JINNAH SINDH MEDICAL UNIVERSITY

STUDY GUIDE
PROGRAM MBBS
MODULE TITLE NERVOUS SYSTEM-1
ACADEMIC YEAR 2nd year, 2025
INTRODUCTION The Nervous system module is developed to provide the learners with
in-depth knowledge about how the brain is structured and how it works
under normal circumstances. Students learn the developmental processes
of the brain in order to understand where the structures come from and
how eachis linked with the others.
This module deals not only with the brain but also with the peripheral &
autonomic nervous systems. Students get to know how the human
body carries out its myriad functions, some of which are under our
control (e.g. walking) while others are not (e.g. beating of the heart).
The Autonomic Nervous system, one of the essential systems maintaining
our homeostasis, is dealt with in detail. One of the main reasons for this
is because many medications alter Autonomic functions. A doctor has
to have detailed knowledge about such medications and their interactions.
RATIONALE Since conditions related to the Nervous system are common in Pakistan,
detailed knowledge of the normal gross, microscopic and molecular
structure and functions are necessary at the initial level.
OUTCOMES By the end of the module, students will be able to describe the normal
gross, microscopic and molecular structure and functions of the central,
peripheral and the Autonomic Nervous Systems.
DEPARTMENTS 1. Anatomy
INVOLVED 2. Biochemistry
3. Physiology
MODULE By the end of the module, the students will be able to:
OBJECTIVES
LECTURES 1. General organization & Histology of Nervous system,
ANATOMY different typesof nerve tissue cells (Neurons & Neuroglia)
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 Explain the general components of nervous system.
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 Discuss the division of nervous system into CNS, ANS & PNS.

 Discuss the structural/ cellular organization of nervous system.

 Classify the types of neuron & neuroglia.

 Describe the structure of neuron & neuroglia.

2. Development of Brain and Spinal cord & anomalies (Embryology)

 Describe the formation of primary & secondary vesicles and flexures.

 Relate the components of ventricular system with the

cavities ofsecondary vesicles.
 Describe the differentiation of the layers from neuro-
epithelium inprimitive spinal cord.
 Describe derivation of alar & basal plates, neuron and
neuroglia cells.
 Discuss positioning of spinal cord.
 Describe the congenital anomalies of spinal cord viz. Spina
bifidaocculta, spinal bifida cystica, Myeloschisis.

3. Gross External features of spinal cord

 Discuss the extent (starting & terminating point) of spinal cord.

 Describe the gross features of spinal cord and its blood supply.

 Discuss the regional enlargements of spinal cord.

4. Histology of spinal cord

 Discuss the microscopic structure of spinal cord.

 Compare the sections at different segmental levels (cervical,
thoracic)

5. Internal features of spinal cord I- (Ascending tracts)

 Discuss the internal features of spinal cord, gray (groups) &

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white(columns) matter.
 Discuss 1st, 2nd & 3rd order neurons of sensory pathway.

 Discuss in detail the ascending (sensory) tracts of the spinal

cord andtheir lesions.

6. Internal features of spinal cord II- (Descending tracts)

 Discuss in detail the descending (motor) tracts of the spinal

cord.

 Relate the lesions of descending tracts.

7. Development of forebrain (Embryology)

 Discuss the process of development of forebrain and its anomalies.

8. Development of midbrain & hindbrain (Embryology)

 Discuss the process of development of midbrain & hindbrain and

theiranomalies.

9. Blood supply (arterial supply & venous drainage) of spinal

cord andclinical manifestations of ischemia

 Describe the Vertebral Systems of arteries.

 Describe the area of spinal cord supplied by different branches.

 Discuss the role of radicular and feeder arteries.

 Describe the venous drainage of spinal cord.

 Relate the clinical consequences of ischemia of spinal cord.

10. Gross anatomy of Cerebellum

 Describe the gross anatomy of the cerebellum

location,structural & functional division (lobes) and
its blood supply.
 Describe the folia, tracts and nuclei of cerebellum.

