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Fore Brain

Medial View
Lateral Brain

cerebrum

cerebellum
brainstem
A. The Cerebrum
Central Sulcus
Lateral Sulcus
Longitudinal Fissure
LEFT
RIGHT
Cerebral Hemispheres
Functional Areas of Cerebral Cortex 1
Anatomically the cortex is
divided into 6 lobes: frontal,
parietal, temporal, occipital,
limbic and insular
Each lobe has several gyri
Functionally the cortex is
divided into numbered areas
first proposed by Brodmann
in 1909
Brodmanns areas were
described based on
cytoarchitecture; later they
were found to be functionally
significant
Functional Areas of Cerebral Cortex 2

Cytoarchitecture is
based on the density
of different cortical
neurons and
thickness of layers
Frontal Lobe

Makes up 1/3 of all


cerebral cortex
Primary motor
Premotor
Frontal eye field
Supplementary motor
Prefrontal
Brocas area
Primary Motor Cortex: Area 4
Somatotopic
organization
Size of areas is
proportional to the
degree of skill
involved with
movement
Lesions of motor
cortex result in
paralysis/paresis of
contralateral body
area
Premotor Cortex: Area 6
Contains programming
for movements
Electrical stimulation
produces slower
movements of larger
groups of muscles
compared to area 4
Lesion produces
apraxia - inability to
perform voluntary
movement in the
absence of paralysis
Frontal Eye Field: Inferior Part of Area 8

Stimulation
produces conjugate
eye movement to
contralateral side
Lesion produces
transient deviation
of eyes to ipsilateral
side and paralysis of
contralateral gaze
Supplementary Motor Area: Parts of
Areas 6 and 8
Medial surface
Stimulation
produces posturing
responses such as
turning head and
eyes toward moving
arm
Programming for
complex movements
involving several
parts of the body
Prefrontal Cortex: Areas 9, 10, 11,
12, 32, 46, and 47
Nearly 1/4 of all cortex
Orbitofrontal area
functions in visceral and
emotional activities
Dorsolateral area
functions in intellectual
activities such as
planning, judgement,
problem solving and
conceptualizing
Prefrontal Cortex
Lesions cause loss of initiative, careless
dress, loss of sense of acceptable social
behavior
Prefrontal leucotomy or prefrontal
lobotomy were once common surgical
procedures to treat patients with severe
behavioral disorders
Now drugs are used
Brocas Area: Area 44 & 45

Part of the inferior


frontal gyrus
Functions in speech
Parietal Lobe

Includes over 1/5 of


total cortex
Primary somatosensory
Secondary
somatosensory
Gustatory
Association
Primary Somatosensory Area: 1,2,3
Somatotopically organized
Areas of cortex
proportional to sensory
discrimination of the area
not to amount of surface
area
Stimulation produces
contralateral tingling or
numbness but never pain
Lesions cause
contralateral loss of tactile
discrimination and position
sense but no relief of pain
Clinical Case
After his wife had a stroke, a husband notices that
his wife's hair is always tangled and uncombed on
the left side of her head, although on the right her
hair is straightened and orderly. The left side of her
face is usually dirty from food remaining there, but
the right face is always clean. She has stopped
putting her ring and watch on her left hand. When
eating, she never uses her fork on the left side of
her plate and, surprisingly, she often asks why she
was not given a fork to eat with. This woman's
stroke most likely damaged the:
Clinical Case 2
In a particular case, one woman lost her concept
of left, with regard to her body and surroundings.
For example when applying lipstick, she
completely neglects the left side of her face.
When eating she complains that her portions are
too small, because she only eats from the right
side of her plate. Where is her lesion?
1. in the right frontal lobe
2. in the left parietal cortex
3. in the right parietal cortex
4. in the left frontal lobe
Secondary Somatosensory Area
Parietal operculum
into posterior insula;
posterior part of
area 43
Bilateral input
Somatotopy poorly
defined
Pain is perceived
here
Primary Gustatory Cortex: Area 43

Anterior part of
parietal
operculum
Lesion results in
contralateral
(mostly) ageusia
Parietal Association Cortex : Areas 5,7,39,40

5 input from S1
7 input from visual
and motor cortex
39&40 input from all
association areas
function in hand
performance
neglect syndrome
astereognosis
Parietal Neglect Syndrome
Clinical Illustration
Failure to recognize
side of body
contralateral to injury
May not bathe
contralateral side of
body or shave
contralateral side of
face
Deny own limbs
Objects in contralateral
visual field ignored
the ability to pay attention to,
identify and plan meaningful
responses to external stimuli or
internal motivations
involves association areas of
cerebral cortex
association areas are responsible
for information processing
between sensory input and motor
output
Contralateral Neglect Syndrome
Most often seen after large areas
of damage to right side parietal
lobe
frequent consequence of stroke on
right side of brain and thus neglect
of everything on the left
Patients ignore everything on side
opposite to lesion
not blindness: patients can
recognize and name objects
Temporal Lobe
1/4 of total cortex
Primary auditory
Auditory association
Visual association
Limbic
Primary Auditory Cortex: Areas
41 &42
Transverse temporal
gyrus
Tonotopic organization
High freq posteromedial
and low freq
anterolateral
Lesion causes difficulty
in recognizing distance
and direction of sound,
especially when the
sound comes from the
contralateral side
Auditory Association Cortex: Area 22
Wernickes area (posterior part of 22)
Language understanding and formulation
Damage can result in aphasia
Limbic Temporal Cortex: Areas
20,21, 27,28,29,30, 34,36,38
Visceral function,
emotions, behavior,
memory
Stimulation can elicit
past events
Left posterior area
memory of verbal info
Right posterior area
memory of visual info
Bilateral lesion of 20,21
causes prosopagnosia,
loss of facial recognition
Often damaged in
Alzheimers disease
Occipital Lobe: Areas 17,18,19
17 striate cortex,
primary visual
cortex
Macular vision in
posterior part
Lesion causes
homonymous
hemianopsia
Occipital Lobe: Areas 18 & 19

