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Nabeel Kouka, Nabeel Kouka, MD, DO, MBAMD, DO, MBAwww.brain101.infowww.brain101.info
Nabeel Kouka, Nabeel Kouka, MD, DO, MBAMD, DO, MBAwww.brain101.infowww.brain101.info
CerebralCerebralCortexCortex
CerebralCerebralCortexCortex
Brodman’s Map of Motor and Sensory AreasBrodman’s Map of Motor and Sensory Areas
Sensory areaSensory area primary sensory areaprimary sensory area secondary sensory areasecondary sensory area
Motor areaMotor area
primary motor areaprimary motor area secondary motor areasecondary motor area supplementary motor areasupplementary motor area
Association areaAssociation area
parietal, occipital and temporal cortexparietal, occipital and temporal cortex - conceptual elaboration of sensory data- conceptual elaboration of sensory data prefrontal (frontal) cortexprefrontal (frontal) cortex - judgement, foresight- judgement, foresight
Functional Localization of Cerebral CortexFunctional Localization of Cerebral CortexFunctional Localization of Cerebral CortexFunctional Localization of Cerebral Cortex
AgnosiaAgnosia
Tactile agnosiaTactile agnosia Visual agnosiaVisual agnosia
AlexiaAlexia Auditory agnosiaAuditory agnosia
ApraxiaApraxia
AphasiaAphasia
Wernicke’s (receptive) aphasiaWernicke’s (receptive) aphasia Broca’s (Motor) aphasiaBroca’s (Motor) aphasia conduction aphasiaconduction aphasia global aphasiaglobal aphasia
Disorders of Association CortexDisorders of Association CortexDisorders of Association CortexDisorders of Association Cortex
ApraxiaApraxiaApraxiaApraxia
The inability to execute a voluntary motor movement despite The inability to execute a voluntary motor movement despite being able to demonstrate normal muscle function.being able to demonstrate normal muscle function.
Cerebral Dominance (Lateralization, Asymmetry)Cerebral Dominance (Lateralization, Asymmetry)
Dominant HemisphereDominant Hemisphere
LanguageLanguage
– – speech, writingspeech, writing
CalculationCalculation
Non-dominant HemisphereNon-dominant Hemisphere
Spatial Perception (3D subject)Spatial Perception (3D subject)
SingingSinging
Playing musical instrumentPlaying musical instrument
LanguageLanguage
SpeechSpeech
WritingWriting
CalculationCalculation
3D perception3D perception
SingingSinging
Playing Musical Playing Musical
instrumentinstrument
Roger Sperry Roger Sperry
(1913-1994)(1913-1994)
1981 Nobel 1981 Nobel LaureateLaureate
Split BrainSplit BrainSplit BrainSplit Brain
CommissuratomyCommissuratomy
(split corpus callosum)(split corpus callosum)
Two minds in one brain?Two minds in one brain?
Sensory Language Area (Wernike's area) ---- Sensory Language Area (Wernike's area) ---- 22, 39, 4022, 39, 40
ReceptiveReceptive AphasiaAphasia - - area 22area 22 defect in comprehension, good spontaneous speechdefect in comprehension, good spontaneous speech AnomicAnomic AphasiaAphasia - - word finding difficultyword finding difficulty JargonJargon aphasiaaphasia - - fluent, but unintelligiable jargon fluent, but unintelligiable jargon
39 (supramarginal gyrus), 40 (angular gyrus)39 (supramarginal gyrus), 40 (angular gyrus)
Superior Longitudinal (Arcuate) FasciculusSuperior Longitudinal (Arcuate) Fasciculus
ConductionConduction AphasiaAphasia good comprehension, good spontaneous speechgood comprehension, good spontaneous speech poor repetition, poor responsepoor repetition, poor response
Motor Language Area (Broca’s area) --- 44, 45Motor Language Area (Broca’s area) --- 44, 45
MotorMotor ApahsiaApahsia good comprehension, no speech, agraphiagood comprehension, no speech, agraphia
Language AreasLanguage Areas
Arcuate FasciculusArcuate FasciculusThe groups of fibers that connect Broca's area with Wernicke's area (these fibers The groups of fibers that connect Broca's area with Wernicke's area (these fibers connect to the angular gyrus) and are located below the supramarginal gyrus. connect to the angular gyrus) and are located below the supramarginal gyrus.