 Relate the clinical conditions associated with cerebellar dysfunction.

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11. Histology of Cerebellum

 Describe the layers of cerebellar cortex.

 Describe the cellular organization in each layer.

12.Diencephalon I- Thalamus
 Describe the gross features, boundaries and division of
diencephalon and its blood supply.
 Describe the gross features and relations of Thalamus.
 Discuss the nuclei, connections and functions of thalamus.
 Relate the clinical conditions associated with thalamus.
13.Diencephalon II- Sub thalamus, Hypothalamus & Epithalamus
 Describe the location, relations, components and structure of
subthalamus, hypothalamus & epithalamus.
 Discuss their nuclei, connections and functions.
 Discuss the lesions of sub thalamus, hypothalamus &
Epithalamus.

14.Limbic system & Reticular formation

 Describe the various parts of limbic system.
 Explain the hippocampal formation.
 Discuss the disorders of limbic system.

15.Basal ganglia & its nuclei

 Describe the location and components of basal ganglia and
their blood supply.
 Discuss their connections and functions.
 Discuss the lesions of basal ganglia.

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16.Histology of cerebrum
 Describe the layers of cerebral cortex.

 Discuss the variation of layers in different cortical regions.

 Describe the types of neurons and fibers distributed in different

layers.

17.White matter of cerebrum -I (Projection fibers and internal capsule)

 Discuss the basic concepts of white matter of cerebrum.

 Describe the location, parts, connections and

relations ofinternal capsule and its blood supply.
 Discuss the common lesion associated with the internal capsule.

18. White matter of cerebrum- II (Commissural & Association fibers)

 Discuss the commissural fibers and their connections.

 Describe corpus callosum and its parts.

 Explain the association fibers and their connections.

 Discuss the common lesions associated with

commissural andassociation fibers.

19. Meninges of brain & spinal cord

 List the meninges of brain & spinal cord.

 Describe the Dural layers, folds, extensions and spaces (subdural

etc.)
 Discuss pia mater and its modifications (ligamentum denticulatum,
telachoroidea).
 Describe the arachnoid mater, subarachnoid space and cisterns.

 Describe the blood and nerve supply of meninges.

20.Dural venous sinuses

 Describe the location, relations, and drainage of Dural venous

sinuses ofbrain.
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 Describe the contents of cavernous sinus and extra
cranialcommunication.

 Discuss the clinical importance of different sinuses.

21.Autonomic Nervous System

 Describe the divisions of ANS (sympathetic & parasympathetic).

 Describe the components of sympathetic nervous system

 Discuss the components of parasympathetic part of nervous system

 List the parasympathetic ganglia.

 Describe the pathways of pre and postganglionic parasympathetic

fibers.
 Differentiate between the 2 systems on the basis of structure and
function.

1. Neuronal membrane potential, generation & propagation

PHYSIOLOGY of nerveimpulse
 Describe the structure and functions of a neuron.
 Discuss the classification & functions of nerve fibers.
 Describe the threshold, initiation of action potential and propagation
of nerve impulse in neuronal cells.

2. Synapses, properties of synapses

 Describe the properties of chemical and electrical synapses.

3. Sensory receptors and neuronal circuits

• Discuss the classification of sensory receptors.
• Describe the functions & properties of different types of receptors.
• Explain the properties of different types of neuronal circuits.

4. Somatic sensations - I
• Explain the general organization of somatic sensation: tactile

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andposition senses.
• Discuss the dorsal-column medial lemniscal pathway.

5. Somatic sensations – II
• Discuss the anterolateral pathway.
• Describe the mechanism of thermal receptors & their excitation.
6. Physiology of pain – I and headache
• Discuss the types of pain and their characteristics
• Explain the mechanism of stimulation of pain receptors
• Discuss the clinical abnormalities of pain: hyperalgesia, headache
& its causes.

