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Department of Human Anatomy,

College of Health Sciences,


Benue State University Makurdi.

Problem-Based-Learning (PBL)
Group 6

Facilitator: Prof. L.C. Saalu.


MBBCh; MPH, M.Sc., Ph.D, MPA , D.Sc
(Professor and HOD Department of Human Anatomy,
College of Health Sciences. Makurdi)
HIGHLIGHTS OF PRESENTATION
Introduction of group members
Case study
Bio data
Points to note
Definition of terms
Anatomy to be learnt
Anatomical basis of the case study
Conclusion
GROUP MEMBERS
1. BSU/MBBS/13/520 Alexander OCHEPO (leader)
2. BSU/MBBS/13/489 Juliana ABAH (Assist. leader)
3. BSU/MBBS/13/507 Kuma IGBASHIO
4. BSU/MBBS/13/510 Bibiana IORNDER
5. BSU/MBBS/13/515 Oryina KPURKPUR
6. BSU/MBBS/13/517 Terkuma MUSA
7. BSU/MBBS/13/518 Samuel NOBLE
8. BSU/MBBS/13/537 Christopher ULOKO
9. BSU/MBBS/14/DE/622 Edward UDEH
10. BSU/MBBS/14/DE/623 Winners VORKYAA
CASE STUDY
ChiefOjo was a seasoned demonstrator
of gross anatomy in one of the medical
schools in southern Nigeria. He was
popularly called Prof by his students
because of his extraordinary knowledge
of human anatomy. He received a severe
head injury during a game of hockey he
so much cherished. He had according to
the attending orthopaedic surgeon a
depressed fracture of the frontal bone
After months at the hospital Prof felt
he could go back to his academic
community. Not long after it became
obvious that Prof social behaviour had
changed drastically. His tutorials
although still amazing no longer had
directions. Although previously a
smartly dressed man, he now kept an
unkempt appearance.
CASE STUDY
Indeed, a colleague had reportedly
seen him urinating on the cadaver
table in the gross anatomy laboratory.
In all these he was tolerated because
of the good work of this encyclopaedia
of gross anatomy. He was however
sacked after he was found defecating
in the anatomy museum.
BIO-DATA
Name: Chief Ojo
Age: Unknown
Sex: Male
Tribe: Unknown
Religion: Unknown
Occupation: Anatomy Demonstrator
Address: Unknown
POINTS TO NOTE

Depressed fracture of frontal bone.


Lectures amusing but lacked direction.
Drastic change in social behaviour
Unkempt appearance

Urinating on cadaver table .

Defecating in the cadaver museum.


DEFINITION OF TERMS
1. Fracture : Is breaking of a hard tissue such
as bone.
2. Frontal bone : The large cranial bone
forming front part of the skull
3. Depressed fracture : This is the breaking of
the skull in which the broken part is directed
inwards compressing the brain
ANATOMY TO BE LEARNT

The neurocranium.
Gross anatomy of the cerebrum.
Histology of the cerebral cortex.
Functional areas of the cerebrum.
OSTEOLOGY OF THE NEUROCRANIUM

The skull is subdivided into two parts:

1. Neurocranium.
The neurocranium has a dome like roof
called the calvaria and a floor called the
cranial base. The neurocranium is the
container for the brain.

2. Viscerocranium
Forms the facial skeleton which lies below
the anterior part of the cranium in humans.
THE NEUROCRANIUM
The neurocranium, consisting of 6 bones, out
of which two are paired and four unpaired

Paired bones
Parietal bones.
Temporal bones.

Unpaired bones
Occipital bone.
Frontal bone .
Ethmoidal bone.
Sphenoid bone.
STRUCTURE OF THE SKULL
The walls of the skull varies in thickness in
different regions .in males the thickness of
the calvaria appears to increase with age
while in females its reversed.
Bones of the calvaria are made up of
external and internal tables of compact
bone. The outer bone is thick and tough and
the inner is thin and brittle, hence termed
the vitreous table.
These two tables are separated by a diploe,
a spongy bone intervening between the two
tables of the calvaria.
It houses and protects the red bone marrow.
It also provides fluid filled spaces for the
reduction of the weight of most bones.
In certain regions it is absorbed leaving
fluid filled spaces between the two tables.
It could be invaded by in growths from air
passages which separates the two tables
and form the air sinuses of the skull.
THE FACIAL (ANTERIOR) ASPECT OF THE
SKULL

The bones seen on this aspect of the skull includes the


frontal, zygomatic, nasal, maxillary and mandibular
bone(s).
Features
Supraciliary arch is a curved elevation in the
frontal bone just above the medial part of the upper
margin of the orbit.
Glabella: a smooth slightly elevation between the
supracilliary arches.
Nasion: a point of intersection between the
internasal and frontonasal sutures.
NORMA FRONTALIS OF THE SKULL CONTD

