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Learning Objectives

Medical knowledge

Fundamentals of neuroimaging

  1. Recognize common spine fractures and dislocations.
  2. Differentiate on computerized images between blood, air, fat, CSF, and bone.
  3. Distinguish the typical imaging characteristics of epidural hematoma, acute subdural hematoma, chronic subdural hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage.

Intracranial hypertension

  1. Define cerebral perfusion pressure and explain how it is used in the management of patients with elevated intracranial pressure.
  2. Describe how blood gases, fluids, and electrolyte balance influence intracranial pressure.
  3. Describe the clinical manifestations of acute brain herniation, including transtentorial, uncal, and subfalcine herniation syndromes.

Diagnosis and management of ischemic cerebrovascular disease

  1. Distinguish the symptoms and signs of anterior and posterior circulation ischemia.
  2. Differentiate the radiographic presentations of the different types of ischemic stroke: embolic, hemodynamic, and lacunar.
  3. Describe the roles and indications of the following treatment options in ischemic disease: medical management, risk factor modification, and surgical therapy.

Diagnosis and management of nontraumatic neck and back problems

  1. Define radiculopathy, myelopathy, and cauda equina syndrome.
  2. Describe the general management of cervical disc herniation, lumbar disc herniation, lumbar instability, and low back pain.
  3. List the most common examples of extradural, intradural-extramedullary, and intramedullary spine tumors.

Diagnosis and management of peripheral nerve injury and entrapment

  1. Describe the differences in the management of sharp lacerating injuries, blunt lacerating injuries, gunshot wounds, stretch injuries, compression injuries, and avulsion injuries to peripheral nerves.
  2. Describe the signs and symptoms of carpal tunnel syndrome and ulnar neuropathy, and outline the surgical indications.

Diagnosis and management of hydrocephalus and spinal dysraphism

  1. List common symptoms and signs of acute hydrocephalus in children.
  2. List common symptoms and signs of normal pressure hydrocephalus in adults.
  3. Define communicating and noncommunicating hydrocephalus and describe the differences in their treatments.
  4. List two examples each of open and closed spinal dysraphism.
  5. Describe the principles of management of myelomeningocele.

Diagnosis and management of surgically treatable pain problems, movement disorders, and epilepsy

  1. Describe the classic presentations of trigeminal neuralgia, failed back surgery syndrome, complex regional pain syndrome 1, and complex regional pain syndrome 2.
  2. Describe the differences in indications for spinal cord stimulation versus spinal infusion pump.
  3. List at least one different surgical treatment each for Parkinson disease, dystonia, spasticity, and hemifacial spasm.
  4. Define the different types of seizures (simple, partial, etc.).
  5. Describe the differences between temporal lobectomy, lesionectomy, and disconnective surgery for seizure disorders.

Patient care

The neurological examination

  1. Evaluate patient’s mental status and speech.
  2. Examine the cranial nerves.
  3. Examine central and peripheral sensory function.
  4. Examine motor function.
  5. Examine cranial and peripheral reflexes.
  6. Examine cerebellar function and gait.

Diagnosis and management of head trauma

  1. Assign the Glasgow Coma Score.
  2. Initiate management of elevated intracranial pressure in head trauma.
  3. Define concussion, brain contusion, and diffuse axonal injury, and initiate management of each.
  4. Distinguish anatomically and radiographically acute subdural and epidural hematoma, and describe the surgical indications for each.
  5. Describe the initial management of penetrating high and low velocity head trauma.
  6. Describe the management of chronic subdural hematoma.


Diagnosis and management of brain tumor and abscess

  1. Know the relative incidence and location of the major types of primary and secondary brain tumors.
  2. Describe the general clinical presentations of brain tumors in the following locations: cerebral hemisphere, cerebellum, brainstem, pituitary, and cerebellopontine angle.
  3. List the advantages and limitations of the following diagnostic tools used in the evaluation of brain tumors: CT, MRI, MR spectroscopy, and angiography.
  4. Describe the surgical indications for the most common benign and malignant tumors in the locations listed in #2.
  5. Describe the indications for and the differences between radiotherapy and radiosurgery in the treatment of malignant brain tumors.
  6. List the major differences between the diagnosis and management of brain tumor and abscess.
  7. List the most common etiologies of cerebral abscess.

Diagnosis and Management of Headache

  1. Distinguish the radiographic presentation of the major causes of intracranial hemorrhage: hypertensive intracerebral hemorrhage, amyloid intracerebral hemorrhage subarachnoid hemorrhage, arteriovenous malformation hemorrhage, tumor hemorrhage, and coagulopathy hemorrhage.
  2. Apply the following diagnostic tools in evaluation of acute headache (CT, MRI, angiogram, and lumbar puncture).
  3. Describe the broad treatment strategies (surgery, radiosurgery, interventional radiology, as well as treatment of vasospasm) of intracranial aneurysms and vascular malformations.
  4. Differentiate the symptomatology of migraine, cluster, tension, and sinusitis headache.

Spinal trauma

  1. Describe the rapid assessment of a patient with spinal trauma
  2. Recognize the common spine fractures on X-ray.
  3. Initiate acute management of spinal cord injury including immobilization, steroids, and systemic measures.
  4. Define the unstable spine.

Interpersonal and communication skills

Case presentations

  1. Present a case to your preceptor, including relevant history, neurological examination, imaging findings, and treatment plan.

Participation on the wards

  1. Ask neurosurgical staff (residents, attendings, etc.) questions as appropriate to enhance learning opportunities both in and out of the OR.

Professionalism

Operating room

  1. Demonstrate professionalism in the operating room; do not be disruptive, but feel free to participate, including asking questions, reviewing images, pathology, intraoperative findings, etc.
  2. Demonstrate level of interest by scrubbing in on cases at the discretion of the resident and attending.

Conferences

  1. Attend all scheduled conferences.
  2. Feel free to participate and ask questions.

patient journey

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