Neuroanatomy

1. Basics of Neuroanatomy

• Define CNS (brain, brainstem, cerebellum, spinal cord) and PNS (dorsal and ventral roots, peripheral nerves).
• Distinguish grey matter (cell bodies, dendrites) from white matter (axons) in the CNS. In the PNS, the equivalents are ganglia (clusters of cell bodies) and nerves (groups of axons).
• Understand tracts and fasciculi (bundles of axons in the CNS that connect particular regions), funiculi (the large columns of white matter in the spinal cord), nuclei (clusters of cell bodies in the CNS) and cortex (the outer layer of grey matter). Know their structure and functional relevance.
• Identify fibre types: association (within hemisphere), commissural (between hemispheres), projection (to brainstem/spinal cord).
• Describe the three parts of the brainstem from top to bottom (midbrain, pons and medulla). Recognise the gyri (ridges) and sulci (grooves) on the surface of the cerebrum.

2. Cells and Components of the Nervous System

• Understand that the CNS comprises neurones and supportive glial cells.
• Describe the roles of astrocytes (support neurones and the blood–brain barrier), oligodendrocytes (make myelin in the CNS) and microglia (the immune cells of the CNS).
• Explain the structure and function of the blood–brain barrier (BBB).
• Identify main neurotransmitter classes: amino acids, biogenic amines (small molecules made from amino acids, such as dopamine and serotonin) and peptides.
• Recognise examples of key neurotransmitters: glutamate (the main excitatory neurotransmitter in the brain), gamma-aminobutyric acid (GABA, the main inhibitory one), dopamine, noradrenaline, serotonin, acetylcholine and substance P (a peptide involved in pain signalling).

3. Arterial Supply to the Brain

• Understand how the brain receives the large amount of oxygen it needs.
• Know the anatomy of the arterial supply of the brain: which arteries supply which parts of the brain. Know the basic clinical effects of a blockage in one of these arteries.

4. Development of the Nervous System

• Understand how the nervous system develops and how this links to function.
• Be aware of some conditions caused by errors in nervous system development.

5. Production and Circulation of CSF and Related Disorders

• Understand cerebrospinal fluid origin, composition, functions including cushioning and metabolic support.
• Identify production of CSF by the choroid plexus (tissue lining the ventricles) within the brain’s ventricular system.
• Trace CSF flow: lateral → third → fourth ventricles, then the subarachnoid space (the space between the arachnoid and pia, the two inner layers of the meninges, around the brain and spinal cord).
• Recognise how CSF leaves the fourth ventricle (through the foramina of Luschka and Magendie, which are openings into the subarachnoid space, and down the central canal of the spinal cord). Recognise how CSF is absorbed back into the blood (through arachnoid granulations, small projections of the arachnoid layer into the venous sinuses). Know that a blockage to CSF flow or absorption can cause hydrocephalus (a build-up of CSF in the ventricles).
• Appreciate CSF’s protective and metabolic roles in brain and spinal cord physiology.

6. Somatosensory System

• Understand the somatosensory modalities (the types of sensation from the body): temperature, pain, pressure, vibration, fine touch and proprioception (the sense of where your body parts are). Know that two-point discrimination is a test of fine touch, not a separate modality: it finds the smallest gap at which two touches are felt as two.
• Explain receptive fields (the patch of skin that one sensory neurone responds to). Explain how field size affects acuity (the ability to tell fine detail), and how the fields of neighbouring neurones overlap.
• Describe adaptation (a receptor firing less during a steady stimulus). Compare rapidly adapting receptors (which fire only briefly when a stimulus starts or changes) with slowly adapting receptors (which keep firing), and how the firing rate of each changes.
• Recognise pathway organisation. First-order neurones (the first in the chain) have their cell bodies in the dorsal root ganglion. Second-order neurones decussate (cross to the other side). Third-order neurones run from the thalamus to the cortex.
• Differentiate the two main ascending pathways to the thalamus and cortex: the spinothalamic pathway (pain, temperature, crude touch and pressure) and the dorsal column-medial lemniscus pathway (fine touch, vibration and proprioception), which runs in the dorsal columns at the back of the spinal cord and then the medial lemniscus in the brainstem.

