BASAL GANGLIA
3 Important Brain Systems for Movement:
1. Cerebral cortex – execution of movement
2. Cerebellum – coordinates the motor activity
3. Basal Ganglia – plans the movement; tells the
cerebral cortex to execute the movement
Basal Ganglia
 Influence the descending motor system
 Planning of movement
 “Ganglia”: groups of neurons located outside the
CNS (*a misnomer)
 X/S of the Brain
- Folding of neural tube forms the cortex with the
gray matter outside
- Peripheral gray: neurons
- Central white: myelin (oligodendrocytes) that cover
the axons
- Subcortical Gray Substance: Basal Ganglia and part
of the diencephalon (Dorsal Thalamus)
 Lesions of the Basal Ganglia:
- Hyperkinesia (Increase in movement):
Huntington’s Disease
- Hypokinesis: Parkinson’s Disease (Bradykinesia –
slow movement)  w/ involuntary movement of
the extremities (tremors) and muscle rigidity
 Emotional control (connection w/ Limbic system),
cognition, and eye movement (connection w/
geniculate body – relay for vision
Components of the Basal Ganglia:
o Caudate nucleus: located at the base of the lateral
ventricle (*Ventricle: cavity in the brain that contains
CSF)
o Putamen
o Globus Pallidus: medial to putamen
1. External globus pallidus
2. Internal globus pallidus
Outside the Striatum:
o Subthalamic nucleus: part of the ventral thalamus
o Substantia nigra: located in the midbrain
Limbic and basal ganglia circuit: link to the limbic
system for emotions
o Nucleus accumbens: at the ventral part of the striatum
o Ventral pallidum
Striatum (Neostriatum)
1. Caudate nucleus
2. Putamen
*They are derived from the same cell/same cellular
development.
*Separated by an internal capsule anteriorly.
Lenticular nucleus – separated from the thalamus
(biggest part of the diencephalon) by the internal capsule
1. Putamen
2. Globus pallidus
Corpus Striatum (Dorsal Striatum)
1. Caudate nucleus
2. Lenticular nucleus
Globus Pallidus (Paleostriatum)
1. Globus pallidus external (GPe)
2. Globus pallidus internal (GPi)
Substantia nigra
1. Substantia nigra pars compacta (SNc): dorsal;
dopamine  execution of movement; lacking in
Parkinson’s Disease
- Nigrostriatal Pathway: connection with the striatum
2. Substantia nigra pars reticulata (SNr): ventral
Basal Ganglia and Related Structures (X/S) – Lateral
to Medial
 Insula (most lateral gray substance): a brain lobe; not
seen from a dorsolateral view because it is covered by
the temporal lobe and the lower part of the fronto-
parietal cortex; viewed by opening the Sylvian fissure
 Extreme capsule (white substance): made up of
myelinated fiber tracts
 Claustrum (very thin gray substance)
 External capsule (white matter substance)
 Putamen
 External medullary lamina (white substance):
separates the putamen from the GPe
 External segment of the globus pallidus
 Internal medullary lamina (white substance):
separates the GPe and GPi
 Internal segment of the globus pallidus
 Internal capsule (big white substance): contains
descending fiber tracts from the cerebral cortex
- Ventral portion: Caudate nucleus
 Dorsal thalamus: dorsal portion of the internal
capsule
 3rd Ventricle: cavity in the midline that contains CSF
 Wall of the thalamus
 Lateral Ventricle: w/ the Foramen of Monro
 Caudate Nucleus: at the base of the lateral ventricle
MARIA KORINA A. DAKIS (2015-2016) 1
Blood Supply of the Basal Ganglia and Related
Structures
 Supplied by the anterior and middle cerebral arteries
1. Striatum and Globus Pallidus: Lenticular Branch of
the Middle Cerebral Artery
- Penetrate deep into the brain
- Lacunar Infarct = stroke
- Rupture due to hypertension = basal ganglia
hemorrhage
2. Medial Globus Pallidus: Anterior Choroidal Artery
(branch of the Internal Carotid Artery)
- Supplies the GPi
3. Head of the Caudate and anterior portions of the
Lentiform Nucleus: Recurrent Artery of Heubner
(branch of Anterior Cerebral Artery)
 Common site of compromise  bleeding or
obstruction/infarction  stroke
Stimulus of the Basal Ganglia
 Caudate Nucleus and the Putamen (Striatum)
- Input nuclei of the basal ganglia
- Receive sensory information from the cerebral
cortex, spinal cord, cerebellum
 Globus pallidus internal and Substantia nigra pars
reticulata
- Output nuclei of the basal ganglia
 Nucleus accumbens (located in the Ventral Striatum –
ventral diencephalon/thalamus)
- Connection with the limbic system
Direct Basal Ganglia Pathway
Cortex  Striatum  GPinternal  Ventral Thalamus
and Ventrolateral Thalamus (sensory relay)  Cortex
 Pathway that facilitates movement
 adenylyl cyclase and cAMP  projected to the
Indirect Basal Ganglia Pathway
Caudate Nucleus  GPexternal  Subthalamic Nucleus
 GPinternal  Thalamus  Cortex
 Inhibits movement
 There is normally a balance between the direct
pathway and the indirect pathway.
 Inhibition of Direct Pathway = slowness of movement
 Increase activity of Direct Pathway = hyperkinesia
 Ventroanterior and Ventrolateral = part of the
thalamus
Intrinsic Nuclei of the Basal Ganglia
 Part of the nuclei of the basal ganglia
 For emotion and eye movement
1. Subthalamic nucleus
2. Substantia nigra pars compacta
3. Globus pallidus external
4. Ventral tegmental area of the brainstem
Limbic Areas for Emotion (VentralStriatal System)
o Nucleus Accumbens
- Located in the ventral thalamus
o Ventral striatum
o Ventral pallidum
o Ventral tegmental area of the brainstem (VTA)
MAJOR INPUTS OF THE BASAL GANGLIA
(Direct Pathway) Cortex, Brainstem (SNc), Thalamus
(Raphe Nucleus)  Striatum  Neurons of the Striatum
Neurons in the Striatum:
1. Medium Spiny Neurons
- Projectional neurons
- Project outside
- Majority (95%) of striatal neurons
- Secrete inhibitory neurotransmitters
 Inhibitory neurotransmitter = GABA
 Co-transmitters of GABA (Direct Pathway):
Substance P and Dynorphin (DYN)  bind with
dopamine D1 receptors  (+) adenylyl cyclase,
increase cAMP activity  projected to GPi and
SNr (Two Output Nuclei of BG) = enhanced
excitatory cortical input
 Co-transmitters of GABA (Indirect Pathway):
Enkephalin (ENK)  bind with dopamine D2
receptors  coupled to G1 proteins that inhibit
GPe
2. Aspiny Neurons
- Stay inside
- Interneurons
- Secrete excitatory neurotransmitters
 Excitatory Neurotransmitter = Acetylcholine
 Driven by cortical inputs  neurotransmitter
from the cortex is excitatory = Glutamate
Input to Medium Spiny Neurons of the Striatum:
Glutaminergic - Corticostriatal Pathway - excitatory
Dopaminergic - Nigrostriatal Pathway – excitatory
MARIA KORINA A. DAKIS (2015-2016) 2
CIRCUITS
 All transmitters produced by the striatum are
inhibitory  GABA
 All transmitters produced outside the striatum are
excitatory  Glutamate
DIRECT PATHWAY:
- Facilitates movement
1. Cortex (via Glutamate)  stimulates Striatum
2. Striatum (via GABA)  stimulates GPi
3. GPi (via GABA)  stimulates subthalamus and
ventrolateral thalamus
4. Subthalamus and ventrolateral thalamus (via
Glutamate)  stimulate the cortex  cortex is excited
and movement is executed
INDIRECT PATHWAY:
- Inhibits movement
1. Cortex (via Glutamate)  stimulates Striatum
2. Striatum (via GABA)  stimulates GPe
3. GPe (via GABA)  stimulates Subthalamic nucleus
(part of the ventral thalamus
4. Subthalamic nucleus (via Glutamate)  stimulate GPi
5. GPi (via GABA)  inhibits the cortex
D1 Receptors
1. Striatum receives info from SNc (Dopamine)
2. LOW DOPAMINE in Parkinson’s  decreased
stimulation of the striatum
3. Less stimulation to Globus pallidus – less inhibition of
GABA
4. Globus pallidus becomes tonically active because of
less inhibition
5. Diminished stimulation of Thalamus
= NO/LESS MOVEMENT
D2 Receptors
Increased inhibition of the globus pallidus  less
inhibition, increased excitatory activity of the thalamus 
inhibits the globus pallidus = NO/LESS MOVEMENT
HUNTINGTON’S DISEASE
 Degeneration of the striatum (caudate nucleus and
putamen)
 Increased glutamate and acetylcholine
*Less inhibitory  increased stimulation of globus
pallidus internal  less inhibition of movement 
increased movement
*Increased stimulation of subthalamic nucleus 
diminished inhibition  increased movement

Mechanism of Disinhibition = inhibitory that is inhibited (SEE POWERPOINT PICS)

becomes excitatory
a. Striatum
b. Globus pallidus
c. Ventral Thalamus
d. Cortex
Striatum at rest (no stimulation from cortex)  Globus
pallidus (inhibitory) is tonically active: fires in the
thalamus  inhibition of the Thalamus = no execution of
movement

Mechanism of Disinhibition:
Striatum is stimulated by Glutamate (outside the cortex)
= excited  Striatum is inhibitory to Globus pallidus =
transient inhibition  inhibition of the inhibitory (GABA
inhibits the Globus pallidus)  becomes excitatory =
movement
 Happens in patients with Hyperkinesia.

