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Major Regions of the Brain

Slide 7.27 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

CerebralhemispheresDiencephalon

Brain stem Cerebellum

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Figure 7.12

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Cerebrum

Slide7.28b

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Thesurface ismade of ridges(gyri) andgrooves(sulci)

Purpose:triplesurface

areaFigure 7.13a



Lobes of Brain

Surface lobes of the cerebrumFrontal lobeParietal lobeOccipital lobeTemporal lobe



Chapter 14The Central Nervous System

The brain is a centerfor:

1. registeringsensations

2. correlating with

stored information 3. making decisions

4. taking action.



The NeocortexThe cerebral cortex is a thin layer of cells about 1.5 to4 mm thick.

The cortex provides the connections and pathways

for the highest cognitive functions, such as language

and abstract thinking.

The cerebral cortex contains about 25 billion neurons,more than 62,000 miles of axons, and

300,000,000,000,000 synapses.

Neocortex layer

The thin layer of the

neocortex is dense

with neurons.



Figure 29-5

Blood Supply

Inferior view of brain showing vertebral, basilar,and internal carotid arteries and branches



Cranial Meninges



Interior Skull SurfaceThe base of the skull is rough,with many bony protuberances.

These ridges can result in injury

to the temporal lobe of the brain

during rapid acceleration.

Bony ridges

Injury from contact

with skull



Blood Vessels of the SkullThe brain requires a rich bloodsupply, and the space between

the skull and cerebrum contains

many blood vessels.

These blood vessels can be

ruptured during trauma,resulting in bleeding.

Groove for middlemeningeal artery



Brain Ventricles Ventricles are Internal chambers within the

CNS



Flow of Cerebrospinal Fluid CSF is formed by

the choroidplexuses and

circulatesthrough the:

ventricles, down central

canal of spinalcord to

subarachnoidspace of cordand brain,

up to beabsorbed by the

i ki



History taking IThere is no single, correct way to take a history; you will develop your own

style; one effective and commonly used sequence as follows:

Full patient personal and contact details to include Gp1. PC: Presenting complaint2. HPI/HPC: History of current illness/complaint3. PMH: Past medical history: Surgical/Gynae/Psych

4. Medications and allergies: Rx, OTC, Herbal, Rxn’s?5. FHx: Family history: Medical/Genetic?6. SHx: Social history: Occupation, Smoking, Alcohol,

Recreational drugs? Elderly: Carer support?Independence? Mobility: frame/sticks?

7. ROS: Review of Systems8. O/E: Examination findings: By System OR Injury

specific9. Patient’s ideas, concerns and expectations 10. Impression11. Plan



Pain assessment



Sensory and Motor Areas of theCerebral Cortex

Slide 7.31 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 7.14



Anatomy



Homunculus Man



MUSCLE POWER

Muscle power is graded on an MRC (MedicalResearch

Council) scale of 0 –5

0 = no visible contraction

1 = visible contraction without active movement

2 = movement possible, but not against gravity

3 = movement possible against gravity 4 = movement possible against gravity and resistance,

but weaker than normal

5 = normal power

Figure 8 116



Figure 8.116Schematic diagram of lateral and anteriorcorticospinal tracts (red) ventral andmotor neurons and axons (black). Lettersand numbers indicate the various

levels of the spinal cord. For details of these tracts see p. 998. (From CarpenterM B 1991. Core text of neuroanatomy,Williams & Wilkins, with permission of author and publisher.)To

Figure 8 111



Figure 8.111Schematic diagram of the anteriorspinothalamic tract (red), and thespinotectaltract (black). The anterior spinothalamic

tract, composed of mainly crossed fibresarises from cells in laminae I, IV to VIII(for details of segmental location andfunctional significance of these cells see p.983, 8.99). The spinotectal tractarises from neurons of laminae I, IV to VIII

and is composed of crossed fibreswhich intermingle and ascend with thoseof the spinothalamic system.Spinotectal fibres project to the superiorcolliculus, and functionally conveynociceptive information. Letters and

numbers represent the segmental levels of the spinal cord. (From Carpenter M B1991. Core text of neuroanatomy, Williams& Wilkins, with permission of author andpublisher.)



