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Central Nervous system
Lecture 1/2 of Module 2: Cortical areas and fucntion
51
Anatomy
Graduate
02/28/2011

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Cards

Term

 

Somatic System

Definition
  • Provides BIDIRECTIONAL control of all voluntary systems
    • (Into CNS from body, reverse)
  • 2 divisions:
    • Somatosensory
      • Conveys info FROM SKIN & MS to brain
    • Somatic motor system
      • Transmits information FROM BRAIN TO SKELETAL muscles
Term

 

Autonomic System

Definition
  • Provides bidirectional communication BTW BRAIN & smooth muscle, cardiac muscle, gland cells
  • 2 Divisions:
    • Sympathetic
      • Fight or flight
      • Response to stimulus
    • Parasympathetic
      • Concerned with VEGETATIVE functions
        • Digestion, glands....
Term

 

Four regions of nervous system

Definition
  1. Cerebral Region
    1. Cerebral hemispheres
    2. Diencephalon
  2. Brain stem and cerebellar region
    1. Brain stem
    2. Cerebellum
  3. Spinal region
  4. PNS region
Term

 

Cerebral Region

Definition
  • Cerebral hemispheres
    • Cerebral cortex
    • Axons connecting cortex w/ other parts of NS
    • Deep nuclei
      • All 3 = cap over diencephalon
  • Diencephalon
    • Thalamus
      • relay station
    • Hypothalamus
      • regulates autonomic function
      • "homeostatic thermostat"
    • Epithalamus
      • Pineal gland here, circadian rhythm, endocrine secretions
    • Subthalamus
      • Controls/contributes to movement
Term

4 D's:

 

Four symptoms of damage to brain stem

Definition
  1. Dysphasia
    • Swallowing difficulty
  2. Dysarthria
    • Speech motor problems (any language articulation problems)
  3. Diplopia
    • Double vision
  4. Dysmetria
    • Difficulty motor planning distances
Term
Brain Stem
Definition

Brain Stem

(Superior to inferior)

  1. Midbrain
    • Sensory/motor function
  2. Pons
    • Sends movement information
  3. Medulla
    • Autonomic stuff
Term
__________ segments in spinal region
Definition

31 spinal region segments

 

 

33 vertebrae

Term

PNS

 

31 pairs of spinal nerves

Definition

8 cervical

 

12 thoracic

 

5 lumbar

 

5 sacral

 

1 coccygeal

Term
Efferent VS Afferent
Definition

Efferent

MOTOR

Sends commands FROM the CNS TO the PNS

****OUT****


Afferent

SENSORY

Brings info INTO CNS FROM PNS 

***IN****

 

(Tract= Bundle of axons working together)

 

Term

Gray Matter

 

vs

 

White Matter

Definition

Gray

  • Mostly cell BODIES
  • Information INTEGRATED here

White

  • Composed of AXONS and MYELIN
  • Axons RELAYING info among NS parts
  • Collection of axons = fasciculus, tract, funiculus, peduncles
Term

Causes of Cortical Dysfunction:

 

STROKE

Definition

Stroke

Focal damage

Most common OT Dx

 

Ischemia (BLOCKS)

- 80% of all strokes

- Damage is result of BLOCKAGE of blood (O2, nutrients, waste removal) supply to brain

»Thrombosis

Vessel that supplies blood gets OBSTRUCTED (Carotid)

»Embolism

Foreign thing (clot) traveling in blood supply causes blockage

 

("Thrombosis=There" ie originates in brain)

 

Hemorrhage (BLEEDS)

-Bleeds in brain that damage tissue

»Subarachnoid Hemorrhage

-Bleed located between Arachnoid and Pia Mater

»Intracerebral Hemorrhage

-Damaged caused by ↓BP in brain (Decreased flow to other brain areas)

-Increased cranial pressure due to pooling of blood=damage

Term
Ischemic Stroke
Definition

Ischemia (BLOCKS)

- 80% of all strokes

- Damage is result of BLOCKAGE of blood (O2, nutrients, waste removal) supply to brain

»Thrombosis

Vessel that supplies blood gets OBSTRUCTED (Carotid)

»Embolism

Foreign thing (clot) traveling in blood supply causes blockage

 

("Thrombosis=There" ie originates in brain)

 

Term
Hemorrhagic Stroke
Definition

Hemorrhage (BLEEDS)

-Bleeds in brain that damage tissue

»Subarachnoid Hemorrhage

-Bleed located between Arachnoid and Pia Mater

»Intracerebral Hemorrhage

-Damaged caused by ↓BP in brain (Decreased flow to other brain areas)