PARKINSON’S DISEASE
 Substantia nigra pars compacta is degenerated = low
dopamine
 Dopamine stimulates D1 and D2 receptors
- D1 receptors  excitatory
- D2 receptors  inhibitory

MARIA KORINA A. DAKIS (2015-2016) 3

 DIENCEPHALON
 Between the telencephalon (cerebral cortex) and
brainstem
 Main processing center for information destined to
reach the cerebral cortex from all ascending sensory
pathways; all sensory information passes through the
thalamus before it enters the cerebral cortex (except
those related to olfaction  goes directly to the uncus
of the temporal lobe)
 Relay for ascending sensory information
 Relations/Boundaries:
 Superiorly – floor of lateral ventricle, corpus
callosum (medial aspect of the hemisphere), fornix
 Laterally – internal capsule
 Anteriorly – Foramen of Monro (cavity between the
lateral ventricle and the 3rd ventricle)
 Caudally – tegmentum of the midbrain
4 Principal Divisions of the Diencephalon
1. Dorsal Thalamus or Thalamus
2. Hypothalamus
3. Epithalamus
4. Ventral Thalamus or Subthalamus
DORSAL THALAMUS OR THALAMUS
 Largest of the 4 principal subdivisions of the
diencephalon
 Project sensory info to nearly all areas of the cerebral
cortex
 Thalamic Relay – sends all sensory info
 Lesions: crude sensory information; touch is interpreted
as severe pain (Thalamic Infarct)
 Participate in a widely diverse array of functions
including motor, sensory, and limbic systems
 Receives a variety of ascending inputs and projects:
- Thalamocortical Fibers  thalamus to cortex; to
various cortical areas or gyri
 Receives reciprocal connections:
- Corticothalamic Fibers  cortex to thalamus
(Cortical targets to which it sends projections)
 “Functional Gateway to the Cerebral Cortex”
 Separated from the basal ganglia by the internal capsule
(white); Oblong-shaped structure
Medial and Lateral Geniculate Bodies: relay; at the
base of the pulvinar nucleus
1. Medial Geniculate Body
- Receives ascending auditory input via the brachium
of the inferior colliculus
- Projects to the primary auditory cortex in the
temporal lobe
2. Lateral Geniculate Body
- Receives visual input from the retina via the optic
tract
- Projects to the primary visual cortex on the medial
surface of the occipital lobe
Internal Medullary Lamina:
- Myelinated fibers; extends into the substance of the
thalamus
- Forms partitions or boundaries that divide the
thalamus into its principal cell groups/compartments
 Cingulate gyrus = emotions (Limbic System)
Principal Thalamic Cell Groups:
1. Anterior Thalamic Nuclei
- Receive dense limbic-related projections from:
 Mammillary nuclei/Mammillary Body
(Mammillothalamic Tract)
 Medial Temporal Lobe (Hippocampus) via the
fornix
 Both are for emotions
- Output of this nucleus is primarily directed to the
cingulate gyrus through the anterior limb of the
internal capsule  hippocampus  mammillary
body  back to anterior thalamic nuclei  cingulate
gyrus (Papez Circuit)
- Important synaptic station in the Papez circuit
which is related to emotion and memory acquisition
2. Medial Thalamic Nuclei
- Dorsomedial Nucleus
- Parvocellular (caudal) and Magnocellular
(Rostral) Nuclei
 Linked to parts of the frontal and temporal lobes
and to the amygdaloid complex (for emotion via
limbic system)
- Paralaminar Subdivision
 Receive input from the frontal lobe and substantia
nigra
May play a role in the control of eye movement
3. Lateral Thalamic Nuclei
- Dorsal Tier:
a. Lateral Dorsal and Lateral Posterior Nuclei
 Connection is formed with the cingulate gyrus
and parietal lobe (respectively)
b. Pulvinar Nucleus (Pulvinar)
 Anterior, Medial, Lateral, and Inferior
Subdivisions
 The Inferior division receives input from the
superior colliculus and projects to the visual
association cortex
MARIA KORINA A. DAKIS (2015-2016) 4
  Pulvinar projects to areas of the temporal,
parietal, and frontal lobes that are especially
concerned with visual function and eye
movements
- Ventral Tier: *VA and VL are motor-related nuclei
(Basal Ganglia)
a. Ventral Anterior Nucleus (VA)
 Receives input from the medial segment of the
globus pallidus and receives afferents from the
reticular portion of the substantia nigra
 Efferent projections are diffuse and appear to
include selected parts of the frontal lobe
b. Ventral Lateral Nucleus (VL)
 Receives information from the cerebellum 
to pre-motor cortex
 Pars Oralis
- Receives a dense projection from the internal
segment of the ipsilateral globus pallidus
- Some of these afferents enter the caudal
subdivision
 Pars Medialis
 Pars Caudalis
- Receives its main input from the
contralateral cerebellar nuclei
c. Ventral Posterior Nucleus
 Ventral Posterolateral Nuclei (VPL)
- Somesthetic information from the body
(Spinothalamic Tract: pain and temperature;
and dorsal column of spinal cord/Medial
Lemniscus: conscious proprioception)
projected to the cerebral cortex
 Ventral Posteromedial Nuclei (VPM)
- Convey somatosensory information from the
head (trigeminal nerve) to the cerebral cortex
– sensation of the face
4. Intralaminar Nuclei
- Embedded within the internal medullary lamina
- Projections to the neostriatum and to other thalamic
nuclei, along with diffuse projections to the cerebral
cortex
- Centromedian: projects to the neostriatum and to
motor areas of the cerebral cortex
- Parafascicular Nuclei: projects to rostral and lateral
areas of the frontal lobe
- Other intralaminar nuclei: receive input from
ascending pain pathways and project to the
somatosensory and parietal cortex
5. Midline Nuclei
- Medial to the intralaminar nuclei
- Paratenial Nucleus
 Inputs are poorly defined
 Efferent fibers reach the amygdaloid complex and
the anterior cingulate cortex  role in the limbic
system
Thalamic Reticular Nucleus:
- Situated w/in the external medullary lamina and
between this lamina and the internal capsule
- Lateral to the thalamus
- Project medially into the nuclei of the dorsal thalamus
or to other parts of the reticular nucleus, but not into
the cerebral cortex
- Afferents are received from the cortex and from nuclei
of the dorsal thalamus (Thalamocortical and
Corticothalamic axons)
- Modulate or gate the responses of thalamic neurons to
incoming cerebral cortical input
- Consciousness/Wakefulness
 Lesion: drowsiness
Summary of Thalamic Organization:
 VL (Motor) – from GPi; to precentral gyrus and
anterior paracentral gyrus
 VPL (Sensory for the Body) – postcentral gyrus and
posterior paracentral gyrus
 VPM (Sensory for the Face) – postcentral gyrus
 MGB (Auditory) – transverse temporal gyrus
 LGB (Vision) – cortex on the calcarine sulcus
 Anterior nucleus projects primarily to the cingulate
gyrus and functions in the broad area of behavior
 Relay Nuclei (MGB, LGB, VPL, VPM, VL, VA,
Anterior Thalamic Nuclei)
- Receives input predominantly from a single source
 Association Nuclei (Dorsomedial, Lateral Dorsal,
Lateral Posterior, Nuclei of the Pulvinar Complex)
- Receives input from a number of different structures
or cortical regions and usually sends its output to
more than one of the association areas of the cerebral
cortex
 All relay nuclei and association nuclei are specific
nuclei of the dorsal thalamus.
Internal Capsule: V-shaped
- Consists mostly of axons that reciprocally link the
thalamus and cerebral cortex
- Descending axons from the cerebral cortex
- Contains cortical efferent fibers that project to the:
 Brainstem – corticorubral, corticoreticular,
corticonuclear-corticobulbar
 Spinal cord – corticospinal
- Anterior limb (between the caudate and lenticular
nucleus), genu, posterior limb (between the dorsal
thalamus and lenticular nucleus), and retrolenticular
limb
HYPOTHALAMUS
 Connected primarily to portions of the forebrain,
brainstem, and spinal cord
MARIA KORINA A. DAKIS (2015-2016) 5
 Control of visceromotor (autonomic) functions,  Increased: sympathetic activity, aggressive behavior,
limbic system (emotions), and endocrine systems hunger, temperature (cutaneous vasoconstriction and
(Pituitary gland) shivering)
 The hypothalamus and pituitary form the link between
the neural and endocrine systems (Hypothalamic- Rostromedial Hypothalamus:
Pituitary Axis)  Activation (Stimulation) – behavioral manifestations
 Participates in: associated with contentment
- Homeostatic mechanism controlling hunger, thirst,  Increased: parasympathetic activity, passive behavior,
sexual desire, sleep-wake cycles, etc. satiety
- Endocrine control via pituitary gland  Decreased: temperature (cutaneous vasodilation and
- Autonomic control sweating)
- Limbic mechanism
Other Hypothalamic Functions:
Pituitary Gland: connected to the hypothalamus via the A. Medial Preoptic Areas
infundibulum o Sexually dismorphic brain nucleus
A. Anterior Pituitary (Adenohypophysis) o Larger in males
- Release of hormones controlled by the hypothalamus o Neurosecretory neurons (GnRH or LHRH)
through the vascular portal system o Role in temperature regulation, activating Heat-
B. Posterior Pituitary (Neurohypophysis) Loss Mechanisms (vasodilation, sweating, panting)
- Does not contain glandular cells o Lesion: Hyperthermia or Hyperpyrexia
- Secretes oxytocin and vasopression B. Anterior Nucleus
o Located immediately caudal to the preoptic area
Hypothalamic Nuclei: (Rostral to Caudal) o Many of its neurons are involved in the
1. Preoptic maintenance of body temperature
2. Supraoptic o Participates in a wide range of visceral and somatic
3. Tuberal functions
4. Mammillary C. Supraoptic Nucleus
o Oxytocin – uterine contraction and ejection of milk
Hypothalamic Zones: (Medial to Lateral) by myoepithelial cells of the mammary glands
1. Periventricular Zone o Vasopressin (ADH) – promotes reabsorption of
- Periventricular Nucleus water by the collecting tubules of the kidneys
2. Medial Zone D. Paraventricular Nucleus
- Preoptic Area o Magnocellular neurons – oxytocin and ADH
- Anterior (Supraoptic) region o Parvocellular neurons – thyrotropin-releasing
- Middle (Tuberal) region hormone, corticotropin-releasing hormones,
- Posterior mammillary region dopamine, somatostatin
3. Lateral Zone E. Suprachiasmatic Nucleus
- Lateral preoptic nucleus o Biologic clock – may mediate circadian rhythms
- Lateral hypothalamic nucleus (hormonal fluctuations that are secondary to light-
dark cycle)
F. Arcuate Nucleus
Regional Functions of the Hypothalamus: o Neurosecretory cells (releasing hypothalamic
 Caudolateral Areas hormones)
- Lateral hypothalamic zone o Contains cells that secrete more than one releasing
- Mammillary region hormone
 Rostromedial Areas o Stress  corticotropin, prolactin, and growth
- Supraoptic region hormone levels in plasma increase (Hypothalamic-
- Most of the tuberal region Pituitary-Adrenal)
G. Ventromedial Nucleus
Caudolateral Hypothalamus: o Considered a “satiety center”
 Activation (Stimulation) – behavioral manifestation o Lesion produces weight gain
generally associated with anxiety H. Dorsomedial Nucleus
o Stimulation produces unusually aggressive
behavior – “Sham Rage” (*can also be elicited by