Figure 8.110Schematic diagram of the anterior (red) andposterior (blue) spinocerebellartracts, and also the cuneocerebellar tract (blue). Fibres forming the posterior

spinocerebellar tract arise from neurons of thethoracic nucleus, and are mainlyuncrossed; this tract carries information from musclespindles and Golgi tendonorgans. The anterior spinocerebellar tract, composedof crossed fibres, arises

mainly from cells in laminae V to VII of thelumbosacral cord; it conveys impulsesfrom Golgi tendon organs. The cuneocerebellar tract,composed of uncrossedfibres, originates from cells of the accessory cuneatenucleus, and is regarded asthe upper limb equivalent of the posterior

spinocerebellar tract. Letters andnumbers denote the segmental levels of the spinalcord. (For details of thesetracts see p. 990.) (From Carpenter M B, 1991. Coretext of neuroanatomy,Williams & Wilkins, with permission of author andpublisher.)

Figure 8.112



Figure 8.112Schematic diagram of the lateralspinothalamic tract. This tract, arising fromcellsin laminae I, IV to VIII is composed mainly

of crossed fibres. Letters and numbersindicate the segmental levels of the spinalcord. For details of segmental locationof the cells and their functional significancesee p. 983, 8.99. (From Carpenter MB 1991. Core text of neuroanatomy,

Williams & Wilkins, with permission of authorand publisher.)



Figure 8.108



gu e 8 08Schematic diagram of the dorsal column –mediallemniscus pathway. The dorsalwhite column contains ascending and descendingfibres of dorsal root ganglioncells. Ascending fibres in the fasciculi gracilis and

cuneatus synapse on neuronsof the nuclei gracilis and cuneatus respectively. Axons from neurons of thesenuclei cross in the lower medulla oblongata to formthe medial lemniscus whichascends to end in the ventroposterolateral nucleusof the thalamus. Neurons of

this nucleus then project axons via the internalcapsule to the somaestheticcortex. Impulses mediated by this pathway areconcerned with discriminativetouch and pressure sense, and also withproprioceptive sense. Dorsal root

ganglia and their fibres entering the spinal cord atvarious levels are colourcoded(red = sacral; blue = lumbar; yellow = thoracic;black = cervical). Lettersand numbers show the segmental levels of thespinal cord. (From Carpenter M B1991. Core text of neuroanatomy, Williams &

Wilkins, with permission of authorand ublisher.

Figure 8.117



Figure 8.117Schematic diagram of the vestibulospinaltracts. The lateral vestibulospinal tract(blue) projects ipsilaterally in the spinalcord. The medial vestibulospinal tract

(red) descends in the medial longitudinalfasciculus at brainstem levels and thenprojects bilaterally in the spinal cord.Letters and numbers indicate thesegmentallevels of the spinal cord. (From Carpenter

M B 1991. Core text of neuroanatomy,Williams & Wilkins, with permission of author and publisher.)



Where is it ? Localization in

neurological disease

Disorders of muscle

Disorders of the NeuromuscularJunction

Disorders of Peripheral Nerve Nerve root Involvement



What is it ? Determining the

cause of a neurological disorder



Figure 29-4

Neural Pathway Involved in Patellar(―Knee- jerk‖ ) Reflex



Figure 23-5

Assessment - Abnormal Reflexes

Abnormal reflexes may beaccompanied by:

Positive Babinski's sign Also called the plantar reflex

Dorsiflexion of the great toe withor without fanning of toes

Relaxation of sphincter tone

with evacuation of the bowelsand/or bladder



I - Olfactory Nerve

Provides sense of smell Damage causes impaired sense of smell

Test with coffee grounds, spice not perfume,Why?

Test for smell NOT reco nition of smell. Ch. 16



II - Optic Nerve

Provides vision

Damage causes blindness in visual field



VisionThe visual cortex resides in theoccipital lobe of the brain.

Sensory impulses travel from

the eyes via the optic nerve to

the visual cortex.

Damage to the visual cortexcan result in blindness.