Supraorbital margin is the boundary between the


squamous and the orbital parts of the frontal bone.
Supraorbital notch: transmitts supraorbital
nerve and vessels
Zygomaticofacial foramen for the passage of the
zygomaticofacial nerve and vessels.
Zygomaticotemporal foramen transmits the
zygomaticotemporal nerve
NORMA LATERALIS
The bones seen on the lateral aspect of skull are :
Frontal bone, parietal bone, occipital bone, sphenoidal
bone and the ethmoid bone.
Features
Temporal fossa: A depression bounded above by the
temporal lines, inferiorly by the zygomatic arch,
anteriorly by the frontal and zygomatic bones.
Zygomatic arch: It is a horizontal bar of bone formed
by temporal process of zygomatic bone and zygomatic
process of temporal bone.
Asterion: It is a meeting point of
parietomastoid, occipitomastoid and lambdoid
sutures. It is located 4cm behind and 12mm
above the centre of the entrance of the ear
canal.
Pterion: The meeting point of frontal,
parietal, squamous temporal and the greater
wing of sphenoid. It is located 3-4cm above
the midpoint of the zygomatic arch. It overlies
the anterior division of middle meningeal
artery.
External acoustic opening: this is the
entrance to the external acoustic meatus.
.
POSTERIOR ASPECT OF THE
SKULL
This aspect of the skull consist of the occipital,
parietal and mastoid parts of the temporal bones.

Features
External occipital protuberance located in the
midline.
External occipital crest descending from the
protuberance toward the foramen magnum.
Superior nuchal lines extends laterally from the
sides of the external occipital protuberance.
Inferior nuchal line is located about midway
between the foramen magnum and the external
occipital protuberance
THE SUPERIOR ASPECT OF THE
SKULL

The bones seen from this aspect of the skull are


frontal, parietal, and occipital bones.
Features
Bregma (point of intersection between the sagittal
and coronal sutures ) this is the anterior fontanelle
in the adult.
Parietal eminence.

Parietal foramina.

Lambda.
THE INTERNAL ASPECT OF THE
SKULL
The internal surface of the cranial base
presents the anterior, middle and posterior
cranial fossae.

THE ANTERIOR CRANIAL FOSSA


Shallowest of the three fossae.

It is made up of the frontal bone, ethmoid and


the sphenoid bones.
It contains the frontal lobe of the brain.
THE ANTERIOR CRANIAL
FOSSA CONTD
Boundaries
Anteriorly and on the sides by the frontal
bones
Posterioly by the free posterior border of the
lesser wing of the sphenoid, anterior clinoid
process and the anterior margin of the sulcus
chiasmatus.
Floor it is formed by the frontal, ethmoid and
sphenoid bone.
The anterior cranial fossa presents with the
foramen cecum at its base and the cribriform
plate which transmits axons of the olfactory
nerves.
THE MIDDLE CRANIAL FOSSA
It is Butterfly shaped.
It is made up of the sphenoid, parietal and temporal
bone.
This fossa contains the temporal lobe of the brain.

Features
Optic groove: leads on each side to the optic canal.

Sella turcica: a saddle shaped depression found on


the upper surface of the sphenoid. It has 3 parts the
tuberculum sellae, hypophyseal fossa and the
dorsum sellae.
The hypophyseal fossa houses the hypophysis cerebri
FORAMINA
Optic canal: optic nerve and ophthalmic artery.
superior orbital fissure: transmits the
occulomotor trochlear, abducent, the lacrimal,
frontal and nasocilliary branches of opthalmic
nerve, and superior ophthalmic veins.
Foramen spinosum, transmits the middle
meningeal vessels and the meningeal branches of
trigeminal nerve.
Foramen ovale, transmits mandibular nerve
and accessory meningeal artery and lesser
petrosal nerve.
Foramen rotundum transmits the maxillary
nerve.
Foramen lacerum
THE POSTERIOR CRANIAL FOSSA
Largest, and deepest of the 3 fossae,
It contains the pons, the medulla oblongata and the
cerebellum.

Boundaries
Posterioly by the occipital bone
Anteriorly by the dorsum sellae of the sphenoid,
Lateraly by the mastoid part of the temporal bone.

Features of this fossa includes:


clivius
Internal acoustic meatus transmitts
vestibulocochlear nerve, facial nerve and labyrinthine
artery,
THE POSTERIOR CRANIAL FOSSA
CONTD
Jugular foramen, transmitts cranial nerves IX, X,
XI and internal jugular vein.
Hypoglossal canal transmitting the hypoglossal
nerve.
Foramen magnum. Apical ligament of dens,
longitudinal band of cruciate ligament, membrana
tectoria, medulla oblongata and associated meninges,
anterior spinal artery, posterior spinal arteries,
vertebral arteries, sympathetic plexus, spinal root of
the accessory nerve.
GROSS
ANATOMY
OF THE
CEREBRUM
EXTERNAL FEATURES OF THE
CEREBRAL HEMISPHERE

The external features of the cerebral


hemispheres include:
Surfaces,

Sulci and Gyri.