7. Motor System

• Understand difference between upper motor neurones (UMNs) and lower motor neurones (LMNs)
• Describe LMN signs: weakness, areflexia (absent reflexes), muscle wasting, hypotonia (low muscle tone) and fasciculations (visible muscle twitches under the skin)
• Explain the UMN pathway: cortex → internal capsule (a band of white matter deep in the brain) → crossing to the other side (decussation) in the medulla → spinal cord ventral horn
• Identify UMN lesion features: hyperreflexia (exaggerated reflexes), hypertonia (raised muscle tone) and extensor plantar reflexes (the big toe goes up when the sole is stroked)
• Recognise primitive spinal reflexes (automatic reflexes of infancy that the maturing nervous system normally suppresses). Recognise spinal shock (temporary loss of reflexes below the level of an acute spinal cord injury) and its effects after UMN injury

8. The Cerebellum: Circuits, Coordination and Clinical Signs

• Trace what goes into the cerebellum, how the cerebellar cortex processes it with its local circuits, and what leaves through the deep cerebellar nuclei (clusters of cell bodies in the white matter of the cerebellum). Use this to explain error correction, motor learning and clinical signs.

9. Visual System

• Understand the anatomy of the visual pathway: retina (the light-sensitive layer at the back of the eye), optic nerve, optic chiasm (where the two optic nerves meet and part of each crosses to the other side), optic tract, optic radiations (fibres that carry signals to the visual cortex) and visual cortex.
• Describe visual field mapping and interpretation in lesion localisation.
• Recognise common visual pathway lesions: hemianopia (loss of half of the visual field), quadrantanopia (loss of a quarter of the visual field) and optic neuritis (inflammation of the optic nerve).
• Explain pupillary light reflex and its neural circuitry components.
• Apply basic neuro-ophthalmic examination techniques (examination of the eye and its nerve connections): visual acuity (sharpness of vision), visual field testing and fundoscopy (looking at the back of the eye with an ophthalmoscope).

10. Auditory and Vestibular Systems

• Explain how hair cells in the inner ear turn sound and head movement into nerve signals (hair-cell transduction). Use this to link cochlear tonotopy (different sound frequencies are detected at different places along the cochlea, the hearing organ), the central hearing pathways, the vestibular sensors (the balance organs) and the vestibulo-ocular reflex (the reflex that keeps the eyes steady when the head moves).

11. The Hypothalamus and Limbic System

• Link the hypothalamus, which keeps body variables such as temperature near a set point, with the limbic system (the brain network for emotion, memory and reward). Know the main nuclei (clusters of cell bodies), pathways and outputs involved.

12. Higher Cortical Function

• Understand the cortical regions (the prefrontal cortex, which is the front part of the frontal lobe, and the parietal, temporal and occipital lobes) and their higher functions.
• Describe executive functions (the thinking skills that organise behaviour): planning, decision‑making, inhibition control (stopping unwanted actions) and working memory (holding information in mind for a short time).
• Recognise the language centres, Broca’s area (mainly speech production) and Wernicke’s area (mainly understanding language), and the associated disorders (aphasia, the loss of the ability to produce or understand language).
• Explain spatial processing: the parietal lobe’s contribution to visuospatial skills (judging where things are in space) and to neglect syndromes (ignoring one side of the body or of space despite intact vision).
• Apply clinical assessment: cognitive testing for executive function, language, and spatial deficits.

13. Reticular Formation

• Describe the anatomical location of the reticular formation (a network of nuclei running through the brainstem) and its subdivisions (the raphe nuclei, which lie along the midline and make serotonin, and the medial and lateral nuclei).
• Explain the roles of the reticular formation in arousal, sleep-wake cycles, consciousness, and filtering sensory stimuli.
• Understand the descending reticulospinal tracts (pathways from the reticular formation to the spinal cord): posture, muscle tone, autonomic regulation.
• Recognise the ascending reticular activating system (the pathway from the reticular formation to the cortex that keeps the cortex awake and alert): cortical activation, alertness, response to relevant stimuli.
• Appreciate clinical consequences of damage: coma, disrupted sleep, autonomic dysfunction.

