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Overview of Brain Anatomy and function Wei-Ching Lee, M.D.

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Presentation on theme: "Overview of Brain Anatomy and function Wei-Ching Lee, M.D."— Presentation transcript:

1 Overview of Brain Anatomy and function Wei-Ching Lee, M.D.

2 INTRODUCTION Lobes Lobes Frontal Frontal Parietal Parietal Temporal Temporal Occipital Occipital Brainstem Brainstem

3 Anatomy

4 Anatomy

5 Homunculus Man

6 Circle of Willis

7 Gold: ACA Pink: MCA Blue: PCA

8 Frontal Lobe Conscientiousness Conscientiousness Judgments Judgments How we initiate activity in response to our environment. How we initiate activity in response to our environment. Controls our emotional response. Controls our emotional response. Controls our expressive language. Controls our expressive language. Assigns meaning to the words we choose (abstract thought) Assigns meaning to the words we choose (abstract thought) Attention span Attention span Involves word associations (language planning) Involves word associations (language planning) Memory for habits and motor activities (short term memory) Memory for habits and motor activities (short term memory) Motor cortex—Voluntary movement Motor cortex—Voluntary movement Impulse control Impulse control Perseverance Perseverance

9 Frontal Lobe Deficit—Problems Loss of simple movement of various body parts (Paralysis). Loss of simple movement of various body parts (Paralysis). Inability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee (Sequencing). Inability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee (Sequencing). Loss of spontaneity in interacting with others. Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Loss of flexibility in thinking. Persistence of a single thought (Perseveration). Persistence of a single thought (Perseveration). Inability to focus on task (Attending). Inability to focus on task (Attending). Mood changes (Emotionally Labile). Mood changes (Emotionally Labile). Changes in social behavior. Changes in social behavior. Changes in personality. Changes in personality. Difficulty with problem solving. Difficulty with problem solving. Inablility to express language (Broca's Aphasia). Inablility to express language (Broca's Aphasia).

10 Parietal Lobe Function Location for visual attention. Location for visual attention. Location for touch perception. Location for touch perception. Goal directed voluntary movements. Goal directed voluntary movements. Manipulation of objects. Manipulation of objects. Integration of different senses that allows for understanding a single concept. Integration of different senses that allows for understanding a single concept.

11 Parietal Lobe—Problems resulting from deficit Inability to attend to more than one object at a time. Inability to attend to more than one object at a time. Inability to name an object (Anomia). Inability to name an object (Anomia). Inability to locate the words for writing (Agraphia). Inability to locate the words for writing (Agraphia). Problems with reading (Alexia). Problems with reading (Alexia). Difficulty with drawing objects. Difficulty with drawing objects. Difficulty in distinguishing left from right. Difficulty in distinguishing left from right. Difficulty with doing mathematics (Dyscalculia). Difficulty with doing mathematics (Dyscalculia). Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care. Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care. Inability to focus visual attention. Inability to focus visual attention. Difficulties with eye and hand coordination. Difficulties with eye and hand coordination.

12 Temporal Lobe Function Hearing ability Hearing ability Memory acquisition Memory acquisition Some visual perceptions Some visual perceptions Categorization of objects. Categorization of objects.

13 Temporal Lobe Deficits—Problems Difficulty in recognizing faces (Prosopagnosia). Difficulty in recognizing faces (Prosopagnosia). Difficulty in understanding spoken words (Wernicke's Aphasia). Difficulty in understanding spoken words (Wernicke's Aphasia). Disturbance with selective attention to what we see and hear. Disturbance with selective attention to what we see and hear. Difficulty with identification of, and verbalization about objects. Difficulty with identification of, and verbalization about objects. Short-term memory loss. Short-term memory loss. Interference with long-term memory Interference with long-term memory Increased or decreased interest in sexual behavior. Increased or decreased interest in sexual behavior. Inability to catagorize objects (Catagorization). Inability to catagorize objects (Catagorization). Right lobe damage can cause persistant talking. Right lobe damage can cause persistant talking. Increased aggressive behavior. Increased aggressive behavior.

14 Occipital Lobe Function Vision Vision

15 Occipital Lobe Deficits--Problems Defects in vision (Visual Field Cuts). Defects in vision (Visual Field Cuts). Difficulty with locating objects in environment. Difficulty with locating objects in environment. Difficulty with identifying colors (Color Agnosia). Difficulty with identifying colors (Color Agnosia). Production of hallucinations Production of hallucinations Visual illusions - inaccurately seeing objects. Visual illusions - inaccurately seeing objects. Word blindness - inability to recognize words. Word blindness - inability to recognize words. Difficulty in recognizing drawn objects. Difficulty in recognizing drawn objects. Inability to recognize movement of an object (Movement Agnosia). Inability to recognize movement of an object (Movement Agnosia). Difficulties with reading and writing. Difficulties with reading and writing.