III - Oculomotor Nerve

Provides eye movement, opening of eyelid

Damage causes ptosis (drooping eyelid),double vision



IV - Trochlear Nerve

Moves eye down and out Damage causes double vision & inability to

look down and out



VI - Abducens Nerve

Moves eye laterally (ABduction) Damage results in inability to move eye ______



Innervation of Eye Muscles



V - Trigeminal Nerve

Main sensory nerve to face (touch, pain andtemperature) and muscles of mastication

Damage produces loss of sensation & impaired

chewing or can cause increased pain = trigeminal

VII - Facial Nerve



VII Facial Nerve

Provides facial expressions, sense of taste onanterior 2/3’s of tongue, salivary glands and tear,nasal & palatine glands

Damage produces sagging facial muscles &

disturbed sense of taste (missing sweet & salty)’



Figure 29-12

Bell’s Palsy



TasteThe gustatory complex(green circle) is the part

of the sensory cortex

(purple area) that is

responsible for taste.



VIII - Vestibulocochlear Nerve

Provides hearing & sense of balance Damage produces deafness, dizziness,

nausea, loss of balance & nystagmus



IX - Glossopharyngeal Nerve



IX Glossopharyngeal Nerve

Provides control over swallowing, salivation,gagging, sensations from posterior 1/3 of tongue,control of BP and respiration

Damage results in loss of bitter & sour taste &

impaired swallowing.

X - Vagus Nerve



X Vagus Nerve

The wonderer

Provides swallowing, speech, regulation of 2/3 of GI

tract

XI - Accessory Nerve



XI Accessory Nerve

Contracts upper trap muscles (I don’t know)

Damage causes impaired shoulder

movement

XII - Hypoglossal Nerve



XII Hypoglossal Nerve

Provides tongue movements of speech, food

manipulation & swallowing Damage results in inability to protrude

tongue, TEST – Stick tongue out and it

points right then the XII is broken



Reticular Formation



Reticular Formation

Slide

7.42b Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 7.15b



Figure 22-17

Posturing

Abnormal extension

(decerebrate

posturing).

Abnormal flexion

(decorticate

posturing).



Limbic System



Orientation

Time/Date

Place

Person (body position /situation)

Who am I?

Where am I?

What year is it?



Concentration & Attention

Vigilance (simple)

Vigilance (complex) Concentration

Are you on task?

Specialized Area of the



Specialized Area of theCerebrum

Slide

7.32c Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 7.13c



Language Centers

PET Scans during a Language



PET Scans during a LanguageTask



CognitionThe prefrontal cortex isinvolved with intellect,

complex learning, and

personality.

Injuries to the front lobe

can cause mental and

personality changes.



EmotionEmotions are an extremelycomplex brain function. The

emotional core of the brain is the

limbic system. This is where

senses and awareness are first

processed in the brain.

Mood and personality are

mediated through the prefrontal

cortex. This part of the brain is

the center of higher cognitive and

emotional functions.

Prefrontal cortex

Limbic system



SpeechBroca’s area is where weformulate speech and the

area of the brain that sends

motor instructions to the

motor cortex.

Injury to Broca’s area can

cause difficulty in speaking.

The individual may know

what words he or she wishes

to speak, but will be unable

to do so.

Broca’s Area

A dit A i ti A



LanguageWernicke’s area is aspecialized portion of the

parietal lobe that recognizes

and understands written and

spoken language.

Wernicke’s area surrounds the

auditory association area.

Damage to this part of the

brain can result in someone

hearing speech, but not

understanding it. Wernicke’s Area

Auditory Association Area



HearingThere are two auditory

areas of the brain:

• The primary auditory

area (brown circle) is what

detects sounds that are

transmitted from the ear. It

is located in the sensory

cortex.

• The auditory association

area (purple circle) is the

part of the brain that is

used to recognize the

sounds as speech, music,or noise.



Visual Processes

Tracking

Neglect Suppression /Extinction

Visual Quadrants



Auditory Processes

Hearing and Neglect

Suppression orExtinction

What’d you say?



Tactile Sensation

Neglect

Suppression

Reach out and

touch someone .

d l



Motor and Balance

Balance

PurposefulMovements

Come on and move with me!

M d L i



Short-Term Memory

Learning Curve

Recent Memory

Remote Memory

Retention

Memory and Learning

Now, what

was I supposed

to remember?