MARIA KORINA A. DAKIS (2015-2016) 6

 stimulation of other hypothalamic and  Zona Incerta
extrahypothalamic areas) - Contains output neurons that project to a variety of
I. Posterior Hypothalamic Nucleus locations (cerebral cortex, superior colliculus,
o Merges imperceptively with midbrain pretectal region, basilar pons)
periaqueductal gray - Afferent projections arise from the motor cortex and
o Associated with emotional, cardiovascular, and as collaterals from the medial lemniscus
analgesic functions attributed to the periaqueductal
gray

EPITHALAMUS
 Dorsal wall of the posterior part of the 3rd Ventricle
beneath the splenium of the corpus callosum
 Functionally related to the limbic system
 Main Structure – Pineal Gland (circuit for controlling
circadian rhythms, sleep-wake cycle)
 Other structures: habenular nuclei, posterior
commissure
 Pineal Gland
- Consists of richly vascularized connective tissue
containing glial cells and pinealocytes but no true
neurons
- The production of melatonin by pinealocytes is
rhythmic and calibrated to the 24-hour cycle of photic
input to the retina (Circadian Rhythm)
 Habenular Nuclei
- Anterior to the pineal gland
- Habenulointerpeduncular Tract (Fasciculus
Retroflexus)
 Stria Medullaris Thalami
- Conveys input to habenular nuclei
- Habenular Commissure – connects the habenular
regions of the two sides

VENTRAL THALAMUS
 Smallest subdivision of the diencephalon
 Area at the mesencephalodiencephalic junction
 Linked to the basal nuclei of the forebrain and functions
 Includes the subthalamic nucleus (part of the basal
ganglia circuit)
 Lesion – Hemiballismus: involuntary movements (1
side of the body)
 Often compromised in accidents and trauma
 Subthalamic Nucleus (Motor Activity)
- Receives input from motor areas of the cerebral cortex
- Projects to the substantia nigra
- Reciprocally connected with the globus pallidus
- Hemiballismus
 Prerubral Area (Field H of Forel)

