2Have you completed the Pre-Test???? ObjectivesReview Brain Anatomy and Physiology for ICD-10-CM/PCS CodingOverlap of Circulatory and Nervous SystemsFunctions of BrainComponents of BrainCells of BrainBrain NervesICD 10 CM TerminologyICD 10 PCS TerminologyIntegrated into presentationHave you completed the Pre-Test????
3Overlap of Circulatory and Nervous Systems in Brain Connected through organ & bodily function controlAll body functions are regulated by brain through nervous systemW/o messages from brain, circulatory system does not workHeart function & fluid circulation triggered by nervous systemMessages sent from the brain control both blood and lymphatic parts of circulatory systemBlood provides energy for brainBrain = 2% of mass, uses 20% of energyAvg weight of adult brain is about 3 pounds
4Examples of Overlap in brain Blood pressure and heart rate regulationVagus nerve controls pumping of heartAs heart pumps, blood moves through blood passageways around body to organsBaroreceptors pass information about blood pressure to brain so brain makes adjustments to heart rateDependent on each other to ensure homeostasisNervous system may have control, but circulatory system must relay information for adjustmentsBoth systems need to function properly & work together to ensure proper body functions
5Circulatory System Components of Brain Precerebral ArteriesAKA ExtracranialLeading to cerebrum, but NOT in cerebrumRight vs Left for codingBasilar arteryCarotid (Common, Internal)External does NOT feed brain)VertebralOtherAnterior spinalAuditory internalCerebral ArteriesAKA IntracranicalMiddle CerebralAnterior /Posterior CommunicatingAnterior/Posterior CerebralCerebellarOther specified
6Circle of Willis Basilar Internal carotid Vertebral artery
7Functions of Brain Control Center of body Maintains homeostasis (w/endocrine system)
8Nervous System Components of Brain Nervous system = 2 partsCNS = Brain and Spinal Cord (not part of this webinar)Cerebrum, cerebellum, brain stemPNS = Nerves and GangliaSomatic – connect CNS with skeletal muscles and skinAutonomic – connect CNS with cardiac/smooth muscle and glands
9Cerebrum (L, brain) Largest Part of brain Cortex = Gray Matter on surface6 layers of nerve cell bodiesMillions of cellsCerebral White MatterUnder cortexMyelinated axons of nerve cellsTransmit in 3 directionsAssociation = within same hemisphereCommissural = from one hemisphere to otherProjection = from cerebrum to other parts of CNS
10Functions of Cerebrum 3 general functions Motor = Govern muscle movementSensory = Interpret sensory inputVision = % of cortexTouch = %Hearing = 3 %Association = Emotional and intellectual processes
11Cortex As brain grows, more gray matter Cortex folds on itself, creatingGyri (AKA convolutions) Gk, gyro, circleUpfolds winding over surfaceFissures – Deep downfoldsSulci –sulcus /sul·cus/ (sul´kus) pl. sul´ci [L.] a groove, trench, or furrowshallow downfolds separating gyri
12Hemispheres of Cerebrum Right and Left halves of brainDivided by Longitudinal FissureConnected by Corpus CallosumLarge bundles of transverse nerve cell fibers“Rain Man” – born w/oEach hemisphere divided into 4 lobesFrontal, Parietal, Temporal, and OccipitalFifth lobe = InsulaOval region of cerebral cortex overlying extreme capsule, lateral to lenticular nucleus, buried in depth of the fissura lateralis cerebri (sylvian fissure)Separated from the adjacent frontal, parietal, and temporal opercula by circular sulcus of insula.Synonym(s): insular area, insular cortex, island of Reil
13Corpus Callosum L, - callous, hard AKA colossal commissure of brain A tract of nerve fibers passing from one side to other of spinal cord or brainLarger in womenCan transfer data between R & L hemispheres faster than menWoman’s intuition
15Frontal Lobe Functions Responsible for higher cognitive functions, including:Problem solvingMemoryLanguageJudgmentSpontaneityMotivationImpulse ControlSocial and Sexual Behavior
16Temporal Lobe Functions Role in emotionsResponsible forSmellingTastingPerceptionMemoryUnderstanding musicAggressivenessSexual behaviorLanguage areas of brain
17Language areas of Brain Broca’s areaFrench surgeon, 1861Frontal lobeMotor neuronsControl of SpeechWernicke’s areaGerman pathologist, 1874Temporal lobeComprehension of Language, Speech sounds
18Uncus L. – uncus – hook From Gk onkos Hooklike anterior end of hippocampal gyrus on temporal lobe of brain
19Parietal Lobe Functions Role in sensations of touch, smell, and tasteProcesses sensory & spatial awarenessKey part of eye-handco-ordination & arm movementWernicke’s areaMatching written words to soundof spoken speech
