2014 05 26 g1ha 1 intro bb
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MULC
LEIDSUNIVERSITAIRMEDISCHCENTRUM
LM C
U
Hersenen en AansturingIntroductie
G1HA 1314
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MULC 2Blokcordinatoren
Dr. E.L.E.M. Bollen (Neurologie)
Dr. E.A.J.F. Lakke (Neuroanatomie)
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MULC 3
e.a.j.f.lakke@lumc.nl
071 527 9357 (never there)
0649 034226
mailto:e.a.j.f.lakke@lumc.nlmailto:e.a.j.f.lakke@lumc.nl -
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MULC Hersenen en Aansturing
Onderwerpen
Macroscopische NeuroanatomieColleges, snijzaal, WG MRI
Th 1: Het 2emotorneuron
Th 2: Het 1emotorneuron
Th 3: Hersenzenuwen en Coma
Th 4: Parkinson en AtaxieTh 5: Sensibiliteit en Dermatomen
Th 6: Visueel systeem en Cognitieve functies
Th 7: Gedragsstoornissen bij kinderen
Th 8: Depressie
Themas
Steeds HC basis, HC kliniek, studieopdracht, WG, RC
WG Populaire Neurowetenschap
4
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MULC Hersenen en Aansturing
Toetsing:
HalfwegtoetsMaandag 3 juni
16 open vragen over Macroscopische Neuroanatomie en Thema 1-3
Hiervan 9 MRI
Eindtoets
Vrijdag 5 juli64 MC/EM vragen over alles
WG Populaire Neurowetenschap
V/NV, als NV een vervangende opdracht
5
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MULC Blackboard 6
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MULC Macroscopische neuroanatomie 7
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MULC Leerdoelen
U kunt de highlights uit de geschiedenis van de neurofilosofie beschrijven.
U kunt beschrijven uit welke celtypen centraal en perifeer zenuwstelsel bestaan en wat de functie van deze
cellen is.U kunt de onderdelen van het neuron en hun functie beschrijven.
U kunt uitleggen hoe de membraan- en actiepotentiaal ontstaan, en welke rol de evenwichtspotentiaal van de
belangrijkste ionen hierin speelt.
U kunt uitleggen hoe de actiepotentiaal zich verplaatst langs het axon en wat de rol van de myelineschede
hierbij is.
U kunt uitleggen hoe de synaps functioneert, en u kunt de belangrijkste neurotransmitters beschrijven.
U kunt uitleggen wat een EPSP en een IPSP is, en hoe deze een volgende actiepotentiaal kunnen veroorzaken.
U kunt de neuromusculaire overgang beschrijven en u kunt uitleggen hoe een spiervezel tot een maximale
contractie gebracht kan worden.
U kunt de onderverdeling en onderdelen van het zenuwstelsel redelijk gedetailleerd beschrijven, en deze labelen
in plakken, CT en MRI.
U kunt de twaalf hersenzenuwen benoemen, en hun beloop en functie beschrijven.
U kunt de vascularisatie (arterieel en veneus) van het centraal zenuwstelsel beschrijven, alsmede destroomgebieden van de belangrijkste cerebrale vaten.
U kunt de doorgangen door de schedelbasis en de inhoud van die doorgangen beschrijven.
U kunt de holten in het brein beschrijven en op plakken, CT en MRI labelen.
U kunt de vliezen rond het centraal zenuwstelsel en de bijbehorende duplicaturen en ruimten beschrijven,
alsmede hun inhoud.
U kunt uitleggen hoe de liquor cerebrospinalis door de ruimten in en om het brein circuleert.
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MULC Sixty-Six Salient Structures
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MULC Sixty-Six Salient Structures
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MULC Neuroanatomie studiemateriaal
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MULC 12Slices
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MULC Links
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MULC 14Links
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MULC 15HeadNeckSpine; Brain MRI
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MULC 16Links
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MULC 17Links
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MULC 18Harvard Whole Brain
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MULC 19Harvard Whole Brain
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MULC 20Links
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MULC 21S4 Viewer
This viewer employs the same slices as in the lectures and ppt files!