7. Physiology of pain II- Brain analgesic system

• Explain the analgesic system of brain.

• Discuss the opiate system of brain.
• Describe visceral & referred pains.

8. Spinal cord and cord reflexes

 Describe the motor functions of spinal cord.
 Explain the structure and function of muscle spindle.
 Discuss the muscle, stretch reflex and its clinical applications.

9. Muscles proprioceptors (muscle spindle and Golgi tendon organ)

 Discuss the mechanism of flexor reflex, crossed extensor reflex,
scratch reflex, postural and locomotive reflexes.
 Discuss spinal cord transection and spinal shock (Brown-Sequard
syndrome)
 Explain the mechanism of Golgi tendon reflex and its
significance in controlling motor activities.

10. Somatosensory cortex

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 Discuss the orientation of various areas of cortex and their
associatedfunction.
 Describe the layers of somatic sensory cortex and their functions.
11. Function of brain stem
 Explain the role of brain stem nuclei in controlling motor functions.
 Discuss the vital and non- vital functions of brain stem

12. Cerebellum and its functions

 Explain the functional areas of cerebellum.
 List the functions of Vermis, Intermediate zone and lateral zone of
cerebellum.

13. Neuronal circuits of cerebellum and

associated disorders
 Discuss the afferent and efferent pathways of cerebellum.
 Describe the Functions of Purkinje cells and deep cerebellar nuclei.
 Explain the abnormalities associated with cerebellar lesion.
14. Vestibular system and maintenance of equilibrium
 State the names of the parts of vestibular system.
 Explain the functions of the vestibular system.
 Discuss the role of utricle & saccule in static equilibrium.
 Discuss the role of semicircular ducts in
angular acceleration.

15. Functions of diencephalon

 Discuss the functions of thalamus and its nuclei.
 Explain the functions of various nuclei of epithalamus and
hypothalamus.

16. Regulation of body temperature and fever

 Distinguish between skin temperature and core temperature.

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 Describe the following mechanisms of heat loss from the body;
conduction, convention, radiation and evaporation.
 Explain the role of anterior and posterior hypothalamus in regulation
of body temperature.
 Elaborate “set-point” of temperature control mechanisms and the
role of pyrogens in altering the set point to cause fever.

17. Limbic system and hypothalamus

 Describe the functional areas of limbic system.
 Discuss the role of hypothalamus in limbic system.
 Discuss the importance of reward and punishment centers.
 Explain the role of hippocampus and amygdala.
 Discuss the effects of Kluver-Bucy syndrome.

18. Basal ganglia and its nuclei

 Explain the functions of caudate & putamen pathways.

 List the functions of specific neurotransmitters of basal ganglia.
 Explain the disorders associated with basal ganglia

19. Motor cortex, pyramidal tract, Upper and lower Motor Neurons
 Explain the functions of pyramidal tract.
 List the functions of specific cortical motor areas.
 Differentiate between upper & lower motor neuron lesions

20. Physiology of sleep and sleep disorders

 Explain the physiology of slow wave sleep & rapid eye
movement(REM) sleep.
 Explain the basic theories of sleep & origin of brain waves.

21. Learning and memory

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 Define the role of cerebral cortex in higher intellectual functions.
 Classify the different types of memories.

22. CSF: formation, circulation and function

 Describe the mechanism of CSF formation, its circulation &
functions.
23. Autonomic Nervous System -I
 Explain the functional division of Autonomic Nervous System

 Discuss the organization of sympathetic & parasympathetic

nervous system, their neurotransmitters and receptors in body
systems.

24. Autonomic Nervous System-II

 Explain the effect of sympathetic and parasympathetic nervous
system on various organs.
 Discuss various abnormalities caused by activation of
sympathetic and parasympathetic nervous system.