-Increased cranial pressure due to pooling of blood=damage

Term
Other causes of Cortical Dysfunction
Definition
  • Anoxia
    • Lack of O2 to brain
    • MORE DIFFUSE DAMAGE AREA
  • TBI
    • Falls
    • MVA
  • Cerebral palsy
  • Inflammatory disease
  • Toxic and metabolic diseases
    • West Nile
    • Meningitis
  • Brain Tumors
    • Malignant
      • Astrocytoma: Most common
      • Glioblastoma: Aggressive
      • Metastatic: Originated elsewhere
    • Benign
      • Meningioma
      • benign tumors can grow and cause damage that way even if they aren't spreading
  • Brain Atrophy
    • Dementia
Term
Gross anatomy of Cerebral Hemisphere
Definition

Lobes (From largest to smallest, superficial to deep)

Frontal

Parietal

Temporal

Occipital

Limbic

Insular

 

Sulci/Fissures

Longitudinal F

Central S

Lateral S

Parietooccipital S

 

Gyri

Precentral

Postcentral

Term

Subcortical White Matter:

 

 

Types of White Matter Fibers

Definition

From longest to shortest:

  1. Projection
  2. Commisural
  3. Association
Term

 

 

PROJECTION FIBERS

Definition
  • Longest
  • Axons connecting subcortical structures with cerebral cortex (ie Cortico-spinal tract)
  • Form the ascending and descending tracts
Term

 

COMMISURAL FIBERS

Definition
  • Intermediate Length
  • Axons connecting the two cerebral hemispheres (usually homologous areas)
  • Example: Corpus Collusum, anterior commisure
Term

 

 

ASSOCIATION FIBERS

Definition
  • Shortest Fibers
  • Axons connecting gyri in the same hemisphere

LONG                                                     SHORT              

Connects different                                  Within same lobe

lobes                                                        (Gyri to Gyri)

(Frontal to Parietal)

Term
Three Levels of Complexity
Definition
  1. Primary Areas
    • Initial sensory detection
      • Sound
  2. Secondary Association Areas
    • Integration area
      • Dog bark vs Doorbell
  3. Tertiary Association Areas
    • Complex integration of multiple cortical areas
      • eg when a song "takes you back"

 

    Term
    Flow of Information by Lobe
    Definition

    Frontal:

    3-2-1

    (This makes sense because motor PLANNING must occur PRIOR to movement)

     

    Parietal, Temporal, Occipital:

    1-2-3

    *Primary areas = symmetrical in both hemi's*

    *Secondary areas= tend to be adjacent to their 1° areas*

    Term

    Primary Motor Cortex

     

    ______ Lobe

    Location

    Function

    Dysfunction

    Definition

    Primary Motor Cortex

    Frontal Lobe

    Location: Precentral Gyrus

     

    F(x): Muscle contraction

             Execution of movement

    -Motor Homunculus

     

    Dysfunction

    Hemiparesis:

    One-sided dysfunction

    Low tone, spasticity, paralysis, etc

    Severity and type of damage correlates to area damaged

    Dysarthria:

    Speech disorders resulting from:

    Paralysis

    Incoordination

    Spasticity of speaking muscles

     

     

     

     

    Term

    PREMOTOR (secondary) CORTEX

                 Lobe

    Location

    Function

    Dysfunction

    Definition

    PREMOTOR (secondary) CORTEX

    Frontal Lobe

     

    Location: Anterior to Primary Motor Cortex

     

    Function:   Coordinates movement

    Control of gross or postural movements

    Develops programs for motor routines for

    skilled voluntary actions

    Dysfunction:

    Apraxia: (Motor coordination dysfunction)

    Disorder of skilled, purposeful movement

    Not caused by deficits in primary motor cortex or comprehension problems

    Motor Apraxia:

    Loss of kinesthetic memory patterns so that PURPOSEFUL MOVEMENT CANNOT BE ACHIEVED 

    IDEA AND PURPOSE OF TASK IN TACT

    Premotor Perseveration:

    Compulsive repetition of the same movement

    "Mmmmmargret" example Kathy gave

     

     

    Motor Apraxia & Premotor Perseveration often comorbid due to anatomical proximity

     

    FYI:

    DYSpraxia= haven't developed a skill

    Apraxia= loss of skill

     

     

     

    Term

    SUPPLEMENTAL MOTOR CORTEX

     

    ______ LOBE

     

    LOCATION

    FUNCTION

    DYSFUNCTION

    Definition

    SUPPLEMENTAL MOTOR CORTEX

    Frontal Lobe

    Location: Anterior to motor area, on medial side of hemi

    Function: Drive for the INITIATION of movement

    Dysfunction: Initiation problems; can't get started

    Term

    MOTOR SPEECH AREA

    (Broca)

     

    ______ Lobe

     

    Location

    Function

    Dysfunction

    Definition

    MOTOR SPEECH AREA

    (Broca)