MARIA KORINA A. DAKIS (2015-2016) 7

 CEREBELLUM
(BLACKBOARD)
 “small-brain”
 Has 3 surfaces:
1. Superior Surface – separated from the occipital lobe
of the cerebrum by the Tentorium cerebelli (a fold
of meninges)  separates supratentorial structures
(cerebral cortex) and the infratentorial structures
(cerebellum and brainstem)
 Clinical Significance: check for corticospinal
tracts and spinothalamic tracts (long tracts) found
in the brainstem; check for cranial nerves; check
the cerebellum
 Cranial nerves I and II are not true cranial nerves.
- Cranial Nerve I: telencephalically-derived; an
outpouching
- Cranial Nerve II: diencephalically-derived; an
outpouching
2. Inferior Surface
3. Medial Surface
 Must be connected to the brainstem
- Connections via the long tracts: *Long Tract signs
a. Corticospinal (Motor)
b. Spinothalamic (Sensory)
c. Cerebellar Tracts  PEDUNCLES
 Peduncles connect the cerebellum to the brainstem.
1. Inferior Cerebellar Peduncle aka Restiform Body
- Cerebellum to the medulla
- Very near to the IV ventricle, near the vestibular
nucleus = Juxtarestiform Body
- Restiform body + Juxtarestiform body = ICP
2. Middle Cerebellar Peduncle aka Brachium Pontis
- Cerebellum to the pons
3. Superior Cerebellar Peduncle aka Brachium
Conjunctivum
- Cerebellum to the midbrain
 Can be separated from the brainstem by cutting through
the peduncles.
 Horizontal Cut through the Midbrain:
- Superior surface of the cerebellum is visible
- Roughly in the location of the tentorium cerebelli
Horizontal Cut through the Midbrain: (see drawing)
Landmarks
 Primary Fissure: conspicuous fissure on the superior
surface of the cerebellum
 Postero-Lateral Fissure: separates the cerebellum
from the flocculo-nodular lobe
 Structures in front of the Primary Fissure: Anterior
Lobe (“Paleocerebellum”)
 Structure behind the Primary Fissure: Posterior
Lobe (“Neocerebellum”)
 Behind the Postero-Lateral Fissure: Flocculo-
nodulare lobe (“Archicerebellum”)
Spinocerebellar Fibers - unconscious proprioception
Dorsal Spinocerebellar tract nucleus: at Rexed Lamina
VI  dorsal nucleus of Clarke  from the lower
extremities (Thoracic region)  enter the cerebellum
via the ICP
Cuneocerebellar Tracts  accessory cuneate nucleus
 for the upper extremities (Cervical region)
Anterior Spinocerebellar Tract: no dorsal nucleus of
Clarke; w/ an upper limb component called the
accessory spinocerebellar tract  enter the cerebellum
via the SCP
From the spinal cord, enter the cerebellum via the
Restiform body  enter the cerebellum anteriorly
 Neuron #1 of all sensory fibers = dorsal root ganglion
*Neuron #2 of pain and temperature – Dorsal Horn
*Neuron #2 of conscious proprioception (position,
vibration, two-point tactile) – nucleus gracilis and
nucleus cuneatus
DIVISIONS OF THE CEREBELLUM
 Nodular Divisions
 Medial Zone: Vermis (Vermia) = Vestibulo-cerebellar
Intermediate Zone
Lateral Zone: Cerebrocerebellar = Pontocerebellar
Nodules at the Flocculonodular lobe
Vermis
o Vestibulo-cerebellar
o Fibers enter the medial zone
o Vestibular Nuclei (VIII)
o Nystagmus
o Vertigo
o Truncal ataxia  Vermian Syndrome; includes
spinocerebellar tracts from the lower extremities
o Drunken gait, loss of balance
Intermediate Zone
o w/ truncal and limb problems
Lateral Zone
o Pontocerebellar
o Fibers from the brachium pontis enter the lateral zone
o Ipsilateral dysmetria or Ipsilateral Limb ataxia
o “Fast-Pointing” test
MARIA KORINA A. DAKIS (2015-2016) 8
Cerebellar Lobules Granular Layer
 With ridges in between them = called Cerebellar Folia  Granule Cells: must be in contact w/ the Purkinje cell
 In the vermis: numbered I to IX (X is in the dendrites; widespread and large; axons enter the
flocculonodular lobe) cerebellum and run parallel to the folia = aka Parallel
 In the intermediate zone: HI to HIX (HX in the Fibers
flocculonodular lobe)  Axons enter the molecular layer in association w/ the
 Before the primary fissure (in front): I to V Purkinje cell dendrites  a critical connection because
 After the primary fissure (behind): VI to IX it tells us that the granule cells have an indirect
 Important Lobules: connection w/ the Purkinje cells
1. I – Lingula  Granule cells form a glomerulus
2. IX – Uvula  To form a Glomerulus:
3. HIX – Tonsils  near the medulla; may herniate and - Mossy Fiber (central): in association w/ the granule
push the medulla cell
- Golgi Cell (axon)
- Granule Cell (dendrite)  parallel fibers as axons
 3 Layered Cortex and go into the molecular layer and synapse with the
1. Molecular Layer Purkinje cell dendrites = critical synapse (1:200,000)
2. Purkinje Layer
3. Granular Layer Mossy Fibers:
 Folia - Come from the Granular Layer, become Parallel Fibers
 Deep Cerebellar Nuclei as they reach the Molecular Layer
- From the spinal cord (Spinocerebellar)
- From the reticular formation
DEEP CEREBELLAR NUCLEI - Aminergic input aka Multi-Layered Input:
1. Dentate Nucleus – in lateral zone Noradrenergic  from Nucleus Ceruleus;
2. Embolliform Nucleus – in intermediate zone Serotonergic  from raphe nuclei in the reticular
3. Globosus Nucleus – in intermediate zone formation; Histaminergic  from the hypothalamus
4. Fastiguus Nucleus – in medial zone (tubero-mammillary)
- From the cerebral cortex (Motor Cortex, Visual
“(Outside) Don’t eat greasy food.” Cortex, Cingulate gyrus  descend and look for the
pontine nuclei  Corticopontine Fibers)
*Medial 3/5 of the Midbrain: Corticospinal and
CEREBELLAR CORTEX Corticobulbar Fibers
(one folia of the cerebellum) *Laterally: Corticopontine fibers  pontine nuclei 
3 Layers: pontocerebellar fibers enter the cerebellum = MOSSY
1. Molecular Layer (most external) FIBERS
2. Purkinje Cell Layer – large cells
3. Granular Layer  Form the glomerulus
 Mossy fibers and parallel fibers indirectly influence
Purkinje Cell Layer the Purkinje cells.
 Most important EFFERENT LIMB (axons) of the  Parallel fibers make important connections w/ the
cerebellum dendrites of the Purkinje Cell.
 Send axons into the deep cerebellar nuclei (Dentate,
Embolliform, Globosus, Fastiguus – according the the Direct Influence to the Purkinje Cell: Climbing Fibers
zone of location of the nuclei) - Originate only from the Inferior Olives (opposite) 
i.e. Into the vermis – to the Fastiguus nucleus Olivocerebellar Tract  enters the cerebellum via the
Into the lateral zone – to the Dentate nucleus Juxtarestiform body
 INHIBITORY  GABAergic - Go directly to the Purkinje cells
 Dendrites are located in the molecular layer

Molecular Layer INTERNEURONS IN THE CEREBELLUM

 Contains the dendrites that go to the Purkinje cell layer  Stellate Cells: superficial
 Basket Cells: straddles between the Purkinje cells and
the molecular layer; form basket-like structures;