Lobes.
THREE SURFACES
a) Superolateral surface.
b) Medial surface.
c) Inferior surface.
FIVE LOBES
a) Frontal lobe.
b) Parietal lobe.
c) Temporal lobe.
d) Occipital lobe.
e) Insula lobe.
SULCI AND GYRI
The cerebral cortex is thrown into a
complicated series of tortuous folds, called
gyri or convolutions.
The grooves between the gyri are termed as
sulci.
Each gyrus consists of a central core of white
matter covered by an outer layer of grey
matter.
The convolutions greatly increase the surface
area of the cerebral cortex.
CLASSIFICATION OF SULCI
ACCORDING TO FUNCTION

1. Limiting sulcus: Seperates at it floor


two areas that are different functionally
and structurally. e.g. central sulcus.
2. Axial Sulcus: Develops around the axis
of a rapidly growing homogenous area eg
calcarine.
3. Operculated sulcus: Seperates by it
lips two areas and contains a third in the
wall of the sulcus eg lunate sulcus.
ACCORDING TO FORMATION
1. Primary sulcus:
Formed before birth.

2. Secondary sulcus:
produced by other factors other than
exuberant growth in the adjoining areas
of the cortex. eg lateral and occipital
sulcus.
ACCORDING TO DEPT
1. Complete Sulcus
Very deep so as to cause elevation of
the walls of the lateral ventricle e.g.
collateral and calcarine sulcus.

2. Incomplete sulcus
Are superficially situated and are not
very deep. e.g. precentral sulcus.
THREE PRINCIPAL SULCI

a) Central sulcus of Rolando.


b) Lateral sulcus of Sylvius.
c) Parietooccipital sulcus.
SULCI AND GYRI ON
SUPERIORLATERAL SURFACE
ON THE FRONTAL LOBE
a) Precentral sulcus.
b) Superior frontal sulcus.
c) Inferior frontal sulcus.
d) Precentral gyrus.
e) Superior frontal gyrus.
f) Middle frontal gyrus.
g) Inferior frontal gyrus.
ON THE PARIETAL LOBE
a) Postcentral sulcus.
b) Intraparietal sulcus.
c) Postcentral gyrus.
d) Superior parietal lobule.
e) Inferior parietal lobule.
f) Supramarginal gyrus.
g) Angular gyrus.
ON THE TEMPORAL LOBE
a) Superior temporal sulcus.
b) Inferior temporal sulcus.
c) Superior temporal gyrus.
d) Middle temporal gyrus.
e) Inferior temporal gyrus.
f) Transverse temporal gyrus.
ON THE MEDIAL SURFACE
a) Callossal sulcus.
b) Cingulate sulcus.
c) Marginal sulcus.
d) Calcarine sulcus.
e) Corpus callosum.
f) Cingulate gyrus.
g) Paracentral lobule.
h) Precuneus.
i) Cuneus.
j) Lingual gyrus.
ON THE INFERIOR SURFACE
a) Olfactory bulb.
b) Olfactory tract.
c) Olfactory trigone.
d) Anterior perforated substance.
e) Collateral sulcus.
f) Occipitotemporal sulcus.
g) Medial occipitotemporal gyrus.
h) Lateral occoipitotemporal gyrus.
i) Hippocampal sulcus.
j) Parahippocampal gyrus.
k) Uncus.
l) Hippocampus.
m) Dentate gyrus.
INSULA/ISLAND OF REIL (ALSO CALLED
CENTRAL LOBE)

The insula is the submerged (hidden)


portion of the cerebral cortex in the
floor of the lateral sulcus.
It has been submerged from the surface
during development of brain due to the
overgrowth of the surrounding frontal,
parietal, and temporal opercula.
INSULA CONTD

It is triangular in shape at its apex


called limen insulae which is continued
with the anterior perforated substance.
The insula is divided into two regions,
anterior and posterior by a central
sulcus.
It functions in olfaction.
Parietal opeculum
Frontal opeculum

Temporal opeculum
INTERNAL
STRUCTURES OF THE
CEREBRUM
The internal structures of the cerebrum
are located deep to the cerebral cortex.
They include:

White matter.
Masses of gray matter: the basal
ganglia.
A cavity: the lateral ventricle.
WHITE MATTER OF CEREBRAL
HEMISPHERES

The white matter is composed of myelinated


nerve fibers that connects the various parts of
the cerebral cortex to one another and also
other parts of the CNS
They may be classified into three groups
according to their connections:
(1) Association fibers

(2) Commissural fibers

(3) Projection fibers.


ASSOCIATION FIBERS
Connects different cortical areas of the same
cerebral hemisphere to one another
They are subdivided into

i. Short association fibers which


connects adjacent gyri to one another .
ii. Long association fibers which
connects more widely separated gyri to
one another e.g. the uncinate fasciculus,
the cingulum, superior longitudinal
fasciculus etc.
COMMISSURAL FIBERS
Essentially connect corresponding regions of the
two hemispheres.
They are as follows

Corpus callosum.
The anterior commissure.
The posterior commissure.
Hippocampal commisure (the commissure of the
fornix).
The habenular commissure.
THE CORPUS CALLOSUM
The largest commissure of the brain, connects
the two cerebral hemispheres.
It is divided into

I. Genu; the anterior end.


II. Rostrum; Directed downward and
backwards from the genu and is related to
the anterior horn of lateral ventricle.
III. Body; the middle part between the genu
and splenium.
IV. Splenium; the posterior end.
THE ANTERIOR COMMISSURE

Small bundle of nerve fibers that


crosses the midline in the laminar
terminalis connecting the archipalia
(olfactory bulb, piriform area and
anterior part of temporal lobe) of the
two sides.
THE POSTERIOR COMMISSURE