According to Geschwind, damage to this area results in Conduction AphasiaAccording to Geschwind, damage to this area results in Conduction Aphasia
Language Areas (Geschwind Model)Language Areas (Geschwind Model)
Photograph of the brain Photograph of the brain of Paul Broca’s patient of Paul Broca’s patient called “Tan” (real name called “Tan” (real name is Leborgne).is Leborgne).
Broca’s AreaBroca’s AreaBroca’s AreaBroca’s Area
Pars triangularis and Pars triangularis and pars opercularis of the pars opercularis of the inferior frontal gyrus of inferior frontal gyrus of dominant hemisphere.dominant hemisphere.
Paul Broca (1824-1880)Paul Broca (1824-1880) Carl Wernicke (1848-1905) Carl Wernicke (1848-1905)
PET (positron emission tomography) scanPET (positron emission tomography) scan
PET (positron emission tomography) scanPET (positron emission tomography) scan
Composite radioisotope brain scanComposite radioisotope brain scan
Sensory HomunculusSensory HomunculusSensory HomunculusSensory Homunculus
Motor HomunculusMotor HomunculusMotor HomunculusMotor Homunculus
DiencephalonDiencephalon
Dorsal surfaceDorsal surface
DiencephalonDiencephalon
Ventral surfaceVentral surface
Diencephalon
Medial Surface
THALAMUSTHALAMUS
Classification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic Nuclei
I. I. Lateral Nuclear GroupLateral Nuclear Group
II.II. Medial Nuclear GroupMedial Nuclear Group
III.III. Anterior Nuclear GroupAnterior Nuclear Group
IV.IV. Posterior Nuclear GroupPosterior Nuclear Group
V.V. Metathalamic Nuclear GroupMetathalamic Nuclear Group
VI.VI. Intralaminar Nuclear GroupIntralaminar Nuclear Group
VII.VII. Thalamic Reticular NucleusThalamic Reticular Nucleus
Classification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic Nuclei
Basal Basal Ganglia Ganglia Basal Basal
Ganglia Ganglia
Traditional Concepts of Traditional Concepts of Basal GangliaBasal Ganglia
Corpus StriatumCorpus Striatum
Caudate NucleusCaudate Nucleus
Lenticular Nucleus PutamenLenticular Nucleus Putamen
Globus Pallidus Globus Pallidus PaleostriatumPaleostriatum Pallidum Pallidum
Corpus Amygdaloideum Corpus Amygdaloideum ArchistriatumArchistriatum
NeostriatumNeostriatum Striatum Striatum
Basal Ganglia Introduction Basal Ganglia Introduction Basal Ganglia Introduction Basal Ganglia Introduction
Afferent Connections of Basal GangliaAfferent Connections of Basal Ganglia
Efferent Connections of Basal GangliaEfferent Connections of Basal Ganglia
Clinical FeatureClinical Feature
Principal Pathologic Lesion:Principal Pathologic Lesion:
Corpus StriatumCorpus Striatum (esp. caudate nucleus) (esp. caudate nucleus) and Cerebral Cortexand Cerebral Cortex
- Predominantly - Predominantly autosomal dominantlyautosomal dominantly inherited chronic fatal diseaseinherited chronic fatal disease (Gene: chromosome 4)(Gene: chromosome 4)- Insidious onset: Usually 40-50- Insidious onset: Usually 40-50- Choreic movements in onset- Choreic movements in onset- Frequently associated with- Frequently associated with emotional disturbancesemotional disturbances- Ultimately, grotesque gait and sever- Ultimately, grotesque gait and sever dysarthria, progressive dementiadysarthria, progressive dementia ensues.ensues.
