NeuroII- phathophysiology-Cohen

major changes in behavior, personality, and speech.

left hemisphere has different functions then the right, and different areas preform different functions, such as Broca's area and Wernicke area.

Left Frontal lobe

Left temporal lobe

Helps control eye movement.  Damage to this part of brain will cause eye to deviate toward the side of injury.  the roll of brodmann's 8 in healthy individual is to move eyes toward opposite side.  (8 looks like a pair of glasses)

It is the primary motor cortex.  Anterior to the Central Sulcus.

• It is located posterior to the Central sulcus as the somatosensory portion of the brain.  Lesions affecting the primary somatosensory cortex produce characteristic symptoms including: agraphesthesia, astereognosia, hemihypesthesia, and loss of vibration, proprioception and fine touch (because the third-order neuron of the medial-lemniscal pathway cannot synapse in the cortex). It can also produce hemineglect,
• if it affects the non-dominant hemisphere. Destruction of brodmann area
• 3, 1, and 2 results in contralateral hemihypesthesia and astereognosis.
• It could also reduce nociception, thermoception, and crude touch, but, since information from the spinothalamic tract is interpreted mainly by other areas of the brain (see insular cortex and cingulate gyrus), it is not as relevant as the other symptoms

The auditory cortex, the primary auditory area of the brain.  Located in the temporal lobe on the superior portion, loss of both sides results in complete cortical defness.  Only slight deffness results from loss of one side.

Pars opercularis, part of the frontal cortex, anterior to the premotor cortex, phonological and syntactic processing, also known as Broca's area.  Broca's aphasia is also known as expressive aphasia, "they know what they want to say, they just can't say it."

Affects Brodmann's area 22, and the patients cannot interpret/understand written or spoken language.

Located in the occipital lobe, used for visual cortex.

• Movement
• Reasoning
• Behavior
• Memory
• Personality
• Planning
• Decision Making
• Judgement
• Initiatie
• Inhibition
• Mood

• tell right from left
• calculations
• sensations
• reading
• writing

vision

• language comprehension
• behavior
• memory
• hearing
• emotions

• balance
• coordination
• fine muscle control

• hormones
• growth
• fertility

• Breathing
• blood pressure
• hearbeat
• swallowing

Also known as the colossal commissure, a wide flat bundle of neural fibers under the cortex.  connects the right and left hemispheres.

Works in conjuction with the primary motor cortex and the corticospinal tracts to control motor function.  Also called the extrapyramidal system. Dz of the basal ganglia include PD, movement disorders, and often damaged in stroke or tumor.

Caudate, Putamen (together called STRIATUM), Globus Pallidus I and II, Thalamus.

Midbrain of brainstem.

important in emotions like fear, happiness, and rage.  Connects to basal ganglia and nucleus ccumbens.  DZ include schizophrenia, depression, bipolar dz, epilepsy, drug addiction.  Also may have role in memory and maternal behavior.

Brainstem

Mesencephalon

3- Oculomotor, moves muscles of the eye such as superior rectus, inferior rectus, medial rectus, inferior oblique levator palpebrae superiouris (upper eye lid muscle)

4-Trochlear nerve, moves the superior oblique muscle of the eye, makes the eye look down

Pons

5- Trigeminal nerve, responsible for sensation of the face and biting/chewing.  Opthalmic, maxillary, and mandibular branch (both sensory and motor). 

6- Abducens, controls lateral rectus muscle of the eye.

7- Facial, controls facial expression muscles and taste for the anterior 2/3 of tongue.

8- Vestibulocochlear, transmits sound and equilibrium information from the inner ear to the brain.

Medulla oblongata

9- Glossopharyngeal, has 5 function. sensory for skin of external ear, sensory for taste of posterior 1/3 of tongue, information of carotid sinus/carotid body, innervation of parotid gland, motor to the stylopharyngeus muscle.

10- Vagus, supplies parasympathetic fibers to most organs of body, nothing after the 2nd segment of the transverse colon.  some skeletal muscles like levator veli palatini and cricothyroid, others.

11- Accessory, innervates the sternocleidomastoid and trapezius muscles. 

12- Hypoglossal, control of the tongue speech and food, swallowing,

collection of poorly described nuclei in medulla and pons.  Maintains consciousness and relays info about state of body to sensory and motor cortices.  Involved in the sleep and wake cycle.

from midbrain to cerebral cortex.

Vermis is found in midline of cerebellum and connects the two hemispheres.

Dentate, responsible for planning, initiation and control of voluntar movements.  Crucial for posture, equilibrium, conscious and subconscious movement.  great density of neurons, often site of dz and metastatic cancer.

Each hemisphere of the cerebellum coordinates movement on its own side.  info leaves cerebellum via superior cerebellar peduncle, crosses brainstem on way to thalamus on other side.  Thalamus sends info to the motor cortex on its side.  via the corticospinal tracts, which cross at the bottom of brainstem, control muscles on same side as the original cerebellar hemisphere.

carotid arteries

Vertebral Arteries

Middle Cerebral Arteries

Basilar artery.  the vertebral arteries join together to form the basilar artery that then splits into the posterior cerebral (after the circle of willis)

Sinuses

Venous infarct.  Can be caused by infections, meningitis, bony sinuses, mastoid sinuses or from pregnancy or childbirth

cerebral aqueduct

Cisterna magna

Hydrocephalus.  Can be benign, serious, or fatal with complete blockage.

• Dura mater
• Arachnoid
• Subarachnoid space
• pia mater

pia mater

Between pia mater and arachnoid in the subarachnoid space.

pia mater and arachnoid

phrenic nerve- innervates the diaphragm

upper extremity, especially c6 and c7

umbilicus

lower border of L1 vertebral body

lower extremity, L5 and S1 are clinically important

Cortical spinal

Lateral and anterior spinothalamic

Gracile and cuneate fasciculi (posterior Columns)

Cross at the level that they enter the spinal cord via substantia gelatinosa and ascend spinal cord on opposite side.  Carry pain and temperature.  synapse in the ventralposterior thalamus.

Carry proprioception and vibration via the gracile and cuneate fasciculi.  Ascend the spinal cord on the same side that they enter until they reach the brainstem and cross as the medial lemniscus tract to the thalamus.

Lateral geniculate nucleus

• Retinal detachment
• vitreous hemorrhage
• central retinal artery occlusion
• CVA (Stroke)
• Trauma

• age
• cataracts
• glaucoma
• HIV-CMV infections
• Autoimmune dz
• Diabetes
• Congenital
• Macular Degeneration
• Neoplasm
• Pseudotumor cerebri

Homonymous hemianopia

stroke, tumor, or trauma to one occipital lobe

Quadrantanopia

• Upper- dz of temporal lobe
• lower- dz of parietal lobe

tragic, uncommon disorder due to bilateral occipital dz.  usually emboli to posterior cerebral ateries

Patient denies they are blind.

Bitemporal hemianopia

Check for a pituitary gland tumor compressing the optic chiasm.  Affect the medial half of the retina axons.

Edinger westphal nucleus

Parinauds Syndrome

May not be pathologic, elderly can have normal loss of upward vision

Look to the left.  Brodmann's 8 pushes the eyes.

the pons pulls the eyes.  (pull, pons).  an injury on the left would leave the eyes looking to the right

• palsies of CN 3, 4, 6.
• Myasthenia gravis
• Multiple sclerosis
• stroke
• damage to medial longitudinal fasiculus, connects cranial nerve 3 to contralateral CN4.

superior oblique

• superior rectus
• medial rectus
• inferior rectus
• inferior obique

lateral rectus