    Frontal Lobe

     

    Location: Inferior frontal gyrus of the LEFT cerebral hemi

     

    Function: Planning movements of the mouth during speech

      Grammatical aspects of speech

     

    Dysfunction: Broca's Aphasia

    Difficulty expressing one's self using language

    Motor planning of speech is impaired

     

    Comprehension and control of muscles for other actions (chewing, etc) still IN TACT

     

    Speech presents as choppy, difficult to get out: "car.... crash... hurt"

     

    Term
    Premotor Perseveration
    VS
    Prefrontal Perseveration
    Definition

    Premotor Perseveration

    Compulsive repetition of the same movement

    "Mmmmmargret" example Kathy gave

     


     

    Prefrontal Perseveration

    Compulsive repetition of same task

    Eg. Brushing teeth. Terminating. Go to wash face but instead begin brushing teeth again

    Term

    Dysfunction:

     

    Premotor Cortex

     

    VS

     

    Prefrontal Cortex

    Definition

    PREMOTOR CORTEX                      PREFRONTAL CORTEX


    -Motor Apraxia                                     - Ideational Apraxia

     

    -Premotor Perseveration                       - Prefrontal Perseveration

    Term

    PREFRONTAL CORTEX

     

    DORSOLATERAL FRONTAL CORTEX

     

    ______ LOBE

     

    Location

    Function

    Dysfunction

    Definition

    PREFRONTAL CORTEX

     

    DORSOLATERAL FRONTAL CORTEX

    Frontal Lobe

     

    Location: Anterior to premotor cortex

     

    Function: Concerned with EXECUTING GOAL-DIRECTED

    ACTIVITIES ("Executive functions")

     

    Dysfunction:

    Ideational apraxia

    Prefrontal perseveration

    Intellectual deficits

    Sequencing & organizational deficits

    Poor judgment (affects safety)

    Loss of abstraction (concreteness)

    Bradykinesia w/ L CVA

    Impulsivity w/ R CVA

    (Impacts safety)

    Poor problem solving

     

     

     

     

    Term

     

     

    IDEATIONAL APRAXIA

    Definition

    IDEATIONAL APRAXIA

     

    BREAK DOWN OF KNOWING WHAT NEEDS TO BE DONE

     

    COMPREHENSION DIFFICULTY

     

    INAPPROPRIATE TOOL USE

    Term

    Prefrontal Cortex

     

    ORIBITOFRONTAL CORTEX

     

    ______ LOBE

    Location

    Function

    Dysfunction

     

    Definition

    ORIBITOFRONTAL CORTEX

    Frontal Lobe

     

    Location: Base and medial aspect of the frontal lobe

     

    Function: Tertiary association cortex of limbic system

    Involved w/ consciusness/arousal

    Personality

    Emotions

    Memory

     

     

    Dysfunction:

    Arousal deficits

    eg. volitional dysfucntion

    Personality/Emotional distrubances

    eg. Lability, Apathy

    Impaired Judgment

    Lack of Insight

    Memory deficits/Confabulation

    Filling in memory gaps

     

    Term
    Components of Prefrontal Cortex
    Definition
    1. DORSOLATERAL FRONTAL CORTEX
    2. ORBITOFRONTAL CORTEX
    Term

     

     

    Prefrontal Speech Deficits

    Definition

    Prefrontal Speech Deficits

     


    Echolalia

    Repeats words

     

    Anomia

    Difficulty naming

    Paraphasia

    Misuse or replacement of words

    (Saying brother instead of sister)

    Term

    Primary Sensory Area

     

    ______ Lobe

     

    Location

    Function

    Dysfunction

    Definition

    Primary Sensory Area

     

    Parietal Lobe

     

    Location: Post central gyrus

     

    Function:     Detection of touch,

    Conscious proprioception

    Kinesthesia (Movement sense)

    SENSORY HOMUNCULUS

     

    Dysfunction: Lack of sensation to contralateral side

    Term

    Secondary Sensory Association Area 

     

     

    _____ Lobe

     

    Location

    Function

    Dysfunction

    Definition

    Secondary Sensory Association Area 

      

    Parietal Lobe

     

    Location: Superior Parietal Lobe

     

    Function: Coordinates

    Integrates

    (and) Refines perception of sesory input

     

    ***Making sense of sensation***

     

     

    Dysfunction: Impaired or absent:

    - Localization

    - 2-point discrimination

    - Sharp/dull discrimination

    - Stereognosis

    - Graphesthesia

     

     

     

     

     

     

    Term

    Tertiary Association Area

     

    Location

    Function

    Dysfunction

    Definition

    Tertiary Association Area

     

    Location: Inferior PARIETAL lobe

    Function: Complex functions that REQUIRE INTEGRATION of P,T,O

    lobes

    Dysfunction: APRAXIA

    - Motor

    - Ideational

    - Constructional

    *Inability to construct 3-D designs

    -Dressing apraxia

    PERCEPTUAL DEFICITS

    - Figure-ground deficits

    - Spatial positioning, position in space...