16 Cerebellum Function Coordination of voluntary movement Coordination of voluntary movement Balance and equilibrium Balance and equilibrium Some memory for reflex motor acts. Some memory for reflex motor acts.

17 Cerebellum Deficits—Problems Loss of ability to coordinate fine movements. Loss of ability to coordinate fine movements. Loss of ability to walk. Loss of ability to walk. Inability to reach out and grab objects. Inability to reach out and grab objects. Tremors. Tremors. Dizziness (Vertigo). Dizziness (Vertigo). Slurred Speech (Scanning Speech). Slurred Speech (Scanning Speech). Inability to make rapid movements. Inability to make rapid movements.

18 Brainstem Midbrain Midbrain Pons Pons Medulla Medulla

19 Brainstem Function Breathing Breathing Heart Rate Heart Rate Swallowing Swallowing Reflexes to seeing and hearing (Startle Response). Reflexes to seeing and hearing (Startle Response). Controls sweating, blood pressure, digestion, temperature (Autonomic Nervous System). Controls sweating, blood pressure, digestion, temperature (Autonomic Nervous System). Affects level of alertness. Affects level of alertness. Ability to sleep. Ability to sleep. Sense of balance (Vestibular Function). Sense of balance (Vestibular Function).

20 Brainstem Deficits—Problems Decreased vital capacity in breathing, important for speech. Decreased vital capacity in breathing, important for speech. Swallowing food and water (Dysphagia). Swallowing food and water (Dysphagia). Difficulty with organization/perception of the environment. Difficulty with organization/perception of the environment. Problems with balance and movement. Problems with balance and movement. Dizziness and nausea (Vertigo). Dizziness and nausea (Vertigo). Sleeping difficulties (Insomnia, sleep apnea). Sleeping difficulties (Insomnia, sleep apnea).

21 Midbrain Function: Body posture Body posture Equilibrium Equilibrium Autonomic Nervous System Autonomic Nervous System Blood pressure Blood pressure Temperature Temperature Emotional influence Emotional influence Reg appetite and hormones Reg appetite and hormones Nuclei of CN III and IV Nuclei of CN III and IV

22 Midbrain lesion Variable LOC Variable LOC Abnormal extensor tone Abnormal extensor tone Hyperventilation Hyperventilation CN III and IV deficits CN III and IV deficits CN IV nerve lesion: head tilted away from lesion CN IV nerve lesion: head tilted away from lesion CN IV nucleus lesion: head tiled towards lesion CN IV nucleus lesion: head tiled towards lesion CN III: innervates all eyes muscles except LR6 and SO4, eye deviated laterally and downward with eyelid down (levator palpebrae) CN III: innervates all eyes muscles except LR6 and SO4, eye deviated laterally and downward with eyelid down (levator palpebrae)

23 Pons Function Function Respiration Respiration Chewing Chewing Taste Taste Arousal, wakefulness, alertness Arousal, wakefulness, alertness Nuclei of CN V, VI, VII, VIII Nuclei of CN V, VI, VII, VIII

24 Pons lesion Semi-coma Semi-coma Abnormal extensor tone Abnormal extensor tone Apneusis Apneusis Withdrawal Withdrawal CN V,VI, VII (facial colliculus syndrome) CN V,VI, VII (facial colliculus syndrome) CN V: ipsi jaw deviation upon opening CN V: ipsi jaw deviation upon opening VI: diplopia, paralysis of ipsi LR but also inablity to turn contra eye medially VI: diplopia, paralysis of ipsi LR but also inablity to turn contra eye medially VII: can’t close eye or smile VII: can’t close eye or smile

25 Medulla Function: Life-sustaining control center: controls hear, respiration, vasomotor Life-sustaining control center: controls hear, respiration, vasomotor Cough, gag, swallow, vomit, digest Cough, gag, swallow, vomit, digest Nuclei of CN VIII, IX, X, XI, XII Nuclei of CN VIII, IX, X, XI, XII

26 Medulla Lesion Comatose Comatose Abnormal breathing Abnormal breathing Ataxic Ataxic Absent gag reflex Absent gag reflex Absent cough Absent cough CN VIII, IX, X, XI, XII deficits CN VIII, IX, X, XI, XII deficits VIII: ipsi stumbling but contra nystagmus VIII: ipsi stumbling but contra nystagmus IX, X, XI: absent gag reflex, contra uvula deviation, dysphonia, dysphagia IX, X, XI: absent gag reflex, contra uvula deviation, dysphonia, dysphagia XII: ipsi tongue deviation and atrophy XII: ipsi tongue deviation and atrophy