Construction/Spatial/Fine



/ p /Motor

Bender

Clock Drawing

Complex Figure Test (Rey orTaylor)

Fine Motor Sequencing

Nonverbal & Tactile



Nonverbal & TactileProcessing

Rhythm

Tactile Comprehension



F t l L b



Frontal Lobe

Conscientiousness Judgments How we initiate activity in response to our

environment. Controls our emotional response. Controls our expressive language. Assigns meaning to the words we choose (abstract

thought) Attention span Involves word associations (language planning) Memory for habits and motor activities (short term

memory) Motor cortex — Voluntary movement

Impulse control

F t l L b D fi it P bl



Frontal Lobe Deficit —Problems Loss of simple movement of various body parts

(Paralysis). Inability to plan a sequence of complex movements

needed to complete multi-stepped tasks, such asmaking coffee (Sequencing).

Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Persistence of a single thought (Perseveration). Inability to focus on task ( Attending). Mood changes (Emotionally Labile). Changes in social behavior. Changes in personality. Difficulty with problem solving. Inablility to express language (Broca's Aphasia).

P i t l L b F ti



Parietal Lobe Function

Location for visual attention. Location for touch perception.

Goal directed voluntary movements.

Manipulation of objects.

Integration of different senses that allowsfor understanding a single concept.

Parietal Lobe —Problems resultingfrom deficit



from deficit Inability to attend to more than one object at a

time. Inability to name an object ( Anomia).

Inability to locate the words for writing( Agraphia).

Problems with reading ( Alexia).

Difficulty with drawing objects.

Difficulty in distinguishing left from right.

Difficulty with doing mathematics(Dyscalculia).

Lack of awareness of certain body parts and/orsurrounding space (Apraxia) that leads to

difficulties in self-care.

T l L b F ti



Temporal Lobe Function

Hearing ability

Memory acquisition

Some visual perceptions Categorization of objects.

Temporal Lobe Deficits —Problems



Difficulty in recognizing faces(Prosopagnosia).

Difficulty in understanding spoken words(Wernicke's Aphasia).

Disturbance with selective attention to whatwe see and hear.

Difficulty with identification of, andverbalization about objects.

Short-term memory loss. Interference with long-term memory Increased or decreased interest in sexual

behavior. Inability to catagorize objects

(Catagorization).

O i it l L b F ti



Occipital Lobe Function

Vision

O i it l L b D fi it P bl



Occipital Lobe Deficits--Problems

Defects in vision ( Visual Field Cuts). Difficulty with locating objects in

environment.

Difficulty with identifying colors (Color Agnosia).

Production of hallucinations Visual illusions - inaccurately seeing objects. Word blindness - inability to recognize words. Difficulty in recognizing drawn objects. Inability to recognize movement of an object

(Movement Agnosia)

Functions of Cerebrum Lobes



Frontal contains voluntarymotor forplanning, mood, smell andsocial judgement

Motor is in FRONT of a car

Parietal integrates

it com-pairs

Occipital is optical

Temporal contains areas for hearing,emotional behavior, learning, memory, smell

Basal Nuclei (Basal Ganglia)



Basal Nuclei (Basal Ganglia)

Masses of gray matter deep to cerebralcortex

Involved in motor control & inhibition of tremors



The Limbic System



The Limbic System

A. Cingulate gyrus

B. Fornix

C. Anterior thalamic

nuclei

D. Hypothalamus

E. Amygdaloid nucleusF. Hippocampus

The limbic system is the

area of the brain thatregulates emotion and

memory. It directly

connects the lower and

higher brain functions.

EEG and Brain Waves



EEG and Brain Waves

Electroencephalogram (EEG) graphs brain waves May be used to diagnose epilepsy and other seizure

disorders

It may also provide useful information regarding sleepand wakefulness.

Reticular Activating System



g y(RAS) Throughout pons,

midbrain & medulla

Regulate balance

& posture

Regulates sleep

& conscious attention

injury leads to irreversible coma

Diencephalon



Diencephalon Thalamus

Pineal Gland

Thalamus, Hypothalamus and Epithalamus (houses pineal glan

The pineal secretes melatonin to influence diurnal cycles

THALAMUS



THALAMUS

Thalamus is located superior to themidbrain and serves as relay station for

all sensory impulses, except smell , tothe cerebral cortex

1) medial geniculate (hearing),

2) lateral geniculate (vision)

Hypothalamus



Hypothalamus

Hypothalamus is found inferior to thethalamus

Is a relay station for smell . Major regulators of homeostasis

It controls and integrates the autonomic nervoussystem, which regulates contraction of smooth

muscle, cardiac muscle, and secretions of manyglands.