18 parastriate cortex
19 peristriate cortex
Receive visual info from 17 bilaterally
Complex processing for color, movement,
direction, visual interpretation
Lesion can cause visual agnosia
Hemispheric Lateralization of Function
Hemisphere with language function is termed dominant
10% of population is left-handed
13% male, 9% female are left-handed
95% of right-handers have language in left hemisphere
75% of left-handers have language in left hemisphere
Handedness and language dominance develop before speech
begins
Dominant hemisphere also excels in analytical thinking and
calculation
Nondominant hemisphere excels in sensory discrimination,
emotional/nonverbal thinking, artistic skill, music, spatial
perception and perhaps face recognition
Language Areas of the Brain 1
Brocas area, 44 & 45 is
the motor speech
center
Motor programs for
speech production
Projects to motor cortex
areas controlling vocal
cords, tongue and lips
Lesion causes
expressive aphasia with
poor articulation, short
sentences, slow
speech
Language Areas of the Brain 2
Wernickes area,
posterior part of 22
Functions in
comprehension and
formulation of
language
Lesion causes
receptive aphasia
with defective use of
words, meaningless
verbiage, lack of
comprehension
Spoken Description of Visualized Scene
Visual input to 17 with
further processing in 18 &
19
On to area 39 where
objects named and
recognized
Then to 22 where words
are assembled into
sentences
Then to Brocas area 44 &
45
Then to adjacent motor
cortex for expression
Aphasia
Broca's Aphasia
A type of nonfluent aphasia, so called because speech
production is halting and effortful. Damage is typically in
the anterior portion of the left hemisphere. The dominant
feature is agrammatism (impaired syntax). Content
words (nouns, verbs) may be preserved but sentences
are difficult to produce due to the problems with
grammar, resulting in "telegraphic speech." In its more
severe form, spoken utterances may be reduced to
single words. Comprehension is typically only mildly to
moderately impaired, and impairments are primarily due
to difficulty understanding complex grammar. Repetition
of words and sentences is usually poor.
Aphasia
Wernicke's Aphasia type of fluent aphasia.
Damage is typically in the posterior portion of the left
hemisphere. Comprehension is poor and the person
often produces jargon, or nonsensical words and
phrases when attempting to speak. These utterances
typically retain sentence structure but lack meaning. The
person is usually unaware of how they are speaking and
may continue to talk even when they should pause to
allow others to speak; this is often referred to as "press
of speech." Repetition of words and sentences is poor.
Conduction Aphasia
Conduction Aphasia type of fluent aphasia with a
prominent impairment with repetition.
Damage typically involves the arcuate fasciculus and the
left parietal region. The patient may be able to express
him- or herself fairly well, with some word-finding issues,
and comprehension can be functional. However, the
patient will show significant difficulty repeating phrases,
particularly as the phrases increase in length and
complexity and as they stumble over words they are
attempting to pronounce. This type of aphasia is rare.
Aphasia
Transcortical Sensory Aphasia type of fluent aphasia
similar to Wernicke's with the exception of a strong ability
to repeat words and phrases. The person may repeat
questions rather than answer them ("echolalia").
Transcortical Motor Aphasia type of nonfluent aphasia
similar to Broca's aphasia, but again with strong repetition
skills. The person may have difficulty spontaneously
answering a question but can repeat long utterances
without difficulty.
Global Aphasia type of nonfluent aphasia with severe
impairment of both expressive and receptive skills. Usually
associated with a large left hemisphere lesion. People are
often alert and may be able to express themselves
through facial expressions, intonation, and gestures.
Clinical Case 3
A 59-year-old woman had a cerebrovascular
accident 9 months ago. Her past medical
history is remarkable for hyperthyroidism and
atrial fibrillation. She initially presented with
slurred speech and right hemiparesis. The
hemiparesis resolved, but her speech is still
agrammatic and nonfluent, and she has
difficulty finding words and completing
sentences. Her comprehension is intact, and
she appears frustrated when she attempts to
speak. The remainder of the neurologic
examination is normal. A lesion which areas
would most likely account for her deficits?
Clinical Case 4
A 77-year-old right-handed man with a history of
atrial fibrillation and diabetes mellitus is brought to
the emergency department by his family. His son
describes that when his father awoke that morning,
he was unable to use words or sentences that made
any sense. On examination, the patient has
spontaneous, fluent speech, with normal
grammatical constructs and prosody. However, the
majority of what he says is meaningless. He is unable
to follow commands, except to close his eyes. When
asked to identify objects, he uses inappropriate
substitutions of words. He also fails to repeat words
and is unable to read. A lesion which areas would
most likely account for his language deficits?