    - Unilateral spacial neglect

    - Body scheme disorders

    - Somatoagnosia

    * can't recognize body part as own

    * typically w/ sever hemiparesis

    - L/R discrimination

    LANGUAGE DEFICITS

    - Wernicke's/receptive aphasia

    - Agraphia

    * Difficulty writing

    - Alexia

    * Reading

    - Acalcula

    Term
    Primary Auditory Cortex
    Definition

    Primary Auditory Cortex

    Temporal Lobe

     

    Location: Superior temporal gyrus

     

    Function: Reception of auditory information

     

    Dysfunction: Decreased hearing acuity in both ears

    -Greater loss to contralateral side

    Term
    Secondary Association Area
    Definition

    Secondary Association Area

    Temporal Lobe

     

    Location: Wernicke's area

     

    Function:     Language comprehension

    Sound modulation

    Perception of music

    Auditory memory

     

    Dysfunction: In Dominant/Left hemi:

    - Unable to understand spoken language

    - Deficits in discrimination of phonemes

     

    In Non-Dominant/Right hemi:

    - Impairment in discriminating tones

    - Impairment w. loudness

     

     

    Term

    Tertiary Association Area

    (part of limbic association cortex)

    Definition

    Location: Temporal Pole

     

    Function:     Memory

    Emotional behavior

    Personality

    Motivation

     

    Dysfunction: Memory deficits

    - Verbal and visual memory

    - STM and LTM

    - Retrograde memory loss

    *Loss of memory prior to trauma

    - Anterograde memorry loss

    * Can't remember moving forward

    Emotional disorders

    Personality disorders

    Term

    Visual Association Area

     and

    Tertiary Association Area

    Definition

    Visual Association Area and Tertiary Association Area

    Occipital Lobe

    Location

    Adjacent to the primary visual area

     

    Function

    Synthesizes visual information and integrates it

    Aides in the formation of visual memory

    Dysfunction

     

    Visual object agnosia

    Not being able to recognize an object

    Prosopagnosia

    Can’t recognize faces

    Term
    Left Brain Damage
    Definition

    Left brain damage

    • Right sided paralysis and or sensory loss
    • Speech and language deficits
    • Slow, cautious behavior
    • Memory deficits
    • Helpful hints: Show these individuals how to do something, do not use language. .. Best to give commands and limit language.
    Term
    Right Brain Damage
    Definition

    Right brain damage

    • Left sided paralysis and/ or sensory loss
    • Spatial-perceptual deficits
    • Quick-impulsive behavior
    • Memory deficits
    • Helpful hints: Use language when describing things, do not demonstrate….  Stay away from viso-spatial descriptions.
    Term

     

     

    Blood Supply to Brain

    Definition

    2 Internal Carotid Arteries

     

    +     2 Vertebral Arteries


    4 Total arteries supplying brain

    Term

     

     

    L & R vertebral arteries merge to form ________

    Definition

     

     

    L & R vertebral arteries merge to form BASILAR ARTERY

    Term

     

     

    Basilar Artery terminates by bifurcating into ________

    Definition

     

     

    Basilar Artery terminates by bifurcating into POSTERIOR CEREBRAL ARTERIES (PCA)

    Term

     

     

    ACA supplies______

    Definition

     

     

    ACA supplies  MEDIAL SURFACE of cerebral hemispheres

    Term

     MCA supplies __________

     

    Definition

     

    MCA supplies LATERAL SURFACE of cerebral hemispheres

    Term

     

     

    PCAs supply ______

    Definition

    PCAs supply POSTERIOR surface of hemispheres ESPECIALLY medial and basilar surf.

    Term

     

     

    Circle of Willis

    Definition

    2 Internal Carotid Arteries

    2 Anterior Cerebral Arteries (ACA)

    2 Posterior Cerebral Arteries (PCA)

    2 Posterior Communicating Arteries

    1 Anterior Communicating Artery


    9 Total Arteries = Circle of Willis 

    Term

    of

     

    ACA Occlusion- Location of Damage

    Definition

    ACA Occlusion- Location of Damage

    • Medial and Superior
      • of FRONTAL AND PARIETAL
    Term
    Flow of CSF
    Definition
    1. Lateral Ventricles
    2. Intraventricular Foramina
    3. 3rd (THIRD) Ventricle
    4. Cerebral Aqueduct
    5. 4th (FOURTH) Ventricle
    6. Lateral and Medial Foramina
    7. Subarachnoid Space
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