This is a bundle of nerve fibers that


crosses the midline immediately above the
opening of the cerebral aqueduct into the
third ventricle.
This fibres connects the superior colliculi.
THE HIPPOCAMPAL COMMISSURE

This is also called the commissure of the


fornix.
This connects the hippocampus and the
crura of the fornix of both sides to each
other.
THE HABENULAR COMMISSURE
This is a slender bundle of white
fibres connecting the habenular
nuclei of both sides.
THE PROJECTION FIBERS
This are fibres that connects parts of the
cerebral cortex to other parts of the CNS.
They are either:

Corticopetal which carries fibres to the


cortex .e.g. the auditory radiations.
Corticofugal carrying fibres away from
the cortex e.g. are the efferents from the
cortex to the thalamus and the brain
stem.
INTRENAL CAPSULE
This is a large band of fibers situated in the
inferior medial part of the cerebral hemisphere.
It contain fibers go to and from the cerebral
cortex.
Superiorly, it continues as the corona radiata and
with the crus cerebi of the midbrain inferiorly.
INTRENAL CAPSULE CONTD
It is divided into the
1. Anterior limb; contains anterior thalamic
radiation.
2. Genu: contains corticonuclear fibers and
superior thalamic radiation( fibers from head
and neck)
3. Posterior limb: corticospinal and superior
thalamic radiation.
4. Retrolentiformpart: contains optic radiation
5. Sublentiform part: contains auditory radiation
BLOOD SUPPLY OF INTERNAL CAPSULE
Anterior limb
Upper part: Striate branches of middle cerebral artery
Lower part: Recurrent branch anterior cerebral artery
(artery of Heubner)
Genu
Upper part: Striate branches of middle cerebral
Lower part: Direct branches of internal carotid artery
Recurrent branch anterior cerebral artery
Posterior limb
Upper part: Striate branches of middle cerebral
Lower part: Anterior choroidal artery.

Retrolentiform and sublentiform part


Anterior choroidal artery.
BASAL GANGLIA (BASAL NUCLEI)
Is a collection of masses of grey matter
situated within each cerebral hemisphere.
They are the

Corpus striatum.
caudate nuclues and putamen.

Globus pallidus.
Functionally, it also include the substantia
nigra which projects dopaminergic fibers the
basal ganglia.
CORPUS STRIATUM
The corpus striatum is situated lateral to
the thalamus.
It is almost completely divided by a band
of nerve fibers, the internal capsule into
the caudate nucleus and the
lentiform nucleus
CORPUS STRIATUM CNTD
The caudate nucleus is a large C-
shaped mass of grey matter that is
surrounded by the lateral ventricle.
It has a head which forms the floor of
the anterior horn of the lateral
ventricle, The body forms the floor of
the central part of the lateral ventricle.
CORPUS STRIATUM CONTD
The tail forms the roof of the inferior
horn of the lateral ventricle and ends
by joining the amygdaloid body at
the temporal pole
CORPUS STRIATUM CONTD

The lentiform nucleus is a wedge-


shaped mass of grey matter that forms the
lateral boundary of the internal capsule.
Medially, it is related to the internal
capsule which separates it from the
caudate nucleus and the thalamus.
Laterally, it is related to the external
capsule that separates the claustrum.
CORPUS STRIATUM CNTD
The lentiform nucleus is divided into
two parts;
A larger lateral part called the
putamen. It is structurally similar to the
caudate nuclues and
A smaller medial part called the globus
pallidus.
CONNECTIONS OF THE BASAL
GANGLIA
Afferent Fibers
Corticostriate Fibers
Glutamate is the neurotransmitter.
Thalamostriate Fibers
Norepinephrine is the neurotransmitter.
Nigrostriate Fibers
liberate dopamine as the neurotransmitter.
Brainstem Striatal Fibers
liberate serotonin as the neurotransmitter.
Striatopallidal Fibers (to globus pallidus)
Have GABA as their neurotransmitter.
CONNECTIONS OF THE BASAL
GANGLIA CONTD
Efferent Fibers
Striatopallidal Fibers (from putamen)
They have gamma-aminobutyric acid (GABA) as their
neurotransmitter
Striatonigral Fibers
Some of the fibers use GABA or acetylcholine as the
neurotransmitter while others use substance P.
Pallidofugal Fibers
can be divided into groups:
(1) Ansa lenticularis, which pass to the thalamic nuclei.
(2) Fasciculus lenticularis, which pass to the subthalamus.
(3) Pallidotegmental fibers, which terminate in the caudal
tegmentum of the midbrain.
(4) Pallidosubthalamic fibers, which pass to the
subthalamic nuclei.
FUNCTION OF CORPUS STRIATUM

The corpus striatum is concerned


with muscular movement which is
accomplished by controlling the
cerebral cortex rather than through
direct descending pathways to the
brainstem and spinal cord.
LATERAL VENTRICLE
There are two lateral ventricles, and one is
present in each cerebral hemisphere .
Each ventricle is a roughly C-shaped cavity
lined with ependymal cells and filled with
cerebrospinal fluid.
The lateral ventricle may be divided into a

Body which occupies the parietal lobe .

