Lecture 4.

Functional
anatomy of the brain

Department of Neurology and Rehabilitation

• Anatomical and functional relationships of the brain
(age, gender aspects). Clinical testing, imaging (CT,
MRI, X-ray), clinical illustrations.
• Features of anatomic and functional relationship of
the brain by pathology.
Introduction
Neuron
Neurons are the structural and
functional building blocks of the
nervous system.
This type of cell is specialized for
the reception,
integration, and
transmission of electrical
impulses.
 Synapse and neurotransmitters
• The sites at which neurons
transmit impulses to each other
are called synapses

• Neural impulses are transmitted

across synapses by chemical
substances called
neurotransmitters
 CELL MEMBRANE AND CHANNELS
• Neurons are enclosed by a double-layered cell membrane with an
inner phospholipid layer and an outer glycoprotein layer.
• Specialized protein molecules within the cell membrane form
channels that are selectively permeable to sodium, potassium, or
chloride ions. Some ion channels open only when a specific ligand
binds to them, e. g., the neurotransmitter molecule that conveys
neural impulses from cell to cell. These channels are called ligand-
dependent ion channels.
• Voltage-dependent ion channels, on the other hand, are found
mainly on the axonal membrane. They open and close depending on
the transmembrane electrical potential.
Reflex
From Functional Anatomy to Clinical Neurology
Neurologic
Differential
Diagnosis
THE NERVOUS SYSTEM
 THE NERVOUS SYSTEM

The nervous system can be divided, topographically, into two

parts: the central nervous system and the peripheral nervous system.
The central nervous system comprises the brain and spinal cord,
which are located, respectively, in the cranial cavity and the vertebral
(spinal) canal, and are continuous with each other at the foramen
magnum (where the medulla oblongata of the brain stem adjoins the
spinal cord).
The peripheral nervous system comprises the twelve pairs of
cranial nerves, thirty-one pairs of spinal nerves, the ganglia associated
with the cranial and spinal nerves, and the right and left ganglionated
sympathetic chains.
A Functional Overview of the Nervous System
 The brain

On a functional basis, the brain may By another convention, based on

be pictured as being made up of four embryological development, the
major divisions: brain may be divided into:
1 brainstem (comprising, from below - the forebrain (comprising the
upwards, the medulla oblongata, cerebral hemispheres and
pons and midbrain) diencephalon)
2 cerebellum - midbrain and
3 diencephalon (comprising, mainly, - hindbrain (made up of the pons,
the thalamus and hypothalamus) medulla oblongata and cerebellum)
4 cerebral hemispheres
The medulla contains the
respiratory, cardiac and vasomotor
centres – the ‘vital centres’
The cerebellum is principally concerned with balance and the
regulation of posture, muscle tone and muscular co-
ordination

Cerebellar lesions result in disturbance of one or more of these

motor functions, manifesting as any one or more of the
following:
unsteady gait, ataxia, hypotonia, tremor, nystagmus, dysarthria
and dysdiadokokinesia (the inability to perform alternating
movements rapidly, e.g. supination/pronation)

Lesions of the cerebellum give rise to symptoms and signs on

the same side of the body
Lesions of the hypothalamus may present to the
clinician as a variety of autonomic and non-
autonomic disturbances, e.g. somnolence,
disturbances of temperature regulation and obesity,
as well as a variety of endocrine abnormalities, e.g.
hypogonadism and hypothyroidism
Clinical effects of lesions affecting the principal cortical areas of cerebral
hemispheres :

1 Frontal cortex – impairment of higher mental functions and emotions

2 Precentral (motor) cortex – weakness of the opposite side of the body;
lesions low down the cortex affecting the face and arm, high lesions affecting
the leg. Midline lesions (meningioma, sagittal sinus thrombosis or a gunshot
wound) may produce paraplegia by involving both leg
3 Sensory cortex – contralateral hemianaesthesia (distributed in the
same pattern as the motor cortex) affecting especially the higher sensory
modalities such as stereognosis and two-point position sense
4 Occipital cortex – contralateral homonymous hemianopia
5 Lesions adjacent to the lateral sulcus in the frontal, parietal or
temporal lobes of the dominant hemisphere result in aphasia
Motor Function
 FIRST (central) MOTOR NEURON
Lesions of the first motor neuron in the precentral gyrus, or at any
other site, produce the following deficits:
• spastic weakness (elevated muscle tone, diminished raw strength,
and impaired fine motor control);
• increased intrinsic muscle reflexes, spreading of reflex zones, and
pathological reflexes (Babinski, Oppenheim, and Gordon, persistent
clonus);
• diminished or absent extrinsic muscle reflexes (e. g., abdominal skin
reflex);
• no muscle atrophy (though there may be mild atrophy of disuse in
the later course of disease);
• asymmetry of the reflexes if the lesion is unilateral.
 The second (peripheral) motor neuron

Lesion of the peripheral motor neuron:

• flaccid weakness (diminished muscle tone and raw strength);
• diminished or absent intrinsic muscle reflexes;
• muscle atrophy becoming evident about three weeks after injury and
progressing thereafter.
 Motor end plate and muscle
In addition to the first and second motor neurons, normal motor
function requires effective impulse transmission from the peripheral
nerve to the muscle fiber, followed by fiber contraction.