25. Speech and its disorders

 Explain the physiology of speech and associated disorders.
BIOCHEMISTRY 1. Lipids of the nervous system: Chemistry of Brain Lipids
 Classify brain lipids with examples
 Explain the chemistry of brain lipids
 Describe the chemical composition and functions of myelin
 Discuss the clinical significance of lipid storage diseases

2. Blood Brain Barrier

 Define Blood Brain Barrier
 State the biochemical composition of the Blood Brain Barrier
 Explain the functions of the Blood Brain Barrier
 Explain the impact of Blood Brain Barrier disruption

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 Discuss the clinical disorders associated with Blood Brain
Barrier disruption
3. Cerebrospinal fluid
 Describe the chemical composition of CSF and its functions
 Explain the mechanism of production, route of flow and re-
absorptionof CSF
 Explain the procedure of lumbar puncture
 Interpret the laboratory investigations of CSF in different diseases
4. Introduction of Neurotransmitters
 Define Neurotransmitters
 Classify Neurotransmitters with examples
 Describe the mechanism of action and functions of
Neurotransmitters
 Classify receptors of Neurotransmitters
 Explain the synthesis and degradation pathways of
Neurotransmitters
 Discuss the disorders associated with Neurotransmitter

5. Acetylcholine & Dopamine

 Describe the chemical structure of Acetylcholine and Dopamine
 Describe the metabolism of Acetylcholine and Dopamine
 Explain the mechanism of action and functions of
Acetylcholine &Dopamine
 Discuss the receptors of Acetylcholine and Dopamine
 Explain the clinical disorders associated with
Acetylcholine and dopamine
6. Serotonin & GABA
 Describe the chemical structure of Serotonin and GABA
 Describe the metabolism of Serotonin and GABA
 Explain the mechanism of action and functions of Serotonin and
GABA
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 Discuss the receptors of Serotonin and GABA
 Explain the clinical disorders associated with Serotonin and GABA

7. Neurodegenerative diseases of CNS

 List the common Neurodegenerative diseases
 Discuss the common mediators of Neurodegenerative diseases

 Discuss the biochemical changes in Neurodegenerative diseases

 Describe the biochemical phenomenon of ageing

8. Role of free radicals & Vitamins in CNS disorders

 Explain the role of free radicals in Neurodegenerative diseases
 List the free radicals causing degenerative diseases
 List the sources of free radicals
 Explain the mechanism of free radical injury
 Describe the role of free radicals in diseases
 Classify the antioxidants with examples
 Discuss the process of oxidative stress response
 Discuss the biochemical importance of vitamins in
neurologicaldisorders
 Discuss the sources, biochemical role and daily
requirements ofvitamins B1, B6, B9, B12 and folic acid
 Explain the deficiency diseases related to these vitamins
DEMONSTRATIO 1. Skull as whole, vault of skull + Anterior cranial fossa
NS/TUTORIALS  Describe the gross anatomy of skull.
ANATOMY  Discuss the sutures of skull.
 Discuss different views (normal) of skull.
 Discuss the divisions of the cranial cavity.
 Describe the boundaries, bony prominences and foramina
of theanterior cranial fossa.

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2. Middle & Posterior cranial fossa
 Describe the boundaries, bony prominences and foramina of the
middle& posterior cranial fossa.

3. Spinal cord lesions, transection & spinal shock

 Discuss the lesions of anterior & posterior nerve roots.
 Elaborate the lesions of ascending & descending tracts.
 Discuss the mechanism & consequences of tabes dorsalis, spinal
shock.syndrome, Brown Sequard syndrome, poliomyelitis,
Syringomyelia.

4. Brainstem I- Medulla Oblongata

 Enumerate the parts of brainstem.
 Describe the gross anatomical features of Medulla Oblongata
and itsblood supply.
 Discuss in detail the internal features of Medulla Oblongata.
 Discuss the cranial nerves emerging from Medulla Oblongata.
 Discuss the clinical importance of Medulla Oblongata.