MARIA KORINA A. DAKIS (2015-2016) 9

 influence the Purkinje cells; they are INHIBITORY 
GABAergic
 Brush Cells: in the Purkinje cell layer only choose the
mossy fibers that enter the Fastiguus nucleus (midline –
Vestibulo-cerebellar)
 Spinocerebellum and Vestibulocerebellum: for
posture and balance because they have input from the
spinal cord and vestibular nuclei
 Ipsilateral Ataxia – “Double Decussation” 
Lateral Zone, Dentate Nucleus
1. Corticopontine fibers (Sensory motor fibers from
the cerebral cortex) go down and pass through lateral
1/5 of the midbrain
2. Go to the pontine nuclei
3. CROSS
4. Enter the MCP
5. Reenter the midbrain through the SCP  relay
nucleus: red nucleus
6. Goes into the ventral anterior and ventral lateral
nucleus of the thalamus
7. Enter the pre-motor cortex and motor cortex
8. Exit as the corticospinal tract (medial 3/5 of the
midbrain) that DECUSSATES at the caudal medulla
and into the spinal cord
(POWERPOINT)
2 Major Functions:
1. Coordinates skilled voluntary movements
2. Controls equilibrium, posture, and muscle tone
 Monitor or modulator of motor activity originating in
the brain centers
 Regulates muscle tone, posture and equilibrium
 Automatic excitation of antagonist muscles at the end
of movement, with simultaneous inhibition of agonist
muscles that initiated the movement
Location:
 In the posterior cranial fossa of the skull
 Dorsal to the brainstem
 Infratentorial
2 Major Parts of the Cerebellum (In General)
1. Vermis
2. Hemisphere
Effect of Compression of the 4th Ventricle by
Cerebellar Mass Lesions or Edema:
- Obstructive hydrocephalus
- Increased intracranial pressure
Anatomical Divisions of the Cerebellum: Anterior
Lobe, Posterior Lobe, Flocculonodular Lobe
Somatotopic Organization (Homonculus): Vermis,
Spinocerebellum, Cerebrocerebellum, Flocculus,
Nodulus
Vermian Lesion: Truncal Ataxia
Cerebellar Hemisphere Lesion: Ipsilateral Limb
Ataxia
Cerebellar Peduncle Lesion: clinical manifestations are
referable to limb ataxia plus brainstem manifestation
(cranial nerve deficits, long sensory tract signs)
Cerebellar Tonsillar Herniation: due to increased
intracranial pressure; compression of the medulla w/
respiratory arrest
Chiari Malformation: downward displacement of the
cerebellum into the foramen magnum w/ resulting
obstructive hydrocephalus
LAYERS OF THE CEREBELLAR CORTEX
1. Molecular Layer
 Basket Cells (near the Purkinje cell layer)
 Stellate Cells (superficial)
2. Purkinje Layer – axons go out and may be:
 Corticonuclear  going to the deep cerebellar
nuclei
 Corticovestibular  going out to the vestibular
nucleus
 Dendrites are in the molecular layer
 Climbing Fibers (from the Inferior Olivary
Nucleus) = directly influence the Purkinje cells
 Mossy Fibers (from the Granule Cell layer,) =
indirectly influence the Purkinje cells
3. Granular Layer
 Granule dendrioles
 Golgi Cells
NEURONS OF THE CEREBELLAR CORTEX
1. Purkinje Cells
2. Stellate Cells
3. Basket Cells
4. Granule Cells
5. Golgi Cells
Unipolar Brush Cells:
 Within the granular layer of the vermis and
flocculonodular lobe
MARIA KORINA A. DAKIS (2015-2016) 10
  Receive mossy fiber rosettes (glomerulus) via their DORSAL SPINOCEREBELLAR TRACT
dendrioles o Enter the cerebellum via the ICP
- w/c are excitatory to the cell type in these cortical o Inform the cerebellum of limb position and movement
neurons (posture)
o After processing in the cerebellum and their
connections with the motor cortex, they influence
CEREBELLAR NUCLEI movement of the extremities and muscle tone
1. Fastigial (most medial)
2. Globose VENTRAL SPINOCEREBELLAR TRACT
3. Emboliform o Enters the cerebellum via the SCP
4. Dentate (most lateral) o Cells in the spinal cord that give rise to this tract receive
 Globose and Emboliform: Interposed Nucleus  primary sensory inputs and descending reticulospinal
straddles the vermis and the cerebellar hemispheres and corticospinal fibers
- Have important connections w/ the red nucleus  o In connection w/ the reticular formation
descend as the rubrospinal tract that decussates at the o Provide afferent signals and feedback to the cerebellum
ventro-tegmental decussation and enters the spinal regarding motor circuits in the spinal cord
cord
VESTIBULOCEREBELLAR FIBERS
o Enter via the Juxtarestiform body (part of the ICP)
FUNCTIONAL ZONES OF THE CEREBELLUM o Fibers enter deep cerebellar nuclei  enter as mossy
 Vermal fibers  nearer to the midline (because Vestibular) 
 Paravermal (Intermediate) Nodulus and Vermis
 Lateral o Convey information concerning the position of the head
and body in space, as well as information useful in
o Spinocerebellum (Paleocerebellum - Anterior orienting the eyes during movement (Nystagmus,
Lobe): regulation of muscle tone, coordination of dizziness)
skilled voluntary movement
- Has vermian components and intermediate CEREBROCEREBELLAR PATHWAY
components o Via the middle cerebellar peduncle
- Has vermian connections and intermediate o Come from the fronto-parietal-temporal lobes of the
connections (Interposed Nucleus) cerebral cortex
o Cerebrocerebellum (Pontocerebellum - Lateral - Lateral 1/5 (Turck’s Bundle): Temporopontine
Zone): planning and modulation of voluntary activity, Fibers
storage of procedural memories; in connection with - Medial 1/5 (Arnold’s Bundle): Frontopontine Fibers
the cerebral cortex o Enter the pons (ipsilaterally)  pontine nuclei  cross
o Vestibulocerebellum: maintenance of balance, to the opposite side  cerebellar hemisphere  lateral
control of eye movement zone  to the Dentate nucleus  re-enter the midbrain
via the SCP  decussation
o In planning movement, sensory and motor
CEREBELLAR INPUTS Corticopontine projections provide the spinocerebellar
 From spinal cord (Spinocerebellar Tracts – and pontocerebellar via Pontocerebellar connections w/
Unconscious Proprioception) feed forward information about an intended movement
1. Dorsal Spinocerebellar Tract o This plan can be evaluated in relation to current activity
2. Ventral Spinocerebellar Tract and correction formulated and relayed back to the motor
 From lower brainstem cortex via the thalamus
1. Olivopontocerebellar (from the Inferior Olives) 
Climbing Fibers OLIVOCEREBELLAR PATHWAY
2. Reticulocerebellar o Coming from the inferior olives  decussate  enter
3. Vestibulocerebellar the cerebellum via the Restiform body  enter the
 From cerebral cortex cerebellar cortex and directly go to the Purkinje cell
1. Corticopontocerebellar Tract layer as Climbing Fibers (direct pathway)

RETICULOCEREBELLAR PATHWAY
o Coming from the reticular formation

MARIA KORINA A. DAKIS (2015-2016) 11

 Ipsilateral – Double Decussation that send axons to the molecular layer as Parallel fibers
= Corticopontine fibers enter the pons  pontine  parallel fibers form connections w/ the dendrites of
nuclei  enter the cerebellar cortex via the MCP  the Purkinje cells
choose the dentate nucleus (lateral zone)  exit the
cerebellar nucleus via the SCP  decussate at the
decussation of the SCP (midbrain)  go up to the MULTILAYERED FIBERS (Monoaminergic or
ventrolateral/ventral-anterior nucleus of the thalamus Peptide-Containing)
 cerebral cortex  corticospinal tract goes down   Derived from:
decussates at the level of the medulla - Locus ceruleus (Noradrenergic)
*Dentato-Rubro-Thalamic Tract - Raphe nuclei (Serotonergic)
- Hypothalamus (some are Histaminergic – from
tubero-mammillary nucleus))
CEREBELLAR CIRCUITS  Terminate in molecular and granular layers
1. Mossy Fibers  Modulate output of cerebellar cortex:
 Formed by efferent axons from: a. Decrease the spontaneous discharge rate of Purkinje
- Pontine nuclei cells
- Spinal cord b. Alter the responsiveness of Purkinje cells to
- Vestibular nuclei excitation by climbing fibers and mossy fiber-granule
- Reticular formation cell projection
 Form connection with the granule cells at the
glomerulus
 Indirectly influence the Purkinje cells by sending CEREBELLAR OUTPUT FROM CEREBELLAR
their axons via parallel fibers to the molecular layer NUCLEI (PPT PICS)
where they synapse w/ the dendrites of the Purkinje o Flocculonodular lobe, lateral vestibular nucleus,
cells vestibulospinal tract = for axial and proximal muscles
 Go to the granule cell layer o Corticospinal and rubrospinal tracts = distal limbs
 Synapse with granule cell dendrites
 Excitatory
 Neurotransmitter = Glutamate TRACTS
2. Climbing Fibers  Corticospinal and Rubrospinal: flexors of the
 Formed by afferent axons from the inferior olivary extremities
nucleus  Vestibulospinal and Reticulospinal: extensors of the
 Directly influence the Purkinje cells extremities
 Go directly to the Purkinje cell layer
 Synapse directly w/ Purkinje cell dendrites
 Excitatory Inferior Cerebellar Peduncle
 Neurotransmitter = Aspartate  2 Divisions:
- Restiform Body
 Both fibers are excitatory. - Juxtarestiform Body
 Excitatory Inputs from:  Mostly AFFERENT
- Granule cells (Parallel Fibers) - Inferior olive
- Mossy fibers - Spinal cord (Dorsal Spinocerebellar)
- Climbing fibers
 Some efferent
- Aminergic fibers
 Inhibitory Inputs from (Interneurons):
Middle Cerebellar Peduncle
- Purkinje cells
- Stellate and Basket Cells  Most massive
- Golgi Cells  ONLY AFFERENT fibers to the cerebellum
 Purkinje cells going out are inhibitory. Everything  Majority from the pontine nuclei
else is excitatory.

o Mossy fibers (come from many places)  enter the Superior Cerebellar Peduncle
granule cell layer  form a connection in the  Main pathway for EFFERENT CEREBELLAR
glomerulus  connect w/ the granule cell dendrites FIBERS to brainstem, red nucleus, ventral-anterior and
ventral lateral nucleus of the thalamus

MARIA KORINA A. DAKIS (2015-2016) 12

 Some afferent fibers – spinal cord (Ventral Blood Supply
Spinocerebellar)  Superior Surface: Superior Cerebellar Artery

Parts of the Nervous System Tested in Neurological FUNCTIONAL REGIONS OF THE CEREBELLUM
Examination Motor Pathways
Region Function
o Mental status Influenced
o Cranial nerves Lateral Motor planning Lateral
o Motor Hemispheres for extremities corticospinal tract
o Coordination Lateral
Intermediate Distal limb corticospinal
o Reflexes coordination tract, rubrospinal
Hemispheres
o Sensory tract
Anterior
Cerebellar Examination corticospinal
o Stance and gait tract,
Proximal limb
o Finger to nose test and heel to shin test reticulospinal
Vermis and trunk
o Alternating movements (Alternate Pronation- coordination
tract,
Supination Test) vestibulospinal
o Rebound tract, tectospinal
o Tongue movement tract
o Eye movement Balance and Medial
Flocculonodular
vestibulo-ocular longitudinal
Lobe
reflexes fasciculus
 Heel to Shin Test = patient cannot run heel down leg
evenly; fragmented movements
CEREBELLAR LOBES AND SUBDIVISIONS
 Finger to Nose Test = dysmetria
(See Table in PPT)