Check Help function and set to ADVANCED
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MULC Neuroanatomie studiemateriaal
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MULC MRIcroN
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MULC 24MRIcroN
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MULC 25MRIcroN Viewer
Viewer & datasets
Downloaden via BlackBoard
Unzippen en installeren
Uitleg Hfdst 4.8 BlokBoek
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MULC 26MRIcroN Viewer
Viewer & datasets
Downloaden via BlackBoard
Unzippen en installeren
Uitleg Hfdst 4.8 BlokBoek
DOE DIT VANDAAG
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MULC Snijzaal
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MULC Snijzaal
A once-in-a-l ifetime-opportunity ! !
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MULC Snijzaal 29
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MULC 30Snijzaal
Skillslab, in kelder van Onderzoeksgebouw
Op tijd komen!
Als te laat, telefoon naast ingang gebruiken
Schone witte jas en handschoenen verplicht
A guided tour through the central nervus system.
Maar .you can only see what you know, sothorough
preparation is of the utmost importance!!
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MULC 31Snijzaal
Skillslab, in kelder van Onderzoeksgebouw
Op tijd komen!
Als te laat, telefoon naast ingang gebruiken
Schone witte jas en handschoenen verplicht
A guided tour through the central nervus system.
Als je niet weet wat je gaat zien, kun je er donder op zeggen dat
je het zelfs niet ziet als het je wordt aangewezen.
Bereid je dus steeds grondig voor (Snijzaal handleiding).
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MULC 32
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MULC 33
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MULC 34
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MULC 35
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MULC 36
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MULC 37
ULA k
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MULC 38Anatomie is een LEERvak
Neuroanatomie begint metleren!!
ULP l
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MULC 39Potjeslatijn
Gebruiken we veel, ervan uitgaande dat jullie dat begrijpen.
Zo niet, ZEG DAT DAN, blijf niet stil zitten hopen dat het vanzelf over gaat.
Zoek zelf de BETEKENIS van namen zo veel mogelijk op!
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MULC
LEIDSUNIVERSITAIRMEDISCHCENTRUM
LM C
U
Geschiedenis van de Neurofilosofie
ULN i li hi
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MULC 41Neurosurgery in neolithic eras
Neolithic
10000 BC7000 BC
5000 BC
3500 BC
3500 BC
3500 BC
1750 BC
1500 BC
1000 BC
300 BC
300 BC
300 BC
100 AD 150 AD 150 AD
150 AD
250 AD
ULE id l h
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MULC Epiduraal hematoom 42
ULEd i S i h i l 1700 BC
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MULC 43Edwin Smith surgical papyrus; 1700 BC
ULI h t
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MULC 44Imhotep
Approx 2700 BC; Physicianpriestdeity (Asklepios to the Greeks)
Classes of severity
An ailment I will treat
An ailment with which I will contend
An ailment not to be treated
Knowledge of
Hemi- and quadriplegia
Urinary incontinence
Priapism
Contralaterality
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MUC 45
ULE ti hil h
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M C 46Egyptian neurophilosophy
Consciousness, soul & intelligence located in the heart
Heart is left in place for embalming
Other intestines in separate jars
Brain is discarded
ULA i t G k
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M C 47Ancient Greeks
Anaximander, Heraclitus Panta rei et medn agan),Pythagoras and Empedocles define earth, water, fire and air
as the basic elements
Alcmeaen proposed that the brain as the central organ of
sensation and thought
Hippocrates (460-370 BC) associated the basic elements with
four types of bodily fluids; yellow bile, black bile, blood and
phlegm; humoral theory Locates the soul in the brain!
"Tell me where is fancy bred, or in the heart or in the head"
(Shakespear)
ULTh R h i i
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M C
Galen (130-300 AD)
Advocated the use of dissection to acquire knowledge
No human dissection, proscribed by Roman law
First theory of brain function!
Heart produces vital spirit (life fluid)
Rete mirabile to brain
Brain makes animate spirit (soul fluid)
Flows through hollow nerves to cause movement or
sensation
Animate spirit is instrument of soul
Intellect located in the brain!!
Galen will remain the authority for 1500 years!!
