Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental...

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Cerebral Cortex Structure, Function, Dysfunction Reading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011

Transcript of Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental...

Page 1: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Cerebral CortexStructure, Function, Dysfunction

Reading Ch 10 WaxmanDental Neuroanatomy Lecture

Suzanne Stensaas, Ph.D.March 15, 2011

Page 2: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Anatomy Review

• Lobes and layers• Brodmann’s areas• Vascular Supply• Major Neurological Findings

– Frontal, Parietal, Temporal, Occipital, Limbic• Quiz Questions?

Page 3: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Types of Cortex

• Sensory• Motor• Unimodal association• Multimodal association necessary for

language, reason, plan, imagine, create

Page 4: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Structure of neocortex (6 layers)

Page 5: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

The general pattern of primary, association and mulimodalassociation cortex (Mesulam)

Page 6: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Brodmann, Lateral Left Hemisphere

Page 7: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

MCA left hemispherefrom D.Haines

Page 8: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •
Page 9: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

ACA and PCA -Haines

Page 10: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Issues of Functional Localization

• Earliest studies -Signs, symptoms and note location • Electrical discharge (epilepsy) suggested function• Ablation - deficit suggest function• Reappearance of infant functions suggest loss of inhibition

(disinhibition), i.e. grasp, suck, Babinski • Variabilities in case reports• Linked networks of afferent and efferent neurons in several

regions working to accomplish a task• Functional imaging does not always equate with abnormal

function associated with location of lesion• fMRI activation of several cortical regions• Same sign from lesions in different areas – i.e.paraphasias• Notion of the right hemisphere as "emotional" in contrast to the

left one as "logical" has no basis in fact.

Page 11: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Limbic System (not a true lobe)involves with cingulate gyrus and the

• Hippocampus- short term memory• Amygdala- fear, agression, mating• Fornix pathway to hypothalamus• Hypothalamus- ANS control• Prefrontal Cortex- appropriate behavior

Page 12: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Schematic Diagram of principal limbic areas

From College of DuPage Biology 1152 Syllabus

Page 13: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Amygdala and relationship to ventricle and hippocampus

Page 14: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Classic Hippocampal Circuit

Page 15: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Hippocampal Formation & Amygdala

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Hippocampus

Page 17: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Lateral view gross brain. Left hemisphere Frontal Lobe

Page 18: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Frontal Lobe Motor areas

• Contralateral weakness or paralysis (area 4) body and CN’s

• Premotor planning of action (area 6)• Frontal eye fields for moving eyes to

opposite side (area 8)• Speech production (Broca’s area 44, 45)• e.g. Epileptic discharge

Page 19: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Frontal Lobe prefrontal association cortex

• Bilateral prefrontal damage– distractible, apathetic– lack foresight, abstract reasoning, initiative– stubborn, – perseverate, – lack ambition, responsibility, judgment or

social graces

Page 20: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Apraxia (Error in execution of learned movements without coexisting weakness)

• Damage to dominant parietal, premotor, and supplementary motor areas

• Dominant hemisphere association areas• Parietal - integrates motor sequences

with vision and somatic sensory info• Frontal lobe - execution of act

Page 21: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Language- Frontal-Parietal-Temporal Areas

Page 22: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Aphasias-Motor• Full Broca’s involves operculum, insula and

subjacent white matter with contralateral hemiparesis of face, arm

• Telegraphic speech• Agrammatism - syntax more affected than semantics• Usually agraphia too• Transcortical - interruption of inferred linkage paths

inward to Broca’s area

Page 23: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Aphasias-Sensory

• Wernicke’s• Dominant (left usually) hemisphere• Fluent, paraphasias, poor comprehension, • Naming, repetition, reading and writing

impaired• Less aware and less frustrated than motor

aphasias

Page 24: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Right hemisphere and aphasia

• Emotional tone modulation• Propositional prosody• Body language gestures

Page 25: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Anomia

• Anomia requires special testing• Seen in all language areas and outside

language cortex• Most severe in dominant temporal

lesions

Page 26: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Agnosia-impaired perception or recognition with OK vision, hearing, sensation , attention, intelligence• Visual: colors, faces, letters• Auditory: tunes, spoken words, pure word deafness• Somatosensory - stereognosis, graphesthesia• May not have other signs: aphasia, apraxia• Atrophy or metastatic disease• Disconnections of specific sensory association areas• Corpus callosum, deep white matter near main sensory areas

Page 27: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Global aphasia

• Dominant hemisphere• Frontal• Temporal• Parietal• Head of caudate associated with

language disorders• Internal carotid or proximal MCA,

hemorrhage, or large tumor

Page 28: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Temporal Lobe

• Association auditory cortex• Speech comprehension• Important in naming• Memory - bilateral medial temporal lobe

near hippocampus• Superior part of contralateral visual field

Page 29: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Temporal Lobe Functions• Wernicke speech comprehension - dominant side• Verbal learning- dominant• Inferior temporal gyrus naming and faces - dominant side• Upper homonymous quadrantanopia - (Meyers loop)• Hallucination incld gustatory, visual, auditory with emotion• Lyrics in dominant lobe• Harmony and melody is impaired by lesions of the

nondominant,• Visual learning- nondominant• Visual agnosia dominant, auditory agnosia nondominant

hemisphere• Bilateral: cortical deafness. Otherwise subtle• Bilateral: psychic blindness, Klüver-Bucy rarely full in

man.• Bilateral hippocampal formation : Amnesia

Page 30: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Parietal Lobe

•Somatosensory Cortex-paresthesias•Parietal lobe-reading, writing, naming

• Angular gyrus• Supramarginal gyrus• Multimodal cortex

•(Agraphia can be frontal or parietal)

Page 31: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Contralateral Neglect (asomatognosia)

• Right parietal• Right side is dominant for attention - do not attend to

opposite side, ie. Dressing apraxia• Severe - failure to recognize one’s opposite limb• Impaired visuospatial ability (drawing, copying, 3D,

manipulate objects in space• Fail to appreciate humor

Page 32: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Brodmann, Lateral

Occipital Lobe

Page 33: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Ventral and dorsal Stream, MT

Page 34: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Brodmann, Medial

Page 35: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Medial Gross Brain

Page 36: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Ventral Gross Brain

Page 37: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

PCA ventral view right hemisphere

from D.Haines

Page 38: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Visual Path

Page 39: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Write the patient historyPosterior view, angiogram

FIRST ANGIO SECOND ANGIO next day

R R LL

Page 40: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

STROKE:Remember the 1st Four Letters...S.T.R.O.

If everyone can remember something this simple,

we could save some folks.

Doctors say a bystander can recognize a stroke by asking three simple questions:

Page 41: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

Ask four simple questions:• S Ask the person to SMILE• T Ask the person to TALK and

SPEAK A SIMPLE SENTENCE (Coherently)(i.e. It is sunny out today)

• R Ask them to RAISE BOTH ARMS.• O Ask them to open their mouth

and STICK OUT your tongue. (Does it deviate to one side?)

• K Kall 911• E Every minute counts (180 mins)

Page 42: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •
Page 43: Reading Ch 10 Waxman Dental Neuroanatomy Lecture. Cortex Dental 2011.pdfReading Ch 10 Waxman Dental Neuroanatomy Lecture Suzanne Stensaas, Ph.D. March 15, 2011 . Anatomy Review •

End of Dental lecturego to ARS quiz

2011