5. Brainstem II-Pons
 Describe the location of Pons.
 Discuss the external & internal features of Pons and its blood supply.
 Discuss the relation of Pons with 4th ventricle.
 Discuss the cranial nerves emerging from Pons.
 Discuss the clinical conditions associated with Pons.

6. Brainstem III -Midbrain

 Describe the location of midbrain.
 Discuss the external & internal features of midbrain with its supply.
 Discuss the relation of Pons with cerebral aqueduct.

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 Describes the cranial nerves emerging from midbrain.
 Discuss the clinical conditions associated with midbrain.

7. Gross anatomy of Cerebrum (external features, surfaces, gyri &

sulci)
 Discuss the gross anatomical features of cerebrum (surfaces,
borders,
poles, lobes, sulci & gyri).
 Describe the blood supply of cerebrum.

8. Functional cortical areas of cerebrum & their lesions

 Describe different functional areas of cerebral cortex (motor,
sensory,auditory, visual).
 Discuss the lesions of the functional cortical areas of cerebral cortex.

9. Ventricular system I- Lateral ventricle

 Describe the ventricles of brain.
 Discuss the location, boundaries and relations of lateral
ventricles andits blood supply.
 Discuss the clinical conditions associated with lateral ventricles.

10. Ventricular system II- 3rd & 4th ventricles and CSF circulation
 Describe the structure and location of 3rd and 4th ventricles,
andcerebral aqueduct.
 Briefly discuss the normal CSF secretion, circulation & blood
brainbarrier.
 Discuss the applied anatomy of ventricles of brain and CSF flow.
11. Cranial nerves (I to VI)
 Mention the names of all the cranial nerves in sequence.
 List the locations of the cranial nerve nuclei (I to VI).
 Discuss their distribution.
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 Describe the main effects of lesions of cranial nerves.

12. Cranial nerves (VII to XII)

 List the location of the cranial nerve nuclei (VII to XII).
 Discuss their distribution.
 Describe the main effects of lesions of VII to XII cranial nerves.

13. Functional cortical areas of cerebellum

 Discuss the location and lesions of the functional cortical
areas ofcerebellar cortex.

14. Blood supply of brain

 Discuss the carotid and vertebral systems of vessels.
 List the branches arising from them.
 Describe the formation of circle of Willis.
 Discuss its branches.
 Discuss the area of supply of the 3 cerebral arteries.
 Discuss the veins of brain and their area of drainage.
 Relate the clinical manifestations of ischemia of brain.

15. Spinal cord and its cut sections (Demonstration on Sectra)

 Discuss the various cut sections of spinal cord and associated
lesions.

BIOCHEMISTRY 1. Neurotransmitters-1 Acetylcholine & Catecholamine

 Discuss the clinical importance of Acetylcholine & Dopamine
 Interpret clinical conditions correlated with their
laboratoryinvestigations

2. Neurotransmitters-2 Serotonin & GABA

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 Discuss the clinical importance of Serotonin & GABA

 Interpret clinical conditions correlated with their

laboratoryinvestigations

3. Cerebrospinal fluid
 Discuss the clinical importance of Cerebrospinal fluid
 Interpret clinical conditions correlated with their laboratory
investigations
4. Neurodegenerative diseases of CNS
 Discuss the clinical importance of neurodegenerative diseases
Interpret clinical conditions correlated with their laboratory
investigations
PRACTICALS 1. Lumbar Puncture

BIOCHEMISTRY  Explain the procedure of Lumbar Puncture (LP)

 Identify the chemical tests and bio-techniques to detect analytes in
CSF
 Identify the parts of LP needle
 Interpret the laboratory report in different CNS diseases
Interpret clinical conditions correlated with their laboratory
investigations

2. CSF Glucose Estimation

 Identify the procedure & bio-technique to detect glucose in CSF
 Estimate glucose in CSF
 Interpret the laboratory report of glucose in CSF
 Interpret clinical conditions correlated with their
laboratoryinvestigations