48The Roman physician
ULRete mirabile
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M C 49Rete mirabile
ULPig Human
http://www.ajnr.org/content/vol20/issue5/images/large/i0195-6108-020-05-0765-f03.jpeg -
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M C 50Pig Human
ULMiddle Ages
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M C 51
Early on a Nemesius mistakes Galen, and puts everything (intellect, soul etc) into the
ventricles
From that moment onwards, theres not much going on, brain-wise, except for heated
discussion about what is in which ventricle
Because there is no real interest in the physical brain, the ventricles become
abstracted into three spheres
Middle Ages
ULAndreas Vesalius
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M C 52Andreas Vesalius
1514-1564
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M C 53
UL54
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M C 54
ULC 55Andreas Vesalius
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M C 55Andreas Vesalius
1514-1564
1543 De humanis corporis fabr ica (Ti tiaan)
Rejects ventricular localization, but does not
renounce the spirit theory
MULC 56Thomas Willis
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M C 56Thomas Willis
1621-1675
1664 Cerebri anatome
Locates memory and will in gyri of cerebrum
Functional localization
Clinical observation
Experimental observation
MULC 57Ren Descartes
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M C 57Ren Descartes
1596-1650
1662 De homine
Reflexive theory
Human as automaton, soul for
voluntary stuff
Interaction mind-body through
pineal gland (dualistic!)
MULC 58From animal spirit to bio-electricity
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M C 58From animal spirit to bio-electricity
Jan Swammerdam (1637-1680); frog-leg preparation
Luigi Galvani (1737-1798); electrophysiology
MULC 59
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M C 59
MULC 60Showmanship enters the scene
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M C 60Showmanship enters the scene
Giovanni Aldini (1762-1834)
When one rod was moved to touch the rectum, the whole body convulsed: indeed,
the movements were so much increased as almost to give an appearance of re-
animation.
MULC 61Bell-Magendie
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M C 61Bell Magendie
Bell (1774-1842); Magendie (1783-1855)
Bell-Magendie law: dorsal roots are sensory, ventral roots are motor
=> Functional localization is back!
MULC 62Franz Joseph Gall
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M C 62Franz Joseph Gall
1757-1828
Skull features are an indication of underlying brain development
The development of specific cortical regions correlates with specific talents or
behaviours
Phrenology
MULC 63
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M C 63
MULC 64Flourens (1794-1876)
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M C 64Flourens (1794 1876)
1794-1876
Introduced the tool to study localization: the
stimulation/ablation experiment.
Studied young mammals with this
BAD CHOICE; plasticity
Concluded that cortex could not be subdivided in
functional units
At least partly influenced by his distaste of theunscientific and populist methods of Gall
MULC 65Gall vs Flourens
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M C 65Gall vs Flourens
Gall was right about cortical functional localization, but his science was bogus
Flourens was a good scientist but biased against phrenology
Bogus with the right idea against science with the wrong belief
Gall is an idiot,
and whatever he
says is wrong! !
Who cares??
Im rich and
famous anyway
MULC 66Paul Broca
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M C 66Paul Broca
1824-1880
First description of a functional area of the cortex
Centre of speech (Centre of Broca)
Finally establishes cortical localization
MULC 67Eduard Hitzig & Gustav Fritsch
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M C 67Eduard Hitzig & Gustav Fritsch
1838-1907; 1838-1927
The hunt for cortical localization is on!!
First (partial) map based on electrical stimulation,
describe motor cortex
MULC 68David Ferrier & John Hughlings Jackson
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M C 68David Ferrier & John Hughlings Jackson
1843-1924; 1835-1911
Ferrier extends work of Hitzig & Fritsch by extensive animal experimentation &
correlates the experimental map to Jacksons clinical findings
Neurosurgeons start to use functional maps of the brain to guide them in their surgical
approach
MULC 69Wilder Penfield
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M C 69Wilder Penfield
1891-1976
Stimulates cortex of patients during surgery
MULC 70Cortical somatotopy
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M C Co tical somatotopy
MULC 71Korbinian Brodmann
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M C
1868-1918
Studies the structure of the cortex
6 layers
Subtle differences
46 different areas
MULC 72Form and function
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M C f
1) The cerebral cortex consists of areas that subserve specific functions
2) The laminar construction of the cortex differs subtly between these areas
MULC 73Reticulum vs Neuron
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M C
Purkinje (1787-1869) draws the first neuron
Schwann (1810-1882) proposes that body consists of cells
Everybody says: Thats OK, but not the brain
Not surprising as it was now known that electric current, generated by the brain,
passed in some way through the nerve fibres and nerves to the muscles, and it was a
logical step to presume that the nervous system should be a reticulum.