HUNTINGTON’S CHOREAHUNTINGTON’S CHOREA
SYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREA
- Complication of- Complication of Rheumatic FeverRheumatic Fever- Fine, disorganized , and - Fine, disorganized , and random movements ofrandom movements of extremities, face andextremities, face and tonguetongue- Accompanied by - Accompanied by Muscular HypotoniaMuscular Hypotonia- Typical exaggeration of- Typical exaggeration of associated movements associated movements during voluntary activityduring voluntary activity- Usually recovers- Usually recovers spontaneously spontaneously in 1 to 4 monthsin 1 to 4 months
Clinical FeatureClinical Feature
Principal Pathologic Lesion: Principal Pathologic Lesion: Corpus StriatumCorpus Striatum
HEMIBALLISMHEMIBALLISMHEMIBALLISMHEMIBALLISM
- Usually results from CVA- Usually results from CVA (Cerebrovascular Accident)(Cerebrovascular Accident) involving subthalamic nucleusinvolving subthalamic nucleus- sudden onset- sudden onset- - Violent, writhing, involuntaryViolent, writhing, involuntary movements of wide excursionmovements of wide excursion confined to confined to one half of the bodyone half of the body- The movements are continuous- The movements are continuous and often exhausting but ceaseand often exhausting but cease during sleepduring sleep- Sometimes fatal due to exhaustion- Sometimes fatal due to exhaustion- Could be controlled by- Could be controlled by phenothiazines and stereotaxicphenothiazines and stereotaxic surgery surgery
Clinical FeatureClinical Feature
Lesion: Lesion: Subthalamic NucleusSubthalamic Nucleus
Muhammad Ali in Alanta OlympicMuhammad Ali in Alanta Olympic
Parkinson’s DiseaseParkinson’s Disease
Disease of mesostriatal Disease of mesostriatal dopaminergic systemdopaminergic system
PDPD
normalnormal
Substantia Nigra, Substantia Nigra, Pars Compacta (SNc)Pars Compacta (SNc)
DOPAminergic NeuronDOPAminergic Neuron
Slowness of MovementSlowness of Movement- - Difficulty in Initiation and Cessation Difficulty in Initiation and Cessation of Movementof Movement
Clinical Feature (1)Clinical Feature (1)
Parkinson’s Disease - Paralysis AgitansParkinson’s Disease - Paralysis Agitans
Clinical Feature (2)Clinical Feature (2)
Resting TremorResting TremorParkinsonian PostureParkinsonian PostureRigidity-Cogwheel RigidityRigidity-Cogwheel Rigidity
Parkinson’s Disease Parkinson’s Disease
Paralysis AgitansParalysis Agitans
Numerical DataNumerical Data
Number of neuronal cells in cerebral cortexNumber of neuronal cells in cerebral cortex
neurons ----------- neurons ----------- 10-15 billion10-15 billion
glial cells ----------glial cells ---------- 50 billion50 billion
Estimation of number of cortical neuronsEstimation of number of cortical neurons
von Economo and Koskinas (1925) von Economo and Koskinas (1925) 14.0 billion 14.0 billion
Shariff (1953)Shariff (1953) 6.9 billion 6.9 billion
Sholl (1956)Sholl (1956) 5.0 billion 5.0 billion
Pakkenberg (1966)Pakkenberg (1966) 2.6 billion 2.6 billion
CerebralCerebral CortexCortex
Subdivision of Cerebral CortexSubdivision of Cerebral Cortex
AllocortexAllocortex
Archicortex (Archipallium)Archicortex (Archipallium)
Palaeocortex (Paleopallium)Palaeocortex (Paleopallium)
IsocortexIsocortex
Neocortex (Neopallium)Neocortex (Neopallium)
cf. mesocortex, juxtallocortex, mesallocortexcf. mesocortex, juxtallocortex, mesallocortex
IsocortexIsocortex – – typicaltypical 6 6 layered cortexlayered cortex
I. I. Molecular LayerMolecular Layer
II. II. External Granular LayerExternal Granular Layer
III.III. External Pyramidal LayerExternal Pyramidal Layer
IV.IV. Internal Granular LayerInternal Granular Layer
V. V. Internal Pyramidal LayerInternal Pyramidal Layer
VI. Polymorphic LayerVI. Polymorphic Layer
I. I. Molecular LayerMolecular Layer
II. II. External Granular LayerExternal Granular Layer
III.III. External Pyramidal LayerExternal Pyramidal Layer
Line of Kaes-BechterewLine of Kaes-Bechterew
IV.IV. Internal Granular LayerInternal Granular Layer
Outer band of BaillargerOuter band of Baillarger
- Line of Gennari- Line of Gennari in area 17 in area 17
V. V. Internal Pyramidal LayerInternal Pyramidal Layer
Giant pyramidal cell of BetzGiant pyramidal cell of Betz
Inner Band of BaillargerInner Band of Baillarger
VI. VI. Polymorphic LayerPolymorphic LayerGolgi Golgi NisslNissl WeigertWeigert
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