3. CSF Protein Estimation

 Identify the procedure & bio-technique to detect proteins in CSF
 Estimate proteins in CSF
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 Interpret the laboratory report of proteins in CSF

 Interpret clinical conditions correlated with their

laboratoryinvestigations

4. CSF Chloride Estimation

 Identify the procedure & bio-technique to detect chloride in CSF
 Estimate chloride in CSF
 Interpret the laboratory report of chloride in CSF
 Interpret clinical conditions correlated with their laboratory
investigations
HISTOLOGY 1. Structure of neuron & neuroglia
 Describe the structure of neuron & neuroglia.
 List the types and functions of neuron & neuroglia.
 Discuss the formation of blood brain barrier.
 Identify the histological sections of neuron & neuroglia under
lightmicroscope.

2. Spinal cord, spinal nerve & ganglia

 Identify the histological features of spinal cord, spinal nerve & ganglia
under light microscope.
 Discuss the histological features of spinal cord, spinal nerve & ganglia.

3. Microscopic anatomy of cerebellar cortex

 Identify the histological features of cerebellar cortex under light
microscope.
 Discuss the histological features, layers, cells & nuclei of cerebellum.

4. Microscopic anatomy of cerebral cortex

 Identify the histological features of cerebral cortex under light
microscope.

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 Discuss the histological features, layers, cells & nuclei of cerebrum.
PHYSIOLOGY 1. Examination of Superficial reflexes
 Elicit superficial reflexes viz. Corneal reflexes, Abdominal
reflexes &Plantar reflexes.
 Describe their significance in different neurological disorders.

2. Examination of Deep reflexes

 Perform deep reflexes: Bicep reflex, tricep reflex, knee jerk,
ankle jerk,brachioradialis reflex.
 Describe their significance in upper and lower motor neuron
lesions.

3. Cerebellar function tests

 Perform cerebellar function tests.
 Identify disorders of cerebellar function.

4. Body temperature
 Determine the body temperature by using oral mercury thermometer.
 Describe the significance of body temperature taken through
oral,axillary and rectal route.

5. EEG
 Interpret brain waves with the help of power lab.
6. Examination of Cranial Nerves (CN I – CN VI)
 Perform different tests for examination of the cranial nerves I-VI.

7. Examination of cranial nerves (CN VII – XII)

Perform different tests for examination of cranial nerves VII-XII.
INTERNAL
 Internal evaluation carries 20% weight in professional examination.
ASSESSMENT
The mode of internal assessment may vary from one institution to the
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next.
ANNUAL  MCQs and OSPE (observed + un-observed)
EXAMINATION
MODULE  Course evaluation will be obtained through a feedback form which
EVALUATION will be posted on the JSMU website
SUGGESTED A. GROSS ANATOMY
READINGS
a. K.L. Moore, Clinically Oriented Anatomy
b. Neuro Anatomy by Richard Snell

ANATOMY B. HISTOLOGY
a. B. Young J. W. Health Wheater’s Functional Histology

C. EMBRYOLOGY
a. Keith L. Moore. The Developing Human
b. Langman’s Medical Embryology
BIOCHEMISTRY A. TEXTBOOKS

a. Harper’s Illustrated Biochemistry

b. Lippincott’s Illustrated reviews of Biochemistry

B. REFERENCEBOOKS
a. Lehninger’s Principles of Biochemistry

Biochemistry by Devlin
PHYSIOLOGY A . TEXTBOOKS
1. Textbook of Medical Physiology by Guyton and Hall
2. Ganong’s Review of Medical Physiology
3. Human Physiology by Lauralee Sherwood
4. Berne & Levy Physiology
5. Best &Taylor Physiological Basis of Medical Practice

B. REFERENCEBOOKS
1. Guyton & Hall Physiological Review

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2. Essentials Of Medical Physiology by Jaypee
3. Textbook Of Medical Physiology by InduKhurana
4. Short Textbook Of Physiology by Mrthur

NMS Physiology

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