Cerebral

Cerebral
Cortex
Cortex

Nabeel Kouka, MD, DO, MBA

www.brain101.info
Brodman’s Map of Motor and Sensory Areas
Functional Localization of Cerebral Cortex
Sensory area
primary sensory area
secondary sensory area
Motor area
primary motor area
secondary motor area
supplementary motor area
Association area
parietal, occipital and temporal cortex
- conceptual elaboration of sensory data
prefrontal (frontal) cortex
- judgement, foresight
Disorders of Association Cortex
 Agnosia
Tactile agnosia
Visual agnosia
Alexia
Auditory agnosia
 Apraxia
 Aphasia
Wernicke’s (receptive) aphasia
Broca’s (Motor) aphasia
conduction aphasia
global aphasia
 Apraxia

The inability to execute a voluntary motor movement despite

being able to demonstrate normal muscle function.
Cerebral Dominance (Lateralization, Asymmetry)

Dominant Hemisphere
Language
– speech, writing
Calculation

Non-dominant Hemisphere
Spatial Perception (3D subject)
Singing
Playing musical instrument
Language
3D perception
Speech
Singing
Writing
Playing Musical
Calculation
instrument
 Split Brain

Commissuratomy
(split corpus callosum)

Two minds in one brain?

Roger Sperry
(1913-1994)

1981 Nobel
Laureate
 Language Areas

Sensory Language Area (Wernike's area) ---- 22, 39, 40

Receptive Aphasia - area 22
defect in comprehension, good spontaneous speech
Anomic Aphasia - word finding difficulty
Jargon aphasia - fluent, but unintelligiable jargon
39 (supramarginal gyrus), 40 (angular gyrus)
Superior Longitudinal (Arcuate) Fasciculus
Conduction Aphasia
good comprehension, good spontaneous speech
poor repetition, poor response
Motor Language Area (Broca’s area) --- 44, 45
Motor Apahsia
good comprehension, no speech, agraphia
 Arcuate Fasciculus
The groups of fibers that connect Broca's area with Wernicke's area (these fibers
connect to the angular gyrus) and are located below the supramarginal gyrus.
According to Geschwind, damage to this area results in Conduction Aphasia
Language Areas (Geschwind Model)
 Broca’s Area

Pars triangularis and pa

rs opercularis of the inf
erior frontal gyrus of do
minant hemisphere.

Photograph of the brain

of Paul Broca’s patient c
alled “Tan” (real name is
Leborgne).
Paul Broca (1824-1880) Carl Wernicke (1848-1905)
PET (positron emission tomography) scan
PET (positron emission tomography) scan
Composite radioisotope brain scan
Sensory
Sensory Homunculus
Homunculus
Motor
Motor Homunculus
Homunculus
Diencephalon

Dorsal surface
Diencephalon

Ventral surface
Diencephalon
Medial Surface
THALAMUS
Classification
Classification of
of Thalamic
Thalamic Nuclei
Nuclei
I. Lateral Nuclear Group
II. Medial Nuclear Group
III. Anterior Nuclear Group
IV. Posterior Nuclear Group
V. Metathalamic Nuclear Group
VI. Intralaminar Nuclear Group
VII. Thalamic Reticular Nucleus
Classification
Classification of
of Thalamic
Thalamic Nuclei
Nuclei
 Basal
Ganglia
    Basal Ganglia                                                                      Introduction   
Basal Ganglia                                                                      Introduction   

Traditional Concepts of Basal Ganglia

Corpus Striatum
Caudate Nucleus
Neostriatum Striatum
Lenticular Nucleus Putamen
Globus Pallidus Paleostriatum Pallidum
Corpus Amygdaloideum Archistriatum
Afferent Connections of Basal Ganglia
Efferent Connections of Basal Ganglia
 HUNTINGTON’S CHOREA

Clinical Feature
- Predominantly autosomal dominantly
inherited chronic fatal disease
(Gene: chromosome 4)
- Insidious onset: Usually 40-50
- Choreic movements in onset
- Frequently associated with
emotional disturbances
- Ultimately, grotesque gait and sever
dysarthria, progressive dementia
ensues.
Principal Pathologic Lesion:
Corpus Striatum (esp. caudate nucleus)
and Cerebral Cortex
 SYDENHAM’S
SYDENHAM’SCHOREA
CHOREA

Clinical Feature
- Complication of
Rheumatic Fever
- Fine, disorganized , and
random movements of
extremities, face and
tongue
- Accompanied by
Muscular Hypotonia
- Typical exaggeration of
associated movements
during voluntary activity
- Usually recovers
spontaneously
Principal Pathologic Lesion: Corpus Striatum in 1 to 4 months
 HEMIBALLISM
HEMIBALLISM

Clinical Feature

- Usually results from CVA

(Cerebrovascular Accident)
involving subthalamic nucleus
- sudden onset
- Violent, writhing, involuntary
movements of wide excursion
confined to one half of the body
- The movements are continuous
and often exhausting but cease
during sleep
- Sometimes fatal due to exhaustion
- Could be controlled by
phenothiazines and stereotaxic
Lesion: Subthalamic Nucleus surgery
Parkinson’s Disease PD

Disease of mesostriatal
dopaminergic system

Muhammad Ali in Alanta Olympic normal

Parkinson’s Disease - Paralysis Agitans

Substantia Nigra,
Pars Compacta (SNc)
DOPAminergic Neuron

Clinical Feature (1)

Slowness of Movement
- Difficulty in Initiation and Cessation
of Movement
 Parkinson’s Disease
Paralysis Agitans

Clinical Feature (2)

Resting Tremor
Parkinsonian Posture
Rigidity-Cogwheel Rigidity
 Cerebral Cortex
Numerical Data

 Number of neuronal cells in cerebral cortex

neurons ----------- 10-15 billion
glial cells ---------- 50 billion

 Estimation of number of cortical neurons

von Economo and Koskinas (1925) 14.0 billion
Shariff (1953) 6.9 billion
Sholl (1956) 5.0 billion
Pakkenberg (1966) 2.6 billion
Subdivision of Cerebral Cortex

Allocortex
Archicortex (Archipallium)
Palaeocortex (Paleopallium)

Isocortex
Neocortex (Neopallium)

cf. mesocortex, juxtallocortex, mesallocortex

Isocortex – typical 6 layered cortex

I. Molecular Layer
II. External Granular Layer
III. External Pyramidal Layer
IV. Internal Granular Layer
V. Internal Pyramidal Layer
VI. Polymorphic Layer
 I. Molecular Layer
II. External Granular Layer
III. External Pyramidal Layer
Line of Kaes-Bechterew

IV. Internal Granular Layer

Outer band of Baillarger
- Line of Gennari in area 17
V. Internal Pyramidal Layer
Giant pyramidal cell of Betz
Inner Band of Baillarger
VI. Polymorphic Layer
Golgi Nissl Weigert