The anterior horn extends into the frontal


lobe.
LATERAL VENTRICLE CONTD
The posterior horn extends into the
occipital lobe.
The inferior horn extends into the
temporal lobes.
The lateral ventricle communicates with the
cavity of the third ventricle through the
interventricular foramen (of Monroe).
Body or central part extends from the
interventricular foramen to the splenium of
the corpus callosum. It consist of a medial
wall, roof and floor.
THE LATERAL VENTRICLE
LATERAL VENTRICLE CONTD
Floor: the following are related to the floor
from lateral to medial
The body of the caudate nucleus.

Thalamostriate vein.

Striae terminalis.

A narrow strip of superior surface of


thalamus.
The choroid plexus .

The fornix
HISTOLOGY OF THE
CEREBRAL CORTEX
TYPES OF CELLS
The nerve cells in cerebral cortex are of 5 types
Pyramidal cells

Stellate cells

Fusiform cells

Horizontal cells of cajal

Cells of martinotti
THE PYRAMIDAL CELL
STELLATE /GRANULE CELLS
HISTOLOGICAL LAYERS OF THE CEREBRAL
CORTEX

Molecular layer (plexiform layer)


External granular layer

External pyramidal layer

Internal granular layer

Internal pyramidal layer

Multiform layer (layer of polymorphic cells)


HISTOLOGICAL LAYERS OF THE CEREBRAL CORTEX CONTD

A. Molecular layer (I)


Is the superficial layer below the pia mater.

It is made up predominantly of fibers a few cells


(cells of cajal).
All the remaining layers contain both stellate
and pyramidal cells as well as other types of
neurons.

B. External granular layer (II)


The external layer contains small pyramidal
cells.
HISTOLOGICAL LAYERS OF THE CEREBRAL CORTEX CONTD

C. External pyramidal layer (III)


Contains medium sized pyramidal cells and
Martinotti cells .
Gives rise to association and commissural fibers.

D. Internal granular layer (IV)


Contains white fibres bands called outer band of
Bailarger .
The outer band of Bailarger form the stripe of
Gennari, which is visible to the naked eye.
HISTOLOGICAL LAYERS OF THE CEREBRAL CORTEX CONTD

E. Internal pyramidal layer (V)


Contains the giant cells of Betz, which are found
only in the motor cortex (area 4) of the precentral
gyrus and the anterior paracentral lobule.
Martinotti cells are also found in the pyramidal
layers.
Gives rise to corticobulbar, corticospinal, and
corticostriatal fibers.
Contains white fibres bands called inner band of
Bailarger.
HISTOLOGICAL LAYERS OF THE CEREBRAL CORTEX CONTD

F. Multiform layer (VI)


It is the deepest layer of the cerebral cortex.

Contain cells of various sizes and shape as well


as fusiform cells and cells of Martinotti.
It gives rise to association, commissural and
projection fibers
FUNCTIONAL AREAS OF
THE CEREBRUM
FUNCTIONAL AREAS OF THE
CEREBRUM
Different areas of the cerebral cortex are
functionally specialized.
Many of these areas have distinct neuronal
organization and have since been correlated
to various cortical functions.
The topographical representation of the
homunculus of the primary sensory and
primary motor arranged in an anatomical
fashion and represents the contralateral side.
This means that right cerebral hemisphere
controls the left side of the body and vice
versa.
CEREBRAL DOMINANCE

Certain nervous activity is predominantly


performed by one of the two cerebral
hemispheres.
Handedness, perception of language and
speech are functional areas of behavior that
in most individuals are controlled by the
dominant hemisphere.
Spatial perception, recognition of faces, and
music are interpreted by the nondominant
hemisphere.
CEREBRAL DOMINANCE CONTD

More than 90% of the adult population is


right-handed and, therefore are left
hemisphere dominant.
More descending fibers in the left pyramid
cross over the midline in the decussation
than vice versa.
The anterior horn cells on the right side of
the spinal cord will therefore have more
corticospinal innervation than those on the
left side.
CEREBRAL DOMINANCE CONTD

Lesions of the dominant hemisphere


1. Result in contralateral loss of sensory
discrimination (astereognosis).
2. Result in contralateral neglect.

3. Receptive aphasia.

4. Alexia with agraphia.

5. Tactile agnosia (bimanual astereognosis).


CEREBRAL DOMINANCE CONTD
Lesions of the nondominant hemisphere

1. Contralateral loss of sensory discrimination.


2. Contralateral neglect.
FUNCTIONAL AREAS OF THE BRAIN

There are 3 general kinds of functional areas


I. Motor areas
II. Association areas
III. Sensory areas.

Each of the major senses has a specific brain


region called the primary sensory area.
There also multifunctional association areas
that process information.
PRIMARY MOTOR CORTEX
Located in the precentral gyrus and the
anterior part of paracentral lobule.
It corresponds to Brodmanns area 4.