27 Function of Hemispheres Right Hemisphere Right Hemisphere judging the position of things in space judging the position of things in space knowing body position knowing body position understanding and remembering things we do and see understanding and remembering things we do and see putting bits of information together to make an entire picture putting bits of information together to make an entire picture controls the left side of the body controls the left side of the body Left Hemisphere understanding and use of language (listening, reading, speaking and writing) understanding and use of language (listening, reading, speaking and writing) memory for spoken and written messages memory for spoken and written messages detailed analysis of information detailed analysis of information controls the right side of the body controls the right side of the body

28 Online references online.com/objects/index_tj.asp?objid=OTA502 online.com/objects/index_tj.asp?objid=OTA502 online.com/objects/index_tj.asp?objid=OTA502 online.com/objects/index_tj.asp?objid=OTA ical%20Diseases/Reading/brain_anatomy.html ical%20Diseases/Reading/brain_anatomy.html ical%20Diseases/Reading/brain_anatomy.html ical%20Diseases/Reading/brain_anatomy.html 2_sec04_c_brain.html 2_sec04_c_brain.html

29 SAE Findings commonly seen after right hemisphere stroke include Findings commonly seen after right hemisphere stroke include A) Right hemiplegia B) Aphasia C) Visual-Perceptual deficits D) Agraphia

30 SAE Answer C Answer C Strokes on nondominant hemisphere present with contralateral hemiplegia and hemianesthesia, aprosody (absence of normal speech in pitch, rhythm, and variations in stress), visual spatial deficit, and neglect syndrome. Strokes on nondominant hemisphere present with contralateral hemiplegia and hemianesthesia, aprosody (absence of normal speech in pitch, rhythm, and variations in stress), visual spatial deficit, and neglect syndrome.

31 SAE In TBI, MRI is preferred to CT scan in the In TBI, MRI is preferred to CT scan in the A) Eval of acute brain injury B) Detection of SAH C) Detection of epidural hematomas D) Eval of diffuse axonal injury

32 SAE Answer D Answer D MRI is considered better than CT for evaluating DAI. CT is superior to MRI for detection of acute extra-axial hematomas, and in the eval of acute brain injury MRI is considered better than CT for evaluating DAI. CT is superior to MRI for detection of acute extra-axial hematomas, and in the eval of acute brain injury

33 SAE 74 y/o woman has had a stroke with left hemiparesis and left neglect. Muscle tone is increased, and flexion contractures are beginning to develop in her left elbow, wrist, and hand. Initial intervention would be 74 y/o woman has had a stroke with left hemiparesis and left neglect. Muscle tone is increased, and flexion contractures are beginning to develop in her left elbow, wrist, and hand. Initial intervention would be A) Diazepam 2.5mg tid B) Neurolytic block to median nerve C) Botulinum toxin injection to forearm flexors D) Static muscle stretch E) Baclofen 5mg qid

34 SAE Answer D. Answer D. In treating spasticity, the approach with the least possible adverse effects should be used first. In this case, ROM, stretching, and positioning with splints would be the initial treatment. In treating spasticity, the approach with the least possible adverse effects should be used first. In this case, ROM, stretching, and positioning with splints would be the initial treatment.

35 SAE Following a head injury, a 35 y/o W presents with vertigo. She reports a sensation of spinning beginning several seconds after standing up radiply, bending over, or rolling in bed. Symptoms lasts for approx 30 sec. Exam is notable for nystagmus during episodes of vertigo, normal extremity coordination, and min increase in sway during Romberg. Most likely dx is: Following a head injury, a 35 y/o W presents with vertigo. She reports a sensation of spinning beginning several seconds after standing up radiply, bending over, or rolling in bed. Symptoms lasts for approx 30 sec. Exam is notable for nystagmus during episodes of vertigo, normal extremity coordination, and min increase in sway during Romberg. Most likely dx is: A) Benign positional vertigo B) Cerebellar contusion C) Unilateral vestibular paresis D) Bilateral vestibular paresis

36 SAE Answer A. Answer A. BPV characterized by transient episodes of vertigo precipitated by changes in position of the head. Treatment involves psecific otolith repositioning maneuver or seris of habituation exercises. BPV characterized by transient episodes of vertigo precipitated by changes in position of the head. Treatment involves psecific otolith repositioning maneuver or seris of habituation exercises.


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