How else could current flow from one neuron to the other if they were not incontinuity?
Deiters (1834-1863) demonstrates that nerve fibers and cell bodies belong together
MULC 74Golgi vs Ramon y Cajal
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M C g y j
Golgi (1843-1926) Reticulum doctrine
Ramon y Cajal (1852-1934) Neuron doctrine
MULC 75How do neurons talk?
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M C
Sherrington (1857-1952)
Discovers the delay incurred by going from
one neuron to the next.
Coins the term "Synaps"
MULC 76Synaps electrical of chemical?
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M C y p f
Loewi (1873-1961)
Acetylcholine; first neurotranmitter
MULC 77Axon and action potential
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M C p
Hodgkin (1914-1998) & Huxley (1917)
MULC 78Axon and action potential
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M C p
Hodgkin (1914-1998) & Huxley (1917)
MULC 79To cortex again
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C g
All breakthroughs with respect to cortical functional localization, or with respect to the
functioning of the cortex were made in the human brain!
Cortical function is high-level, and it is hard to know what animals think, feel etc.
Many rreas not even present in animal brain
=> Research in this field will remain restricted to research in humans!!
MULC 80Imaging the human brain
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MULC 81Richard Caton
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1842-1926
Records electricity from cortex (evoked potentials)
Mirror galvanometer
MULC 82Willem Einthoven
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1860-1927
String galvanometer; ECG
MULC 83Willem Einthoven
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1860-1927
String galvanometer; ECG
MULC 84Hans Berger
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1873-1941
Electroencephalogram (EEG)
MULC 85WC Rntgen 1895
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MULC 86Skull X ray
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MULC 87Ventriculography
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MULC 88Angiography
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MULC 89Computed axial tomography
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1959 GN Hounsfield; EMIDEC 1100 (first large all transistor computer)
1963 AM Cormack; mathematical equations for axial tomography
1971 GN Hounsfield; first CAT scanner (head only)
MULC 90
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MULC 91
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MULC 92
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MULC 93MRI
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1946 D Purcell; Magnetic resonance
1971 R Damadian; MR of normal and diseased tissue is different!
1977 R Damadian; first MRI of human body
MULC 94MRI scanner
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Magnetic Resonance Imaging
Harmless
Resolution still improving Many possibilities
Morphology
Functional imaging
Blood flow
Spectroscopy
MULC MRI: normal anatomy 95
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MULC 96Saturation imaging
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Active brain tissue uses oxygen!
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MULC 98fMRI ocular dominance stripes
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MULC 99Cortical plasticity
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fMRI during li p pursing; I n amputees with phantom limb pain l ip cortical representation
has extended into hand/arm region
(Flor et al. Nature Reviews Neuroscience 7, 873
881, 2006)
MULC 100
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MULC 101(f)MRI the technique of your future
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Magnetic Resonance Imaging
Resolution still improving
Many possibilities
Morphology
Functional imaging
Blood flow
Spectroscopy
MULC 102(f)MRI the technique of your future
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Magnetic Resonance Imaging
Resolution still improving
Many possibilities
Morphology
Functional imaging
Blood flow
Spectroscopy
Many questions regarding the cognitive
functioning of our brain will be resolved in
the near future using this technique
MULC 103LUMC promotion
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Leiden Institute for Brain and Cognition
Interdisciplinary
State of the art
Gorter Institute
7T MRI scanner
Highest field in the Netherlands
MULC 104LUMC promotion
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Leiden Institute for Brain and Cognition
Interdisciplinary
State of the art
Gorter Institute
7T MRI scanner
Highest field in the Netherlands
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