It is somatotropically organised as the


motor homunculus with the body
represented upside down.
The size of the functional area is directly
proportional the skilled movement but not
the size of the muscle.
PRIMARY MOTOR CORTEX CONTD
It is here that actions are conceived and
initiated.
The principal subcortical afferents to the
PMC is from the ventral lateral nucleus
(VLN) of thalamus.
PRIMARY MOTOR CORTEX CONTD

VLN receives inputs from the globus


pallidus and dentate nucleus of the
crebellum.
Inputs sources are also from other motor
brain areas like premotor area (area 6)
and somesthetic cortex.
LESION
Upper 1/3 of the PMC
Affectation (paralysis/paresis) of voluntary
control in the lower limb and perineum of
the opposite side.

Lower 2/3 of PMC


Affectation of the head, neck and upper
limbs and trunk of the opposite side.
PREMOTOR CORTEX
Lies anterior to the premotor cortex
It includes the posterior part of the
superior middle and inferior frontal gyri.
It corresponds to Brodmanns area 6.

This area receives afferents from ventral


nucleus of the thalamus.
PREMOTOR CORTEX CONTD
Function
Programming and preparing for
movement and control of posture.

Lesion
Isolated lesion of the premotor cortex
leads to apraxia (inability to perform
skilled movements in spite of absence of
muscle paralysis).
SUPPLEMENTARY MOTOR CORTEX
Located the medial surface of premotor
cortex.
Forms part of Brodmann area 8.

Principal subcortical input is from ventral


anterior nucleus of thalamus which
receives afferents from globus pallidus
and substatial nigra.
SUPPLEMENTARY MOTOR CORTEX CONTD

Function
Programming of complex movement
involving several parts.

Lesion
Bilateral lesion will cause paralysis and
akinetic mutism (inability to neither
move nor speak).
FRONTAL EYE FIELD
Lies in the posterior part of the middle
frontal gyrus.
It corresponds to the inferior part of
Brodmanns area 8.
It controls conjugate movement of the eye.

Lesion
Produces transient deviation of the eye to
the ipsilateral side and paralysis of
contralateral gaze.
PREFRONTAL CORTEX
Lie anterior to the premotor cortex.
Forms nearly of all the cerebral cortex.

It corresponds to Brodmanns areas


9,10,11 and 12.
It has rich connections with the parietal
temporal and occipital cortices.
PREFRONTAL CORTEX CONTD
Function
Intellect.

Judgement.

Prediction.

Motivation.

Planning of behaviour.
LESION
Causes loss of initiative, careless dress
sense and loss of sense of acceptable social
behaviour.
Prefrontal lobectomy or lobotomy were
once common surgical procedures used
treat patients with severe behavioural
disorder.
MOTOR SPEECH AREA(BROCA'S AREA)

Lies in the inferior frontal gyrus in the


dominant (usually left) hemisphere.
It corresponds to Brodmanns areas 44
and 45.
It receives connections from the ipsilateral
temporal parietal and occipital lobes the
share in language

Function
speech
LESION

Due to lesion of the left middle cerebral artery


Expressive or motor aphasia; Inability
to express thoughts, answer or writing in
spite of normal comprehension.
In damage to Brocas area (motor
aphasia),there is normal comprehension but
the speech is distorted (talking nonsense;
patients are aware of this) whereas in
receptive aphasia, the patients is not
aware that he/she is talking nonsense.
SENSORY AREA
PRIMARY SOMATOSENSORY CORTEX

Lies in the postcentral gyrus and posterior part


of the precentral lobule.
It corresponds to Brodmann areas 3, 1 and 2

The thalamocortical neurons (3rd order neuron)


terminate here.
It receives input from the ventral posterior nucl
eus (VPN) of the thalamus.
PRIMARY SOMATOSENSORY CORTEX CONTD

Within the somatosensory cortex, the


contralateral half of the body is represented
upside down.

VPN receives the following tracts:


Medial lemniscus; Fine touch and proprioception.
Spinothalamic tract; Crude touch, pressure pain
and temperature.
Trigeminothalamic tract; General sensation from
the head and neck.
PRIMARY SOMATOSENSORY CORTEX CONTD

Function
It receives and interprets sensory stimuli from
the opposite side of the body.

Lesion
Results in a contralateral loss or reduction of
tactile discrimination, position sense, pain and
temperature.
SECONDARY SOMATOSENSORY AREA
Lies in the parietal operculum and
extends into the posterior part of the
insula.
It corresponds to Brodmanns area 43.

It receives bilateral inputs from the


intralaimar nuclei and posterior group of
nuclei of the thalamus.
Afferent fibers to this nuclei come from
the reticular formation, spinothalamic
tract and trigeminothalamic tract.
SECONDARY SOMATOSENSORY AREA CONTD

It provides less discrimination sensation


to touch and could be responsible for
residual sensation after first somesthetic
sensory area is destroyed
SOMESTHETIC ASSOCIATION AREA
Lies in the superior parietal lobule on the
lateral surface and in the precuneaus on the
medial surface
It corresponds to Brodmanns areas 5 and 7

Afferent fibers come from the first


somesthetic area

Function
Provides comprehensive assessment of an
object
SOMESTHETIC ASSOCIATION AREA
Agnosia (inability to recognise familiar
objects or persons).