Seat of rage & aggression, body temperature.hunger and the satiety, thirst,

Maintains the waking state and sleep patterns

Cerebellum Function



Cerebellum Function

Coordination of voluntary movement

Balance and equilibrium

Some memory for reflex motor acts.

Cerebellum



Cerebellum

Connected to brainstem Arbor vitae (tree of life) visible in sagittal

section

Sits atop the 4th ventricle



Cerebellum Deficits—Problems



Cerebellum Deficits —Problems

Loss of ability to coordinate finemovements.

Loss of ability to walk. Inability to reach out and grab objects.

Tremors.

Dizziness ( Vertigo). Slurred Speech (Scanning Speech).

Inability to make rapid movements.

Brainstem



Brainstem

Midbrain

Pons

Medulla

Brainstem Function



Brainstem Function

Breathing

Heart Rate

Swallowing

Reflexes to seeing and hearing (StartleResponse).

Controls sweating, blood pressure, digestion,

temperature ( Autonomic NervousSystem).

Affects level of alertness.

Ability to sleep

Brainstem Deficits—Problems



Brainstem Deficits —Problems

Decreased vital capacity in breathing,important for speech.

Swallowing food and water (Dysphagia). Difficulty with organization/perception of

the environment.

Problems with balance and movement. Dizziness and nausea ( Vertigo).

Sleeping difficulties (Insomnia, sleep

a nea

Midbrain



Midbrain

Function:

Body posture

Equilibrium

Autonomic Nervous System

Blood pressure

Temperature

Emotional influence

Reg appetite and hormones

Nuclei of CN III and IV

Midbrain



CN III and IV

eye movement

Substantia nigra sends inhibitory signals to thalamus(degeneration leads to tremors of Parkinson disease)

Midbrain

Midbrain lesion



Midbrain lesion

Variable LOC

Abnormal extensor tone

Hyperventilation

CN III and IV deficits

CN IV nerve lesion: head tilted away fromlesion

CN IV nucleus lesion: head tiled towards lesion

CN III: innervates all eyes muscles except

LR6 and SO4 eye deviated laterally and

Pons



Pons

Function

Respiration

Chewing Taste

Arousal, wakefulness, alertness

Nuclei of CN V, VI, VII, VIII

Pons lesion



Pons lesion

Semi-coma

Abnormal extensor tone

Apneusis Withdrawal

CN V,VI, VII (facial colliculus syndrome) CN V: ipsi jaw deviation upon opening

VI: diplopia, paralysis of ipsi LR but alsoinablity to turn contra eye medially

VII: can’t close eye or smile

Pons



Pons Anterior bulge in the brainstem

Pathways between cerebellum

Relays nerve impulses related to voluntaryskeletal movements from the cerebral cortex

to the cerebellum Cranial nerves V- VIII

Medulla



Medulla

Function:

Life-sustaining control center: controls

hear, respiration, vasomotor Cough, gag, swallow, vomit, digest

Nuclei of CN VIII, IX, X, XI, XII

Medulla Oblongata



g

Cranialnerves (IX- XII)

Heart rate, respiratory rate

Adjusts blood vessel diameter Reflex centers for coughing, sneezing,

gagging, swallowing, vomiting, and

hiccupping.

Medulla Lesion



Medulla Lesion

Comatose

Abnormal breathing

Ataxic

Absent gag reflex

Absent cough

CN VIII, IX, X, XI, XII deficits

VIII: ipsi stumbling but contra nystagmus IX, X, XI: absent gag reflex, contra uvula deviation,

dysphonia, dysphagia

XII: ipsi tongue deviation and atrophy

Function of HemispheresRight Hemisphere



Right Hemisphere judging the position of things in space knowing body position understanding and remembering things we do

and see putting bits of information together to make an

entire picture controls the left side of the body

Left Hemisphere understanding and use of language (listening,

reading speaking and writing)

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