Clinical Manifestation of Cerebellar Disease

o Hypotonia
o Ataxia
 Intention tremor
 Dysmetria
 Dysdiadochokinesia
 Decomposition of movement
 Rebound
 Speech disturbance – scanning dysarthria
 Nystagmus

General Principles of Cerebellar Syndrome

1. Ipsilateral signs with lateralized lesions
- Double decussation of efferent cerebellar pathways
- i.e. Right hemisphere lesion – right limb ataxia
2. All deficits are motor
- Are superimposed on normal motor movements (no
paralysis)  incoordination
- No loss of sensory perception
3. Gradual but definite recovery in time
- If disturbances are due to non-progressive pathology
4. Somatotopy of deficits
- Laterally-placed lesions = limbs are affected
- Medially-placed lesions = trunk is affected
5. Severity of deficits
- Considerably increased if lesions involve the SCP or
deep cerebellar nuclei

MARIA KORINA A. DAKIS (2015-2016) 13

 TELENCEPHALON
Triune Brain:
Neocortex (Neomammalian/Primate Brain) – rational or
thinking brain
Limbic Brain (Old Mammalian/Mammalian Brain) –
emotional or feeling brain
Reptilian Brain – instinctual or dinosaur brain
Phylogenetically, Supratentorial Level:
1. The older “inner tube”: limbic lobe, amygdala, basal
forebrain, olfactory structures, hypothalamus, and
thalamic nuclei
 Functions – Internal regulation
Consciousness
Emotion
Motivation
2. The newer “outer tube”: neocortex (not present in
other forms of animals), basal ganglia, thalamic nuclei
connections
 Functions – Higher cognition
Language
Motor programming
Sensory processing (visual,
somatosensory, auditory)
 The diencephalon and telencephalon are supratentorial
(tentorium cerebelli separates the occipital lobe and
the cerebellum).
 The brain is 2% of the total body weight w/ 150 mL of
CSF.
 Large number of infoldings in the brain, more surface
area, more spaces for the neurons – greater functions.
 Telencephalon becomes bigger, diencephalon
becomes found in the inner part (in the inner core of
the cerebrum) and is enveloped by the telencephalon.
Development of the Mature Nervous System:
1. Determination
- Cells in ectoderm (neuron precursor)
- Neural induction
2. Proliferation
- Cell division
3. Migration
- After final division (migrate to final destination)
- Directed by radial glial cells
4. Maturation
- Final location (established connections thru
dendrites/axons)
- Myelination (completed at 2 years old)
Types of Cortex
1. Isocortex (Neocortex): 6 classic layers of cells
(Homogenetic)
- In humans, overshadowed allocortex
- Deals with motor and sensory controls
2. Allocortex (Heterogenetic): 3 layered
- Primitive, phylogenetically older; receives
influences (olfactory cortex)
- Dominant in lower animals (rats)
a. Archicortex: hippocampal formation (memory)
b. Palleocortex: entorhinal; primary olfactory
CEREBRAL HEMISPHERES: 3 layers of tissue
surrounding the ventricles
 Innermost Core – Ventricles (*3rd Ventricle at the
midline)
1. Basal Ganglia – adjacent ventricles/near the thalamus;
gray matter
2. White matter – intermingled axons (surrounds the
basal ganglia); connects nervous system structures
3. Cerebral Cortex – outermost layer; contains neurons
migrated to this location
a. Limbic cortex: most primitive cerebral hemisphere;
vegetative functions (eating/procreating);
interconnected structures (medial)
b. Paralimbic: connects limbic and neocortex
c. Neocortex: layer of neurons; outer surface of
cerebral hemisphere
 Mostly gray – neuronal cell bodies
General Topography
 80% of the brain
 Enormously developed in man
 Convolutions (result of overexpansion) – no pattern;
limited by the skull
 Ridges: Gyri (*Latin word gyrare – twist) – 2/3 of the
cortex is buried
- Gyri: going out
- Sulci: deeper inner part
 Fissures: deeper than sulci (usually reaches the walls of
ventricles)
 Massive folds: temporal lobe (*thumb); fronto-parietal
(*fist); lateral fissure
Landmarks
 Central sulcus of Rolando = starts at the midline and
goes anteriorly, but does not reach the lateral fissure
 Lateral fissure (Sylvian) = separates the temporal lobe
from the frontal and parietal lobes
 Parieto-occipital sulcus/fissure
MARIA KORINA A. DAKIS (2015-2016) 14
 Pre-occipital notch = Posteriorly: Occipital Lobe;
Anteriorly: Parietal and Temporal Lobe
 Corpus callosum = medially located

SULCI AND FISSURES GYRI

Central sulcus of Rolando
Precentral sulcus
Superior Frontal sulcus
FRONTAL LOBE Inferior Frontal sulcus
(41% of brain volume) Lateral Fissure (Ant. Ramus)
Lateral Fissure (Asc. Ramus)
Olfactory sulcus
Orbital sulcus
Lateral fissure (Post. Ramus)
Superior Temporal sulcus
TEMPORAL LOBE
Middle Temporal sulcus
(22% of brain volume)
Inferior Temporal sulcus
Collateral sulcus
Calcarine sulcus
OCCIPITAL LOBE
Parieto-occipital sulcus
(18% of brain volume)
Lunate sulcus
Postcentral sulcus
Intraparietal sulcus
PARIETAL LOBE
Marginal sulcus or ramus
(19% of blood volume)
Precentral gyrus
Superior Frontal gyrus
Middle Frontal gyrus
Inferior Frontal gyrus
Pars orbitalis
Pars triangularis (Broca’s)
Gyrus rectus
Orbital gyrus
Superior Temporal gyrus
Middle Temporal gyrus
Inferior Temporal gyrus
Fusiform (Occipitotemporal) gyrus
Transverse Temporal Gyrus (Heschl)
Lingual gyrus
Cuneus
Postcentral gyrus
Supramarginal gyrus
Angular gyrus
Paracentral lobule
Precuneus

ARCHITECTONIC AREAS
BRODMANN AREA GROSS LANDMARK FUNCTION
3-1-2-5 Postcentral gyrus Somatosensory (General Sense)
7 Anterior Parietal area Sensory association
4 Precentral gyrus Motor
6 Posterior Frontal gyrus Motor organization
8 Superior Frontal gyrus Major part of Frontal Eye Field
17 Occipital pole, calcarine fissure Visual
18 – 19 Surround 17 Visual association, automatic eye motor
Superior Temporal gyrus, floor lateral
41 Auditory
fissure
42 Surrounds 41 Auditory association
Inferior Frontal gyrus, Pars Triangularis
44 Motor speech, LEFT
(Broca’s Area)
23-24 Gyrus cinguli Erotic experience
9-10-45 Anterior Frontal lobe Planning
4 & 6: medial Superior Frontal gyrus, sulcus cinguli Supplementary motor

 2 cm deep (still not a fissure)

FRONTAL LOBE  Begins at the upper margin, 1 cm behind the midpoint
 Zigzag course – Upper Genu: Occipital
CENTRAL SULCUS (ROLANDO) Lower Genu: Frontal
 Important; constant  Constant genu (landmark)
 Divides frontal (motor) and parietal (sensory)  Slopes down 68o, midsagittal line