14. Movement Disorders

• Define major movement disorder types: parkinsonism (slow movement with stiffness and often tremor), tremor (rhythmic shaking), chorea (irregular, flowing, involuntary movements), dystonia (sustained muscle contractions that cause twisting or abnormal postures), myoclonus (sudden, brief jerks) and tics (sudden, repeated movements or sounds).
• Describe how dysfunction in the circuits of the basal ganglia (deep brain nuclei that help control movement) underlies movement disorders.
• Recognise key clinical features of common movement disorders, including what the movements look like (their phenomenology).
• Explain basic neuropsychiatric aspects (problems with mood, thinking and behaviour) associated with movement disorders.
• Outline general diagnostic approaches and differential diagnosis strategies.
• Summarise primary treatment options and management principles.

• Be able to differentiate meningitis, encephalitis (inflammation of the brain itself) and other CNS infections by presentation
• Be able to outline initial investigations (including CSF) and interpret key findings
• Be able to describe immediate management, empiric therapy (antibiotics or antivirals started before the cause is confirmed) and complication prevention

16. Dementia

• Define dementia and distinguish major types like Alzheimer’s, vascular, Lewy body (abnormal protein deposits inside neurones) and frontotemporal (damage mainly to the frontal and temporal lobes).
• Describe key neuroanatomical changes in dementia (e.g., hippocampal atrophy, meaning shrinking of the hippocampus, a brain region needed for forming new memories; and cortical degeneration).
• Recognise clinical features: memory, executive function, behavioural and psychiatric symptoms.
• Outline basic diagnostic approach including cognitive testing and when brain imaging (neuroimaging) is needed.
• Summarise general management strategies: pharmacological treatments and supportive care principles.

17. Delirium

• Define delirium as an acute disturbance in attention, awareness and cognition.
• Identify key risk factors predisposing to delirium development.
• Recognise core clinical features including inattention, disorientation, psychomotor changes (slowing or agitation of movement) and perceptual disturbances (seeing or hearing things that are not there, or misinterpreting what is there).
• Distinguish delirium from dementia, depression and psychosis (loss of contact with reality, for example hearing voices or holding fixed false beliefs) by onset and symptom fluctuations.
• Describe basic diagnostic evaluation including screening tools and investigations.
• Outline general prevention and management: treat underlying causes, non‑pharmacological care, and cautious medication use.

18. Headaches

• Define headaches and differentiate between primary and secondary headache disorders.
• Describe common primary headache types: tension‑type headache, migraine and cluster headache. Describe their presumed pathophysiology (how each is thought to arise).
• Recognise key clinical features distinguishing headache subtypes: pain pattern, duration, associated symptoms.
• Identify red‑flag symptoms indicating potential secondary headache requiring urgent investigation.
• Outline general management principles: acute treatments, preventive strategies and lifestyle modification.

19. Stroke

• Define stroke and its two main types: ischaemic (caused by a blocked blood vessel) and haemorrhagic (caused by bleeding). Define transient ischaemic attack (TIA), in which stroke-like symptoms last less than 24 hours.
• List modifiable versus non-modifiable risk factors for ischaemic and haemorrhagic stroke.
• Identify classic brain artery territories: anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), brainstem, cerebellar and basilar (the basilar artery, a major artery at the base of the brain that supplies the brainstem and cerebellum).
• Recognise stroke symptoms by arterial territory: weakness, speech disturbance, visual field, neglect.
• Understand stroke classifications: Oxford/Bamford (total anterior circulation stroke, TACS; partial anterior circulation stroke, PACS; posterior circulation stroke, POCS; and lacunar stroke, LACS, a small stroke deep in the brain) to guide prognosis.

