的要求】一、掌握内容：掌握急性炎症性脱髓鞘性多发性神经病的临床表现及诊断二、熟悉内容：熟悉急性炎症性脱髓鞘性多发性神经病的鉴别诊断和治疗原则【Objectives】1、Master: the clinica

53、l manifestation and diagnosis of Gullain-Barre syndrome2、Familiar with: the differential diagnosis and treatment principles of Gullain-Barre syndrome【教学时数】 30分钟【lecturing time】 30 min【教学内容】1、病因：多种原因引起的自身免疫性疾病2、病理：神经根、神经节、周围神经的主要病理改变是髓鞘脱失3、临床表现：急性或亚急性发作；对称性四肢周围性瘫痪；未梢型感觉障碍；可伴有颅神经麻痹、电生理检查、脑脊液内的蛋白细胞分离现象

54、，呼吸肌麻痹是主要死因4、诊断和鉴别诊断：本病主要与急性脊髓炎、急性脊髓灰质炎、周期性麻痹鉴别5、治疗：对症治疗、瘫痪（包括球麻痹和呼吸肌麻痹）的治疗。病因治疗：免疫球蛋白、血浆置换【lecturing contents】 1、Etiology: autoimmune mediated2、Pathology:3、Clinical manifestation: supranuclear paralysis of four limbs, distal sensory impairment, cranial nerve palsy, separation of CSF protein and leu

55、cocytes, decreased nerve conduction velocity4、Diagnosis and differentiation: differential diagnosis with low potassium periodic paralysis, myasthenia gravis and acute myelitis5、Treatment: symptomatic treatment; etiologic treatment: plasma exchange, immunoglobulin injection of vein特发性面神经麻痹<面神经炎>（Idiopathic facial palsy）【目的要求】