MARIA KORINA A. DAKIS (2015-2016) 15

  Almost reaches the lateral fissure but does not
Functions (Gyri) of the Frontal Lobe
1. Pre-Central/Paracentral gyrus
o Represented by the homonculus
o Primary somatomotor (contralateral), BA 4
o Parts of the body that need more discrete/fine
movements, take up a bigger part  hand, face,
mouth, tongue
o From Lateral Fissure: “Homonculus”
 Face: 1/3
 Hand and upper extremities: middle third
(emphasis on the hand)
 Trunk: medial third
 Hip: over the edge
 Lower extremities and foot: anterior paracentral
gyrus
2. Frontal Eye Field: depth of precentral sulcus
o controls the conjugate movement of the eyes and
help eyes focus on targets
o Conjugate deviation of the eye away from the
stimulus
o Extends between BA’s 6 and 8
o Evidence: primarily BA 6  CNs 3, 4, 6
o Voluntary eye movement
o Lesions:
- Irritative  away from lesion (conjugate)
- Destructive  toward lesion
3. Language: Inferior Frontal Gyrus (LEFT):
BROCA’S AREA
o Especially Pars Opercularis (BA 44)
o Expressive communication
o Lesion: non-fluent; expressive aphasia (Broca’s
Aphasia (*stroke)
o Ascending Ramus divides the Inferior Frontal gyrus
into 3 parts:
1. Pars Orbitalis (more anterior – nearer to the
orbits)
2. Pars Triangularis: triangle-shaped
3. Pars Opercularis: coming from the operculum
 LEFT CEREBRAL HEMISPHERE is dominant in
most right handed individuals and 80% of left handed
individuals.
 Only 1 hemisphere is dominant, even if ambidextrous.
PARIETAL LOBE
1. Post-central sulcus/Parieto-occipital notch
2. Post-central gyrus
- Extends to the medial surface; BA 3, 1, 2
- Continuous w/ posterior paracentral gyrus
- Rostral border: imaginary line (Central sulcus to
Cingulate)
- Caudal border: marginal sulcus
 Post-central gyrus and Post Paracentral gyrus:
Primary Somatosensory Cortex
3. Intraparietal sulcus – contains superior parietal lobule
4. Superior Parietal gyrus (precuneus)  medial surface
5. Inferior Parietal gyrus
a. Angular gyrus (BA 39): caudal end of Superior
Temporal sulcus)
b. Supramarginal gyrus: crescent-shaped ridge (caudal
end of lateral fissure, BA 40)
 Derived from the end of the lateral and superior
temporal sulcus.
Functions (Gyri) of the Parietal Lobe
1. Primary Somatosensory (BA 3, 1, 2)
o Similar to precentral gyrus
o Face: Lateral third
UE: Middle third
Hip, trunk, thigh: Medial third
Leg foot, genitalia: Post paracentral lobule
o Somesthetic (appreciation, interpretation) sensation
o Damage: altered sensation (pain, thermal,
proprioception)
2. Angular (BA 39) and Supramarginal (BA 40)
LEFT
o WERNICKE’S AREA
o Comprehension of spoken language
o For reception and understanding of what is heard
o Located close to the Transverse gyrus of Heschl
o Lesion: receptive problem
(receptive/sensory/Wernicke’s aphasia)
TEMPORAL LOBE
 Massive fold; lateral fissure and collateral sulcus in
between
1. Superior Temporal sulcus
- Ends in angular gyrus
2. Superior Temporal gyrus
- Transverse Gyrus of Heschl (BA 41, 42) =
primary auditory cortex
Found at the inner part of the Lateral Fissure
3. Middle Temporal sulcus
- Middle temporal gyrus
4. Collateral sulcus
- Occipito-temporal gyrus
Temporal Lobe Functions
1. Primary Auditory Center
- Interpretes sound; localizes sound in space
- Lesion: unable to discriminate (not deaf)
MARIA KORINA A. DAKIS (2015-2016) 16
2. Other functions are related to limbic system and A. Short Association: adjacent gyri
hippocampus (emotion and memory) B. Long Association: distant areas
1. Cingulum
2. Uncinate fasciculus
OCCIPITAL LOBE  Broca’s area and Wernicke’s area are connected via
 Caudal hemisphere; occipital gyri (irregular) long association fibers (Temporal-Parietal to Frontal)
 Lateral surface: small; Important structures are found = Arcuate Fasciculus
medially
1. Parieto-occipital sulcus Commissural Fibers
- In the medial surface, separates cuneus (occipital)  Interconnect corresponding structures between 2
from precuneus (parietal) hemispheres
2. Occipital sulcus (Superior occipital gyrus and Inferior A. Corpus callosum
occipital gyrus)  Largest; superior to diencephalon
3. Calcarine sulcus  Forms the roof of lateral ventricles
- Important landmark (medial)  Parts (Rostro-caudal): rostrum, genu, body,
- Separates cuneus (above) from lingual gyrus (below) splenium
4. Primary Visual Cortex (BA 17) a. Genu: rostrally interconnects frontal lobes
- Gyri that directly border calcarine sulcus (minor forceps)
- Function: discriminate visual images b. Splenium: caudally interconnects occipital lobes
- Lesion: one side  homonymous hemianopsia (loss (major forceps)
of contralateral half of the visual field) B. Anterior Commissure
 Caudal to rostrum (frontal/temporal lobes)
C. Hippocampal Commissure
Insular Lobe  Inferior to splenium (hippocampus)
 Oval cortex deep inside the lateral fissure; central D. Posterior Commissure
sulcus (insula)  Connects caudal diencephalon
 Gyri longus (1 set); Gyri brevis (1 set)  Crosses the base of the pineal gland (posterior to
 Continuous w/ frontal, parietal, and temporal lobes cerebral aqueduct)
 Function: unclear; receives nociceptive (pain) and E. Habenular Commissure
visceromotor inputs  Connects the caudal diencephalon (Habenular
nuclei, near the pineal gland)
Limbic Lobe
 Medial ring of cortex; appears as a circle/limbus Projection Fibers
 Has a unique function: memory, learning, behavior  Interconnects distal areas:
 Parts: - Corticopetal (outside telencephalon/cerebral cortex)
- Subcallosal - Corticofugal (downstream, from cerebral cortex to
- Cingulate targets)
- Isthmus  Large bundles: Internal Capsule  all fibers pass
- Parahippocampus through here
- Uncus  3 Parts of the Internal Capsule:
a. Anterior Limb: between caudate and lenticular
nuclei; fibers from the thalamus, frontal lobe, BG
WHITE MATTER OF CEREBRAL HEMISPHERE b. Posterior Limb: between dorsal thalamus and
 Homogenous mass; below the cortex, enveloping the lenticular nuclei; corticospinal fibers and other fibers
corpus striatum and ventricles from the thalamus going to the other parts of the brain
 Function: pathways for information to and from the c. Genu: intersection; level of interventricular foramen;
cortex (gray matter) corticobulbar fibers
 3 Types of Fibers:
1. Association Fibers
2. Commissural Fibers Internal Capsule
3. Projection Fibers 1. Anterior Limb (Frontal Part)
- From thalamus to frontal lobe
Association Fibers - Lentiform nucleus
 Interconnect areas within the hemisphere - Medial fifth of cerebral peduncle

MARIA KORINA A. DAKIS (2015-2016) 17

2. Genu (knee or flexure)
- From motor (corticobulbar)
3. Posterior Limb (Occipital Part)
- Anterior portion: CST
- Posterior portion: sensory from thalamus, optic
radiation
- Middle of cerebral peduncle

Corona Radiata
 “radiating crown”
 Caused by the funneling of fibers into the internal
capsule
 Fibers (capsule) flare out; distal to the basal ganglia
 Converging corticofugal, diverging corticopetal

LAYERS OF CEREBRAL CORTEX

I. Plexiform (Molecular Layer)
- few small cells and numerous dendrites and axons
- interwoven
- parallel to surface
II. III. Small Medium Pyramidal Cells
- Conical/pear-shaped tips directed toward
surface
IV. Granular Layer (Stellate)
- Well-demarcated
- Small compact, multipolar granule cells
- Chief Receptive Center (incoming impulses)
V. Pyramidal Cells (Large Giant Cells, Betz)
- biggest in precentral gyrus
- Chief Discharge Center (efferent impulses)
VI. Spindles (Fusiform)
- Long axis perpendicular to surface; contribute to
efferents

CEREBRAL HEMISPHERE: PRIMARY AREAS

 Centers: integration, interpretation, dissemination of
impulses (sensory/motor)
1. Primary Motor Area: Frontal
- Precentral Gyrus (BA 4)
2. Primary Somatosensory Area: Parietal
- Postcentral Gyrus (BA 3, 1, 2)
3. Primary Visual Area: Occipital
- Bounded by calcarine sulcus (BA 17)
4. Primary Auditory Area: Temporal
- Transverse Gyrus of Heschl (BA 41, 42)