20Occipital Lobe Functions Controls vision and recognitionVisual perceptionColor recognitionReceives visual input from retinaRetina is part of brainVisual signals are interpreted in occipital lobesEach optic nervehas million fibers
21Cerebellum Sited below back of cerebrum Transverse fissure separates from cerebrum2 hemispheres separated by vermisBoth gray and white matterConnected to brain stem by cerebellar peduncles (paired fiber bundles)
22Functions of Cerebellum Motor area of brainControls unconscious movements in skeletal musclesCoordination, Posture, Balance
23Brain Stem Located below cerebrum & in front of cerebellum Structures (from top to bottom)ThalamusHypothalamusMidbrainPonsMedulla oblongata
24Thalamus (Gk: Inner Room) Oval-Shaped, Large, Located above midbrainRelays all sensory impulses (EXCEPT smell) to cerebral cortex “Gateway”Interprets and produces conscious Pain recognition
25Corpus striatumStriped mass of white & grey matter located in front of thalamus in each cerebral hemisphereConsists of caudate nucleus and lenticular nucleus
26Hypothalamus Controls many homeostasis-related body actions Controls Body temperatureRegulates Biorhythms (Wake/Sleep)ANS – heartbeat, food movement, urinary bladderInterprets viscera-based sensory impulsesRegulates food intake (Hunger/Satiety)Regulates fluid intake (Thirst)Monitors/Works with endocrine systemResponds to Mental states – Fear, etc.
27Midbrain Connects Pons and Cerebellum Short, Constricted Origination of 2 Cranial NervesIII – OculomotorIV - Trochlear
28Pons (L. Bridge) Located anterior to Cerebellum, above Medulla Bridge between spinal cord & BrainConnects other parts of brain as wellOrigination for 4 cranial nervesV – TrigeminalVI – AbducensVII – FacialVIII – Vestibulocochlear
29Medulla oblongata Origination for 4 cranial nerves Lowest part of brainForm upper part of Spinal CordMain Conduction Pathways2 pyramids - ventral aspectMotor tracts from cortex to cordNerve fibers cross to other sideExtrapyramidal = functional, not anatomical, unit comprising nuclei & fibers (excluding pyramidal tract) involved in motor activities; control/coordinate especially postural, static, supporting, & locomotor mechanisms.2 nuclei on dorsal aspectReceive sensory impulses from spinal cord (ascending)Relay to OPPOSITE side of medullaOrigination for 4 cranial nervesIX – GlossopharyngealX – VagusXI – AccessoryXII - Hypoglossal
30Medulla oblongata, cont. Reflex CentersCardiac – Regulates HeartbeatRespiratory – Rate and Depth of BreathVasoconstrictor – Regulates Diameter of Blood Vessels
31Cerebellar peduncles 3 sets of paired bundles of hindbrain, connecting cerebellum toMidbrain (superior)Pons (middle)Medulla oblongata (inferior)
32Tapetum of brain L. tapeta - a carpet Layer of fibers of corpus callosum forming roof of part of lateral ventricle
33Glands in the Brain Pineal (L., Pine cone) Pituitary L. - pītuītārius pertaining to/secreting phlegm
34Pineal Gland Endocrine gland Source of melatonin Hormone derived from tryptophanRegulates circadian rhythm (sleep cycle)Located behind 3rd cerebral ventricleMidline of brain
35Pituitary Gland Master gland Central role in homeostasis,maintaining reproductive cycle, directing activity of other glandsAnterior, intermediate, and posterior lobes function as 3 separate endocrine organsDistinct cell populations, secretory products, & regulatory mechanismsAnterior lobe secretes thyroid stimulating hormone, corticotropin, luteinizing hormone, follicle stimulating hormone, growth hormone, and prolactin.Regulated by hypothalamus via portal vascular systemPosterior lobe releases oxytocin & vasopressin from axon terminals originating in cell bodies located in hypothalamusIntermediate lobe rudimentary in humans, but produces several hormones (which are just now being studied).
36Limbic System of Brain Thalamus Hypothalamus Cingulate gyrus Amygdala HippocampusBasal Ganglia
37Limbic System Functions Regulates emotion and memoryDirectly connects lower & higher brain functionsInfluencesEmotionsVisceral responses to emotionsMotivation and MoodSensations of pain and pleasure
38Limbic System Components Cingulate gyrus , L. - Girdle (surrounding), Gk. - CircleAmygdala, Gk. – Almond(also used for tonsil)Hippocampus, Gk. – seahorseBasal Ganglia, Gk. - knot
39Cingulate gyrus Part of cerebrum gray matter Surrounds, directly connected to parts of inner Limbic SystemServes as conduit for messages to and from inner Limbic System
40Amygdala Makes associations across different modes of stimulus Smell of lilacs = visual memory of my house in Great FallsAppears responsible for influence of emotional states on sensory inputsSame stimulus = Different perceptionsSound of USAF Jets not noise – memory of childhoodResponsible for face recognition?