Types of agnosia
A. Colour agnosia

B. Topographical agnosia

C. Prosopagnosia

D. Tactile agnosia and asterognosia.

E. Autotopagnosia.
PRIMARY AUDITORY CORTEX
Lies in the anterior bank of the middle
of the superior temporal gyrus
It is hidden within the lateral fissure

Its precise location is marked by a


small transverse temporal gyrus
(Hischl gyrus)
It corresponds to Brodmanns areas 41
and 42
PRIMARY AUDITORY CORTEX COTD
It receives input (auditory radiation) from
medial geniculate nucleus (MGN) of the
thalamus
Auditory radiation undergoes partial
decussation in the brain stem before it
reaches the MGN
The cortex therefore receives information
from both ears.
PRIMARY AUDITORY CORTEX COTD
Lesion
Causes difficulty in recognizing
distance and direction of sound
especially when the sound come from
contralateral side
SECONDARY AUDITORY CORTEX
Also known as auditory association
area or Wernicke area
It is located at the floor of the lateral
sulcus and inferior parietal lobule
It lies in the dominant hemisphere
It corresponds to the posterior part
of Brodmanns area 22
SECONDARY AUDITORY CORTEX
CONTD

Function
It is the receptive language area.

Learned sounds and words are interpreted


here
Language understanding and formation

Lesion
Sensory (receptive) aphasia ( inability
to recognize sound or words with hearing
unimpaired
PRIMARY VISUAL CORTEX
Lies in the medial surface of the occipital
lobe in close association to the calcarine
sulcus.
Is corresponds to Brodmanns area 17.

It receives optic radiation from the lateral


geniculate nucleus of the thalamus.
Each lateral half of the visual field is
represented in the visual cortex of the
contralateral hemisphere.
PRIMARY VISUAL CORTEX CONTD
Because of partial crossing, the left visual
field is projected to the right hemisphere
and the upper visual field is projected to
the lower wall of the cortex (below the
calcarine sulcus)
The marcula (yellow spot) projects to the
posterior 1/3 of the cortex
PRIMARY VISUAL CORTEX CONTD

Lesion
Homonymous hemianopia (loss of
sight in the opposite eye field) with
macula sparing.
VISUAL ASSOCIATION CORTEX
Corresponds to Brodmanns area 18 and 19
It receives information from area 17.

The function of the secondary visual area is


to relate the visual information received by
the primary visual area to past visual
experiences thus enabling the individual to
recognise and appreciate what he or she is
seeing
They are interpretative to visual images.
VISUAL ASSOCIATION CORTEX
CONTD

Lesion
Visual agnosia (inability to recognize
a seen object)
OTHER SENSORY CEREBRAL FUNCTIONAL
AREAS

Vestibular area: in front of the superior


temporal gyrus. Concerned with the sense
of hearing.
Olfactory area: near the incus. Concerned
with the sense of smell.
Gustatory area: at the frontal operculum.
It corresponds to area 43. it is concerned
with sense of taste.
BLOOD SUPPLY TO
THE CEREBRUM
The blood supply to the brain is provided by 2 system of
arteries;
A. The internal carotid system: 2 internal carotid
arteries.
B. The basivertebral system: 2 vertebral arteries
uniting to form the basilar artery

The branches of basilar and internal carotid arteries


anastomose at the base of brain around the
interpeduncular fossa forming circulus arteriosus or
circle of Willis.
This is a six-sided polygon of arteries formed by the
anastomosis between branches of the basilar and
internal carotid arteries.

Formation
Anterior cerebral arteries.

Anterior communicating artery.

Internal carotid artery.

Posterior cerebral arteries.

Posterior communicating arteries.


Normally there is little or no mixing of
blood streams in the circle of Willis's.
However, when one of the major arteries
forming the circle is occluded, the circle
provides various alternative routes to
supply the brain.
BLOOD SUPPLY TO THE CEREBRUM
Arterial supply to the cerebrum is from
1. Anterior cerebral artery.
2. Middle cerebral artery branches of
internal carotid artery.
3. Posterior cerebral artery from basilar
artery.
Each cerebral artery give cortical, central
and choriodal branched.
The cortical branches which supply the
cortex anastomose freely.
The central branches are numerous
slender arteries that supply the
centrally located parts and are end
arteries.
The choroidal arteries form the choroid
plexus and project into the ventricles.
ARTERIAL SUPPLY TO THE SURFACE OF
THE CEREBRUM
Superiolateral surface
middle cerebral artery supplies 2/3rd of the
superolateral surface, including the Brocas
and Wernicke's speech area in the left
dominant hemisphere and frontal eye field.
Anterior cerebral artery supplies a narrow
strip 2.5cm adjoining the superomedial border
up to the Parieto-occipital sulcus.
SUPERIOLATERAL SURFACE CONTD

Posteriorcerebral artery supplies a


narrow strip along the lower border of
the temporal and occipital lobe.
MEDIAL SURFACE

Anterior cerebral artery supplies


2/3rd of the medial surface including
the motor and sensory areas.
Middle cerebral artery supplies the
temporal pole of the temporal lobe.
Posterior cerebral artery supplies
the occipital lobe.
INFERIOR SURFACE
Posterior cerebral artery supplies most of
the surface.
Middle cerebral artery supplies the orbital
surface of the frontal lobe and the
temporal pole.
Anterior cerebral artery supplies medial
part of the orbital surface of the frontal
lobe
CEREBRAL VENOUS DRAINAGE
The veins of the cerebrum can be divided
into external and internal cerebral veins.