 Brodmann’s Classification: according to function

MARIA KORINA A. DAKIS (2015-2016) 18

 CEREBRAL CIRCULATION
 About 50% of intracranial problems are vascular in
origin
 Brain: 2-3% of body weight; 15% of cardiac output;
20% of oxygen; 25% of glucose
 Blood Supply: Internal Carotid Artery and
Vertebral Artery
 Anterior Circulation:
 From the Internal Carotid system
 Supplies 80% of the brain
 Posterior Circulation:
 From the Vertebral (Vertebro-Basilar) system
 Supplies 20% of the brain
INTERNAL CAROTID SYSTEM
 Cervical part – lies along the cervical area
 Petrous part
 Cavernous part – near the cavernous sinus
 Inferior hypophysial artery
 Meningeal artery
 Cerebral part – contains majority of the important
branches
 Ophthalmic artery: exits through the eyes; occlusion:
monocular blindness
 Posterior communicating artery: connects the
anterior circulation to the posterior circulation
 Anterior choroidal artery
 Superior hypophysial artery
 Middle and Anterior Cerebral arteries: terminal
branches (termination of the ICA)
Anterior Cerebral Artery
 ACA: ICA to its termination at about the
parietooccipital sulcus
 It is divided into 5 segments:
- A1: Precommunicating segment
- A2: Infracallosal segment
- A3: Precallosal segment
- A4: Supracallosal segment
- A5: Postcallosal segment
 A1 and A2 are located basally
 A3 – A5 are located medially
 Supplies the basal and medial aspects of the cerebral
hemispheres
 Extends to the anterior 2/3 of the parietal lobe
 Perforating branches supply the anterior caudate
nucleus, parts of the internal capsule, putamen, and
anterior hypothalamus
Middle Cerebral Artery
 Usually (70% of the time) larger than ACA
 MCA: ICA to its termination
 Supplies more parts
 It is divided into 4 segments:
- M1: medial portion of the Sylvian cistern
- M2: insular part
- M3: opercular part
- M4: cortical branches
 M1 is the largest and supplies most of the structures
 Supplies most of the convex surface (lateral part) of
the brain
 Deep tissue: basal ganglia, putamen, parts of the globus
pallidus, caudate nucleus, and internal capsule
 M1 Segment:
 ICA and the point where it branches at the
ventromedial aspect of the insula (the limen
insulae)
 Branches serve the adjacent medial and rostral
aspects of the temporal lobe (via lenticulostriate
arteries  penetrating arteries that supply the deep
structures of the brain)
 Lenticulostriate arteries: supply the basal ganglia;
most commonly ruptured in patients w/
hypertension
 Bifurcates into superior and inferior trunks
 Aneurysm commonly arises from the bifurcation of
M1
VERTEBROBASILAR SYSTEM
 Formed by the distal segments of the vertebral arteries
as they join to form the basilar artery (union of 2
vertebral arteries)
 Primary source of supply to the brainstem
Vertebral Artery
 Passes through the transverse foramen
 Divided into 4 segments:
- V1: subclavian artery to the transverse foramen of
the C6 (entrance)
- V2: transverse foramina of C6 – C2
- V3: exit from C2 to atlantooccipital membrane
(passes through C1)
- V4: passes thru dura as it joins to form the basilar
artery (intracranial)
Basilar Artery
 Branches:
1. Anterior Inferior Cerebellar Artery (AICA)
 Lower 3rd of the basilar artery, passes thru CP
cisterns
MARIA KORINA A. DAKIS (2015-2016) 19
  Serves the ventral and lateral surfaces of the
cerebellum, parts of the pons, portion of the
choroid plexus
 Gives rise to the labyrinthine artery
2. Pontine Arteries
 Penetrate the pons immediately as paramedian
branches
 Short circumferential branches
 Long circumferential branches
3. Superior Cerebellar Arteries
 Medial and Lateral Branches
- Serve their respective regions of the superior
surface of the cerebellum and its nuclei
Posterior Cerebral Artery
 Bifurcation of the basilar artery in the interpeduncular
cistern
 Branches to the midbrain and thalamus and to the
ventral and medial surfaces of the temporal and
occipital lobes as far as the level of the parietooccipital
sulcus (*Parietooccipital Sulcus delineates the
structures supplied by the ACA and the PCA –
*Parieto-Temporo-Occipital Area is supplied by the
PCA)
 Segments: P1 to P4
- P1: between the basilar bifurcation and the PCom
artery
 Small perforating vessels and to quadrigeminal
and thalamoperforating arteries
- P2: between the PCom and the inferior temporal
branches
 Medial and lateral posterior choroidal and
thalamogeniculate arteries as well as small
perforating branches to the midbrain
- P3: gives rise to its temporal branches
- P4: parietooccipital and calcarine arteries
 Calcarine Artery serves the primary visual
cortex
Differential Diagnosis:
 Difficulty walking but able to hold a pen = ACA
 Upper extremity weaker than the lower = MCA
CIRCLE OF WILLIS
 aka Cerebral Arterial Circle
 main cerebral circulation
 ACA, MCA, Posterior Communicating, PCA
 Located basally (exudates usually settle here during
infections); coexists w/ the cranial nerves and brainstem
 Main point of bifurcation (sites of aneurysm)
 Structures located inside this circle:
- Optic chiasm and tracts
- Infundibulum and tuber cinereum (associated w/
pituitary gland)
- Mammillary bodies
- Hypothalamus
- Structures of the interpeduncular fossa
VEINS AND VENOUS SINUSES OF THE BRAIN
 The venous drainage of the brain exits the skull through
one major vessel = Internal Jugular Vein
 The major venous sinuses: located w/in the dura
- Superior sagittal sinus: forms the confluence of
sinuses that drains into the transverse sinus 
sigmoid sinus  IJV
- Inferior sagittal sinus: medially located; drains into
the straight sinus
- Straight sinus
 Cavernous Sinus – drainage of the emissary veins;
infected during infections of the skin  manifested as
CNS infection
 Anastomotic veins: connect the superficial cerebral
veins and deep cerebral veins
 Superficial Cerebral veins (Cortical veins)
- Carry blood from the outer 1-2 cm of the brain
surface to large drainage channels
 Deep Cerebral veins (Central Veins)
- Drain blood from the inner regions of the brain
(hemispheric white matter, basal ganglia, corpus
callosum, choroid plexus) and from a few cortical
areas as well
Summary of Venous Drainage (PPT)
NEUROVASCULAR SYNDROMES
Cerebrovascular disorders include cerebral infarcts (most
common) and cerebral hemorrhages.
Middle Cerebral Artery Syndrome
o Contralateral hemiplegia or hemiparesis affecting
primarily the face and upper extremity
o Contralateral sensory deficit, also more prominent in
the face and upper extremity
o Contralateral visual field
o Contralateral conjugate gaze paralysis – involvement of
the frontal eye field (BA 8)
o Aphasia if the dominant (left) hemisphere is involved –
Broca’s, Wernicke’s, or global variety
o Inattention and neglect of the contralateral half of the
body or space and denial of illness if the non-dominant
(right) hemisphere is involved
o Spatial perception (right, non-dominant hemisphere)
- Constructional apraxia
- Topographagnosia
MARIA KORINA A. DAKIS (2015-2016) 20
 - Dressing apraxia Intracranial Hemorrhage Syndromes
o Gerstmann Syndrome (left-sided parietal lesion) May result from:
- Agraphia o Spontaneous rupture of an arterial wall of longstanding
- Acalculia hypertension
- Agnosia (finger) o Rupture of a congenital saccular aneurysm
- Left-right disorientation o Rupture of an arteriovenous malformation
o Trauma
Anterior Cerebral Artery Syndrome o Bleeding disorder
Unilateral occlusion of the ACA is associated with: Hemorrhage may occur:
o Contralateral hemiplegia or hemiparesis affecting o Within the brain parenchyma = Intracerebral
primarily the lower extremity Hemorrhage
o Contralateral sensory deficit affecting primarily the o Into the ventricular system = Intraventricular
lower extremity Hemorrhage
o Transcortical motor aphasia (in between Broca’s and o Into meningeal spaces (subarachnoid, subdural,
Wernicke’s) when the left (dominant) hemisphere is epidural)
affected *Subarachnoid hemorrhage: most deadly
Bilateral occlusion of the ACA is associated with:
dementia-like symptoms
o Loss of initiative and spontaneity
o Profound apathy
o Memory and emotional disturbances
o Akinetic mutism
o Disturbance in gait and posture
o Grasp reflex
o Disorder of sphincter control (center for sphincter
control is in the medial aspect of the frontal lobe)

Internal Carotid Artery Syndrome

o A combination of the MCA and ACA syndromes to
which is added transient monocular blindness.

Posterior Cerebral Artery Syndrome

Unilateral occlusion of the PCAS is associated with:
o Contralateral hemianopia
o Visual and color agnosia
o Contralateral sensory loss of all modalities w/
concomitant pain (thalamic syndrome)
o Pure alexia w/o agraphia w/ a left-sided lesion

Vertebral-Basilar Artery Syndromes

Occlusion of the vertebral-basilar arterial system usually
results in brain stem infarcts.
o Bilateral long tract (motor and sensory) signs
o Crossed motor (weakness of the face on the left and
weakness of extremities on the right - brainstem
lesions) and sensory signs
o Cerebellar signs
o Cranial nerve signs
o Alteration in state of consciousness (stupor or coma)
o Disconjugate eye movements

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