林瑞泰 神經科 教授 Professor Ruey-Tay Lin E-mail ： tay@cc.kmu.tw Office ： 3121101, ext 5853

1. Brain,Mind and Nervous Systeｍ -A man paints with his brains and not with his hands---Michelangelo 林瑞泰 神經科 教授 Professor Ruey-Tay Lin E-mail：tay@cc.kmu.edu.tw Office：3121101, ext 5853

2. 學習目標 • 神經系統相關之醫用英文和普通英文，特別是腦。 • Anatomy and Function • Brain Diseases

3. The Human Brain

4. Human Brain (bottom view)

5. Nervous System: Anatomy & Function (CNS, PNS, ANS) • Brain, Spinal cord and Nerve?—pure or mixed , Muscle • Brain diseases • Neurologist: Diagnosis & Treatment

6. Brain Cell

7. Types of Neurons

8. Types of Neurons

9. Motor Neuron

10. Neurotransmission 神經傳導物質的傳導方式 Nervous impulse 神經衝動 Axon 神經軸 Pre- synaptic neuron 突觸前 Neurotransmitter storage vesicle 神經傳導物質 儲存囊 Neurotransmitter molecule 神經傳導物質 Neuron Terminal 神經元的終端 Neurotransmitter molecule bind to receptor site on the post- synaptic neuron Synaptic cleft 突觸間隙 Receptor 接受體 .Clancy J et al. Coordination I: The nervous system. In:Physiology and Anatomy: A homeostatic approach. 1st ed. London: Edward Arnold, 1995: 348-398.

13. Brain Functions • Sensory • Motor • Association: -memory -learning: conditioned and behavioral -language -cognition • Functional Lateralization

17. Neurological Symptoms and Signs Motor loss symptoms and signs include: • Weakness – loss of power • Paralysis – complete loss of power • Tremor – involuntary rhythmic movement, especially of the hands • Abnormal gait – unusual manner of walking Speech may also be affected, for example with hoarseness – a rough, deep voice as in vocal cord paralysis. Slurred speech means poor articulation, as in cerebellar disease. Dysarthria Dysphasia

20. Morton的字生(logogen)模式 (譯自Morton與Patterson, 1980)

21. Language Disorder • Dysarticulational • Aphasic: • -sensory • -motor • -global • -nominal • Language is best for Identity and Communication

22. Consciousness • Awakefulness • Awareness: • -orientation: time,place and person • -memory : recent and remote • -cognition

23. Neurological tests Coma Coma is unconsciousness with a reduced response to external stimuli Doctors say: The patient is in a coma. The patient is comatose. The Glasgow Coma Scale (GCS) score is calculated as follows:

24. Neurological tests The sensory system: pain, touch and thermal The motor system • Examination of the motor system should include assessment of the following: • Muscle bulk (amount of muscle tissue). Look for signs of wasting (muscle atrophy) • Muscle tone (amount of tension in a muscle when it is relaxed). Tone can be increased (spasticity), or decreased (flaccidity) • Muscle power (strength) • Coordination (the ability to use several muscles at the same time to perform complex actions) • Gait (the manner of walking) • Reflexes (see next slide) • Involuntary movements, for example a tic or a tremor

25. Neurological tests Tendon reflexes Examination of the nervous system normally includes testing the tendon reflexes, for example the knee jerks, with a tendon hammer (also known as a reflex hammer). The reflexes may be absent (0), diminished (-), normal (+) or brisk (+++). The plantar reflexes are also checked. The normal plantar response is a downgoing () movement (plantar flexion) of the big toe. An upgoing () toe (extensor or Babinski response) is abnormal.

26. Examination Of Gait • Apraxic • Festinating • Marche A Petit Pas • Ataxic • Spastic • Steppage • Waddling

27. Instrumentation • X-ray & EEG, Electroencephalography • Brain CT • MRI • Ultrasound • NCV, Nerve Conduction Velocity • EMG

28. Instrumentation

29. Nuclear Magnetic Resonance Résonance Magnétique nucléaire Kernspinresonanz Resonancia magnética nuclear Risonanza magnetica nucleare MRI (Magnetic Resonance Imaginerie) English Français Deutsch Español Italiano Nederlands Nuclear Magnetic Resonance

30. Headache Kopfschmerzen Cefaleas Cefalee Hoofdpijn Céphalées English Deutsch Español Italiano Nederlands Français Headache Vascular, Tensional, Others

31. Insomnia Insomnie Schlaflosigkeit Insomnio Insonnia Insomnie English Français Deutsch Español Italiano Nederlands Insomnia Limbic system, Serotonin

32. Dementia Démences Demenzen Demencias Demenze Dementieën English Français Deutsch Español Italiano Nederlands Dementia Cognitive deficits of higher cortical functions in patient with dementia include memory impairment, space disorientation, acalculia,left-right disorientation, anomia

33. Parkinson’s Disease Parkinson (maladie de) Parkinson-Krankheit Parkinson (enfermedad de) Parkinson (malattia di) Parkinson (ziekte van-) English Français Deutsch Español Italiano Nederlands Parkinson’s Disease Common neurological symptoms of Parkinson’s Disease include rigidity, masked face, tremor, small-step gait , speech disorder, constipation

34. Cerebrovascular accident Accident vasculaire cérébral Schlaganfall Accidente vascular cerebral Ictus cerebrale Cerebrovasculair accident English Français Deutsch Español Italiano Nederlands Cerebrovascular Accident 1.Hemorrhagic: ICH, SAH 2.Ischemic: Lacunar, thrombotic, embolism