1. The external cerebral veins


drains the cortex of the hemisphere and
is divided into:
a) Superior,

b) middle and

c) inferior cerebral veins.


CEREBRAL VENOUS DRAINAGE CONTD

Superior cerebral veins


Are 8-12 in number.

They drain the upperparts of the


superolateral and medial surface of the
cerebral hemisphere.
They ascend upward pierces the arachnoid
mater and transverse the subdural space to
end in the superior sagittal sinus. With the
anterior vein at right angle the posterior
vein obliquely placed.
CEREBRAL VENOUS DRAINAGE CONTD

Middle cerebral veins


are 4, 2 on each side. Superficial middle
cerebral and deep middle cerebral veins.

Superficial middle cerebral vein


lies superficial in the lateral sulcus.
Anteriorly drains into the cavernous sinus
and posteriorly, they communicate with the
superior sagittal and transverse sinus via
the superior anastomotic vein of Trolard
and inferior anastomotic vein of Labbe.
CEREBRAL VENOUS DRAINAGE CONTD
Deep middle cerebral vein
lies deep in the lateral sulcus along with
the middle cerebral artery.
It joins the anterior cerebral vein to form
the basal vein.
CEREBRAL VENOUS DRAINAGE CONTD

Inferior cerebral veins


Are small but more numerous.

Drains the inferior surface and the lower


part of the medial and superolateral surface
into the nearby intracranial dural venous
sinuses.
CEREBRAL VENOUS DRAINAGE CONTD
Internal cerebral veins
One on each side of the midline in the
telechoroidea of the 3rd ventricle.
They are formed by union of the
thalamostriate and choroidal vein and
terminate by uniting to form the great cerebral
vein of Galen
CEREBRAL VENOUS DRAINAGE CONTD

Other veins include:


The anterior cerebral vein draining
the medial surface.
Basal vein of Rosenthal formed by
the union of the anterior cerebral
vein, the deep middle cerebral vein
and striated vein.
ANATOMICAL
BASIS
OF THE CASE
POINTS TO NOTE

Depressed fracture of frontal bone.

Lectures amusing but lacked direction.

Drastic change in social behaviour


Unkempt appearance

Urinating on cadaver table .

Defecating in the cadaver museum.


DEPRESSED FRACTURE OF FRONTAL BONE
The depressed fracture of the frontal bone
sustained by chief Ojo occured as result of the
high energy direct impact to the frontal bone
during the game of hockey which caused the bone
to be broken and displaced inwards.
This caused the inwardly displaced part of the
frontal bone to compress and damage the
underlying frontal lobes whose bulk is formed by
the prefrontal cortex.
This lead to the manifestations seen in chief Ojo.
TYPICAL DEPRESSED FRONTAL
BONE FRACTURE.
LECTURES AMUSING BUT LACKED DIRECTION.
This is due to damage to lateral aspect of the
prefrontal cortex.
Because this area of the prefrontal cortex is
responsible for temporal ordering of events as
well as actively maintaining infromation in
working memory (short term memory task).
DRASTIC CHANGE IN SOCIAL BEHAVIOUR

Due to lesion of the orbital part of the prefrontal


cortex
Bilateral orbitofrontal lesion lead to the deficit in
decision making as well as in planning of
behaviour leading to inappropriate social
behaviour that manifested as
Unkempt appearance,
Urinating on cadaver table and
Defecating in the anatomy museum.
CONCLUSION

Although lesion to the prefrontal cortex did not


produce any marked loss of intelligence, it lead to
the loss of initiative, judgment and planning of
behaviour which caused Chief Ojo to longer
conform to acceptable social behaviour as
manifested in his careless dress sense,
appearance, urinating on the cadaver table and
defecating in the anatomy museum.
Loss of ability to actively maintain information in
working memory is responsible for his lectures
though amusing lacked direction.
REFERENCES
Abraham AA, Saalu LC, (2014) Basic and Clinical
Human Anatomy 1st ed.
BD Chaurasia, (2013) Human Anatomy volume 3, 6th
ed. CBS publishers and distributors Pvt Ltd.
Vishram Singh, (2014), Textbook of Anatomy; Head,
Neck and Brain, Volume 3, 2nd ed. Reed Elsavier
India Private Limited. Haryana, India.
Inderbir Singh,(2011), Textbook of Anatomy, 5th ed,
Jaypee Brothers Medical Publishers (P) LTD, New
Delhi, India.
Roberts RJ, Hager L, Heron C. Prefrontal cognitive
processes, working memory and inhibition of
antisaccade processes, working memory and
inhibition of antisaccade task 1994. In: Krasnegor
NA, Lyon GR, Goldman-Rakic, editors.
Saalu LC, 2016 Functional areas of the cerebral
cortex. Lecture notes delivered to 2015/2016 300L (set
9) medical students. Department of Anatomy BSU
Makurdi.
Snell RS, (2010). Clinical neuroanatomy 7th ed.
Lippincott Williams & Wilkins.
IF YOU WANT TO GO FAST, YOU WALK
ALONE BUT IF YOU WANT TO GO FAR, YOU
WALK WITH PEOPLE

PROF. LC SAALU