20. Raised Intracranial Pressure (ICP)

• Define raised intracranial pressure (ICP) and normal pressure parameters.
• Explain the Monro–Kellie doctrine: the skull is a fixed space, so the volumes of CSF, blood and brain must balance, and a rise in one raises the pressure unless another falls.
• Recognise clinical signs: headache, vomiting, papilloedema (swelling of the optic disc, seen at the back of the eye), ocular palsies (weak eye movements), altered consciousness.
• Describe Cushing’s triad physiology: hypertension, bradycardia (slow heart rate) and abnormal respiration.
• Outline key management principles: treating cause, head elevation, osmotherapy (osmotic drugs such as mannitol or hypertonic saline that draw water out of the brain), ventilation support.

21. Subarachnoid Haemorrhage

• Define subarachnoid haemorrhage and recognise it as a neurological emergency
• Describe common traumatic and aneurysmal causes and key risk factors
• Explain early brain injury and delayed cerebral ischaemia mechanisms
• Recognise classic presentation: thunder-clap headache, vomiting, seizures, neck stiffness, reduced consciousness
• Outline urgent diagnostics: non-contrast CT (a head scan without contrast dye), cerebral angiography (imaging of the brain’s arteries, with CT angiography offered first) and lumbar puncture (a needle in the lower back to take a CSF sample), and the order in which they are used
• Summarise acute management including nimodipine (a calcium-channel blocker given to prevent brain damage from reduced blood supply after the bleed), monitoring, and securing the aneurysm to prevent a re-bleed by endovascular coiling (filling the aneurysm with metal coils through a catheter) or, if coiling is not suitable, neurosurgical clipping (closing the aneurysm with a clip)

22. Anxiety

• Define anxiety and describe its adaptive role and typical physical symptoms
• Explain limbic system structures, stress response stages, and neurotransmitters in anxiety
• Identify medical conditions mimicking anxiety and classify risk factors: predisposing (make a person vulnerable), precipitating (trigger the problem), perpetuating (keep it going)
• Describe features and management of generalised anxiety disorder and panic disorder
• Recognise social and specific phobias (strong fears of social situations or of particular objects or situations). Know the evidence-based therapies, including exposure (gradually facing the feared situation) and cognitive behavioural therapy (CBT)
• Distinguish obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) from acute stress reaction (a short-lived reaction soon after a traumatic event). Outline key treatments for each, such as CBT with exposure and response prevention (gradually facing a trigger without carrying out the compulsion) for OCD, and trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR) for PTSD

23. Mood Disorders

• Define depression, mania (a period of abnormally high or irritable mood with increased energy), hypomania (a milder form of mania) and the diagnostic criteria for bipolar disorder
• List risk factors and precipitating factors for depressive episodes
• Distinguish adjustment reactions (low mood or anxiety after a stressful life event) from clinical depression based on duration and biological symptoms (physical changes such as poor sleep, reduced appetite and low energy)
• Recognise hallmark features of manic and hypomanic episodes
• Describe limbic, frontal, basal ganglia involvement and key neurotransmitters in mood regulation
• Summarise pharmacological and supportive management for depression and bipolar disorder

24. Psychosis

• Define psychosis (loss of contact with reality) and key symptoms: delusions (fixed false beliefs), hallucinations (perceiving things that are not there) and poor insight (not recognising that one is unwell)
• Identify the organic causes (physical causes, such as drugs, infection or brain disease) that must be excluded before diagnosing functional psychosis (psychosis with no physical cause found)
• Recognise the risk factors for schizophrenia (a long-term illness in which psychotic symptoms are central) and Schneider’s First Rank psychotic symptoms (a set of symptoms, such as hearing voices talking about the person or feeling that thoughts are being put into their head, once given special weight in diagnosing schizophrenia)
• Explain dopamine and autoimmune hypotheses underlying schizophrenia pathophysiology
• Outline antipsychotic treatment (drugs that treat psychosis): typical (first-generation) versus atypical (second-generation), mechanisms and side effects
• Distinguish drug-induced, affective (linked to a mood disorder) and post-partum psychoses and their clinical significance