41HippocampusVERY important in transition of information from short to long term memorySearch Engine of brainLearning and consciously remembering everyday facts and eventsAlso part of Temporal LobeDamage to that lobe can result in memory loss
42Basal Ganglia AKA Substantia nigra, Subthalmic nucleus Important in planning & coordinating motor movements and postureBasal Ganglia linked with Cerebral Cortex via complex neural connectionsMajor effect of Basal Ganglia = Prevention of unwanted muscular activityBasal Ganglia Disorders result in exaggerated, uncontrolled movements
43Ventricles (Ependyma) Network of connected cavities filled with cerebrospinal fluid (CSF)2 Lateral VentriclesThird VentricleCerebral AqueductAKA Aqueduct of SylviusFourth Ventricle
44Functions of Ventricles Choroid plexuses located in ventricles produce CSF, which fills ventricles & subarachnoid spaceCycle of production and re-absorption (toxic wastes)Buoyancy, Protection, & Chemical stabilityProtection = CSF in meninges protects brain from striking cranium when head joltedBuoyancy = CSF and brain have similar density, so brain is suspended neutrally, allowing growth without sitting on boneCSF has protein, glucose, electrolytes, etc500 ml per day, space for 130 ml in system
45Meninges Protect brain and spinal cord 3 membranes Dura mater = Outermost, tough, thick, fibrousArachnoid = Middle, delicate, fibrousPia Mater = Inner, transparent, tenderContains blood vesselsOnly layer that adheres to brain surfaceLeptomeninges – 2 innermost; CSF circulates between themGk – Small, thin
47Cells of Brain 100 billion neurons (nerve cells) Sensory (afferent) – messages TO brainMotor (efferent) – messages FROM brainTrillions of Glia (Gk: Glue) (glial cells)AKA NeurogliaConnective tissue of brain4 main typesAstrocytes, ependymal cells, microglia, oligodentrocytesCommon tumors of nervous system
483 classes of neuronsSensory neurons carry information from sense organs (such as eyes and ears) to brainMotor neuronscontrol voluntary muscle activity (ex: speaking)carry messages from nerve cells in brain to musclesAll other neurons are Interneurons
49Neurons - 3 basic partsCell body - includes nucleus, cytoplasm, and cell organellesNucleus =DNA & information needed for growth, metabolism, and repairCytoplasm = substance filling cell, including all chemicals/parts needed for cell to work properlyCell organelles = small structures (chromosomes, Golgi bodies, etc.)DendritesBranch from cell body, act as point of contact for receiving impulses (chemical/electrical signals) from neighboring neuronsAxonSends impulses, extends from cell body to meet/deliver impulses to another nerve cellRange in length from fraction of inch to several feetSciatic nerve axons extend from buttock to top of foot
50Types of Glia cells Microglia = Brain’s immune system Schwann cells/Oligodendrocytes form insulating sleeves around neurons to keep electric signals from diffusing (Myelin)Radial glia in developing brainAfter helpng neurons move aroundThen become astrocytesEpendymal cells (ependymocytes)Cells lining central canal of spinal cord (pyramidal shape) or brain ventricles (cuboidal shape)Produce/absorb/move (cilia) CSF
51Myelin Insulating material wrapped around axons Complex mixture of proteins and fatsNodes of Ranvier – gaps in myelinElectrical signal jumps from node to nodeIncreases conduction speed of electrical signals along nerve fibers to muscleMade by Glial cellsOligodendrocytes in CNSSchwann cells in PNSTransmission electron micrograph of a myelinated axon, generated at the Electron Microscopy Facility at Trinity College, Hartford, CT
52Astrocytes Have starlike rays Most abundant type of glial cells Reach out in all directionsMost abundant type of glial cellsSo, most abundant of all brain cellsOne astrocyte can wrap its rays around a million+ synapsesAstrocytes fuse togetherConduits for molecules moving from cell to cell
53Brain Waves Cells in Cerebrum generate electrical potentials Pass thru skull; Can be detected by electrodesEEG = recording/graph of brain wavesBeta - consciously alert, or feeling agitated, tense, afraidFrequencies from 13 to 60 pulses/second in Hertz scaleAlpha - state of physical and mental relaxation, but aware of surroundingsFrequencies around 7 to 13 pulses/secondTheta - state of somnolence w/reduced consciousness+/- 4 to 7 pulses/secondDelta - unconsciousness, deep sleep or catalepsy0.1 to 4 cycles/second