A lesion or functional disturbance of either or both of these elements

causes:
• flaccid weakness usually accompanied
• by atrophy and
• diminished reflexes
Normal gait
Gait
 Gait
Normal gait Gait disturbances
Anatomical Substrate of
Sensation
 The somatosensory system
The somatosensory system Sensory receptors in the periphery (3)
• Exteroceptive receptors (exteroceptors) transduce
physical stimuli from the external environment (e.
g., mechanoreceptors, thermoreceptors).
• Proprioceptive receptors (proprioceptors) inform
the nervous system about head and body posture,
the positions of the joints, and tension in muscles
and tendons (muscle spindles and Golgi tendon
organs).
• Nociceptors, which subserve pain, occupy an
intermediate position between the extero- and
proprioceptors.

• The density of somatosensory receptors is

greatest in the skin, but they are also found in
most other tissues of the body, including the
viscera (but not in the brain or spinal cord!).
Cortex. High cortical functions.
Speech
The cortical representation of different parts of the body in the primary somatosensory cortex of the postcentral gyrus (left) and

the primary motor cortex of the precentral gyrus (right) in the human being
(After Penfield, W., H. Jasper: Epilepsy and theFunctional Anatomy of the Human Brain. Little, Brown, Boston 1954.)
From IDEA to RESULT
 Classification of Language Disorders
Aphasias can be classified based on fluency,
comprehension, and repetition.
All patients are assumed to have impaired naming
and some paraphasic errors.
The usual lesion locations for different forms of
aphasia are indicated on the brain inset.
Anomic aphasia can occur with lesions in many
locations in the language network.
Classification of Language Disorders
BROCA’S APHASIA
Broca’s aphasia is usually caused by lesions affecting Broca’s area and adjacent
structures in the dominant frontal lobe
The most common etiology is infarct in the territory of the left middle cerebral
artery (MCA) superior division
Clinically, the most salient feature of Broca’s aphasia is decreased fluency of
spontaneous speech
The impaired fluency in Broca’s (in contrast to Wernicke’s) aphasia can be
remembered by the mnemonic Broca’s broken boca (“boca” means “mouth” in
Spanish)
Fluency can be surprisingly difficult to define and assess in an objective manner.
Some helpful guidelines are that patients with decreased fluency tend to have a
phrase length of fewer than five words, and the number of content words (e.g.,
nouns) exceeds the number of function words (e.g., prepositions, articles, and
other syntactic modifiers).
WERNICKE’S APHASIA
Wernicke’s aphasia is usually caused by a lesion of Wernicke’s area and
adjacent structures in the dominant temporoparietal lobes
The most common etiology is infarct in the left MCA inferior division
territory
Clinically, patients with Wernicke’s aphasia have markedly impaired
comprehension
Spontaneous speech in Wenicke’s aphasia has normal fluency, prosody,
and grammatical structure
Impaired lexical function results in speech that is empty, meaningless,
and full of nonsensical paraphasic errors
 HEMINEGLECT SYNDROME
One of the most dramatic syndromes in clinical neurology is
hemineglect syndrome, seen most often with infarcts or other acute
lesions of the right parietal or right frontal lobes

Patients with this syndrome often exhibit profound neglect for the
contralateral half of the external world, as well as for the contralateral
half of their own bodies

Most strikingly, despite their profound deficits, these patients are often
unaware that anything is wrong, and they sometimes even fail to
recognize that the left sides of their bodies belong to them
 The Frontal Lobes: Anatomy and Functions of an
Enigmatic Brain Region
More than any other part of the brain, the frontal lobes enable us to
function as effective and socially appropriate human beings
It should perhaps be no surprise, therefore, that the frontal lobes are also
among the most enigmatic, contradictory, and difficult to study brain regions
The importance of the frontal lobes has been debated over the years, with
some earlier researchers believing that the frontal lobes are generally
superfluous, and others feeling that they are the most important part of the
brain
These different opinions arose because patients with frontal lobe lesions
often have no deficits that can be detected on routine testing, yet they are
completely unable to function normally in the “laboratory” of the real world
Some Functions of the Frontal Lobes
Clinical presentation
????
 Typical appearance of peripheral
nerve palsies affecting the hand
a Wrist drop (radial nerve palsy)

b Claw hand (ulnar nerve palsy)

c Pope’s blessing (median nerve palsy)

d Monkey hand (combined median and

ulnar nerve palsy)

The areas of sensory deficit are shaded blue

??
Facial palsy Central facial palsy (above): the forehead muscles are not affected
Peripheral facial palsy (belove): the forehead muscles are involved along
with the rest of the face on the affected side
?
Time course of
cerebral ischemia.
Stroke
 Cerebral ischemia. Stroke
Classification of cerebral ischemia by Classification of ischemic stroke by
temporal course etiology
Typical gait disturbance of a hemiplegic patient
??
Basal Ganglia
Basal Ganglia. Hyperkinetic and Hypokinetic Movement Disorders
Typical posture of a patient with Parkinson disease
Hand posture in athetosis while walking
?
 The typical foot deformity in Friedreich ataxia
(“Friedreich foot”)
This autosomal recessive hereditary disease
is due to a defect on chromosome 9.
Its major pathological findings include cell
loss in:
- the dentate nucleus and
- combined degeneration of the
spinocerebellar tracts,
pyramidal tracts, and
posterior columns.