55Cranial Nerves ICD-10-CM Index uses numerical order (first, fourth, etc), but alsoprovides namesICD-10-PCS usesNAMES onlyIIIIIIVIVVIVIVIIIAKA AuditoryIXXIIXOnly First and Second Cranial Nerves originate in CerebrumXI
56Mnemonics for Cranial Nerves On Old Olympus’ Towering Top A Famous Vocal German Viewed Some HopsOn Old Olympic Towering Tops A Finn And German Viewed Some HopsOLd OPie OCcasionally TRies TRIGonometry And Feels VEry GLOomy VAGUe And HYPOactiveSome Say Marry Money, But My Brother Says Big Business Makes MoneySome say my mother bought my brother some bad beer, my, myS= Sensory, M = Motor, B = Both
57Bonus Mnemonic for MSSome Lovers Try Positions That They Can't Handle!!! Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
58Neurotransmitters Chemicals that run brain 60+ affect memory, learning, relationshipsThoughts, Food, Drugs affect brain chemicalsStored in sacks near synapse at end of axonElectrical charges from cell body free chemicals, propel them across synapseSpecial receptors at end of dendrites form to accept certain neurotransmitters
59Important Neurotransmitters SerotoninAids in smooth transmission of messages in brain/bodyLarge role in regulating mood, appetite, memory & learningLack of serotonin may result in low self-esteem, depression, aggression DopamineHelps information flow to higher brain levelsKey role in regulating pain/pleasureMelatoninRelated to wake/sleep cyclesEpinephrineMoving body when needs instant action, - fear/dangerAcetylcholineEnhances memory (chemical responsible for many dreams)Endorphin (neuropeptide)Body’s natural pain killer -lots of endorphin can create euphoric feelingsCortisol (neuropeptide)Released when under stressCan be dangerous at high levels – interrupts transmission of messages from neuron to neuron
60Documentation Requirements for Coding LateralitySpecific ArteriesSiteMust use proximal branch for nerve that does not have separate body part value in ICD-10-PCSEx: mandibular nerve is branch of trigeminal nerve, only the trigeminal nerve has a body part valueWhen procedure performed on mandibular nerve, must assign trigeminal nerve for body part value
61Artery/Nerve Families, etc. (ICD-10-PCS Body Key) Alphabetical listing of body parts shows PCS Description to use with Table Rows when constructing a ICD-10-PCS codeAnatomical TermPCS DescriptionCaroticotympanic arteryInternal Carotid Artery, R/LCarotid sinus nerveGlossopharyngeal nerveLeptomeningesCerebral/Spinal meningesMammillary bodyHypothalamusMiddle cerebral arteryIntracranial artery
62QUESTIONS? Homework Review Powerpoint before taking post-test Go online to at least two of the Resource sites with Games and/or Quizzes and see what A&P about the brain you have learned/reinforced
63ResourcesAmar AP, Weiss MH. Pituitary Gland Anatomy and Physiology. Abstract. Neurosurg Clin N Am Jan;14(1):11-23, v.Anatomy of the Brain. American Association of Neurological Surgeons.Anatomy of the Brain and Skull. Philips Medical Games.Brain Anatomy. Game.Brain Anatomy and Functions. Tutorial and Quiz. Getbodysmart.
64ResourcesCliff Notes. Anatomy & Physiology. Well-organized and includes quizzes.Cranial Nerves: Review Info. Quizzes.Cranial Nerves: Review InfoCranial Nerves Dirty Mnemonic Tutorial. Video.Crisan, E. Ventricles of the Brain. Jun 27, Medscape Reference.
65Resources Kean, M. L. The Brain. Tutorial. Division of Disability and Aging Services. Vermont. Brain 101: The neurotypical brain.Gray, H. Anatomy of the Human BodyHuman Brain Anatomy. Study and Quiz Modules.Interactive Tour of the Brain. National Brain Tumor Society.Intro to the Brain. ITS. San Diego State Univ. Includes Test.Kean, M. L. The Brain. Tutorial.
66Resources Match a Brain. Game. McGuire, N. ICD10 Session 11 Chapter 6. Codapedia. 32 Minute video.Neuron-Glia Interactions in Nerve Development and Disease.NIMH. Brain Basics.Pineal Gland. Encyclopedia Brittanica.
67Resources Secret Life of the Brain. PBS. 3-D brain anatomy. Tamarkin, D. A. Glia.University of Bristol. How the Brain Works. Video, 6+ minWebMD. Brain & Nervous System Health Center.WebMD. Medical References Related to Brain & Nervous System.Wernicke area. Encyclopedia Britannica. Videos, Animations.