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Neuro Higher Cortical Systems

Dr. Ampil
Cerebrum use the cortical not the subcortical
Dr. Broadman came up with the brain nomenclature
Wernikers -39, 40

Cerebral cortex seat of higher intellectual functions
4 general functional categories
o Sensory
o Motor
o Unimodal association cortex
o Multimodal association cortex
Primary sensory areas
Receive thalamocortical fibers except olfaction
o Ventral post complex of thalamus Broadmann, 3, 1, 2 in postcentral gyrus
o Lateral geniculate nucleus
Broadmans 17 or primary visual cortex
o Medial geniculate body Broadman 41- 42 or primary auditory cortex in transverse temporal gyrus
Cerebral cortex: unimodal
Association cortices
o Adjacent to each primary association area
o Devoted to a higher level of information processing associated to the primary specific sensory modality
o Visual association cortices
o Broadmans area 18, 19
o Relates the visual information received by the primary visual area to past experiences to enable the
individual to recognize and appreaciate what he is seeing
Cerebral Cortex: Unimodal
Association cortex
o Auditory association cortex
o Posterior to primary auditory area in superior temporal gyrus (Brodmann 22)
o Receives fibers from primary, auditory area and thalamus
o Function
Interpretation of sounds
Association of auditory input with other sensory information
o Somatosensory association cortex
Posterior postecntral gyrus
Superior parietal lobe (5, 7)
Function:
Receive and integrate different sensory modalities
Ex. differentiating coins by touch
Cerebral Cortex: Multimodal association cortex
o Receives information from several different sensory modalities and create complete experiences of our
surroundings
o Critical to higher cortical functions
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Language, reasoning, planning, etc
Dominant hemisphere and language
o Dominant hemisphere in majority is left
In 95% of cases lft hemisphere damage affects language
Almost all rt handed and lft handed are lft cerebral dominant
Rt hemisphere is non dominant in majority
o Language
Faculty of communication using symbols organized by a system of grammar to describe things
and events and to express ideas
Linked to vision and audition but transcends any particular sensory system
Ex. Blind and deaf person can be eloquent
Aphasia
Disturbance of the comprehension and formulation of language
Not a disorder of hearing, vision, or motor control
Motor speech area of broca
o Infoerior frontal gyrus
o Broadman 44, 45
o Lft or dominant hemisphere
o Motor output of speech
o Connections with primary motor area (muscles of larynx, mouth, tounge, soft palate, and respiratory
muscle)
Broca aphasia
o Usually due to occlusion of branches of MCA
Aphasia
Contralateral motion
o Conscious about communication problem so frustration very prominent
o Expressive aphasia or nonfluent aphasia
Lesion in inferior frontal gyrus of left hemisphere (Broadmans area 44, 45)
o Difficulty in turning a concept or thought into a sequence of meaningful sounds
o Telegraphic speech
Labored and slow speech, poor enunciation, nonessential words omitted
o If severe, can lead to mutism
o Typically with difficulty with writing (agraohia) as with speaking
o During recovery, short habitual phrases first to return (hi, yes, thank you)
Temporal lobe
o Sensory speech area of Wernicke
Left dominant hemisphere, superior temporal gyrus with extension around posterior end of
lateral sulcus into parietal area
Connected to Brocas area by arcuate fasciculus
Function:
Understanding of the written and spoken language
Enable person to read, understand, and say aloud
o Wernicke aphasia
Receptive or fluent aphasia
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Defect of comprehension
Damage to supramarginal and angular gyri (Brodmann areas 37, 38, and 40) and the posterior
part of the superior temporal gyrus (Brodmann area 22) in the left hemisphere
Usually due to occlusion of temporal and parietal branches of MCA or thalamic
hemorrhage/tumor with extension laterally and invasion of subcortical WM.
Meyer loop involvement leads to contralateral Homonymous hemianopsia (optic
radiation)
If severe leads to:
Inability to understand what is said to them
Inability to read
Inability to write comprehensible language (argraphia)
Poor awareness of extent of disability
Less frustration and depression than patients with Broca aphasia
Display of fluent paraphasic speech
Clear, fluent and melodic but unintelligible because of frequent errors of word choice
(inappropriate) or use nonsense words
o Literal paraphasia: use of similar sounding words
The cat has claws the cat has clads
spoon smoon
o Verbal paraphasia: use of different, incorrect word;
the cat has tires
spoon snopel
o Semantic paraphasia: use of categorically related words
spoon cup
o Conduction aphasia
Interruption of connections linking the Brocas and wernike areas
Arcuate fasiculus
Normal comprehension, fluent expression
Impaired repitiion
Global aphasia
o Occlusion of left internal carotid or most proximal portion of the MCA
o Involves Broca and Wernicke areas
Characteristics of the aphasia syndromes (chart)
Syndrome Fluency Comprehension Repetition Localization in lft
Hemisphere
Wernickes Fluent Impaired Impaired Posterior Superior
temporal
Conduction Fluent Intact Impaired Arcuate fasiculus
Brocas Nonfluent Intact Impaired Inferior frontal
Global Nonfluent Impaired Impaired Wernickes and
Brocas areas
(large perisylvian)
Language: important points
o Damage to the left head of the caudate is association with the langage disorder of wernike aphasia type
o Nonverbal language can be affected
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Ex. Understanding and performing sign language
o Nondominat hemisphere (parietal area) important with prodsody of speech
Vocal inflections portray emotional content and affect meaning of spoken sentence
Pareital association cortex: Space and attention
o Nondominat hemisphere
Parietal association cortex most highly lateralized in the brain
o Attention deficit
Leads to contralateral neglect
Unaware of objects and events in the left half of his or her surrounding space
o Visuospatial dysfunction
o Constructional Apraxia
Parietal Assiociation cortex: Contralateral neglect
o Tendency to ignore things on the left side of the patients surroundings
o In extreme cases, not able to recognize left side of own body (asomatognosia)
Ignoring left side when dressing (dressing apraxia)
Claims left side of body is different and not his
Parietal Assiociation cortex: Visuospatial Dysfunction
o Inability to function successfully within the spatial surroundings
Route from one area to another
Drawing and visualizing floor plan of an area (ex. House)
Navigating from an area to another
Parietal Assiociation cortex: Manipulate Objects in Space
o Constructional apraxia
Unable to duplicate a simple block construction while looking at a model
Not due to a visual or motor problem
Due to an inability to internalize and duplicate images
Parietal Assiociation cortex: Other deficits
o Disorder of affect
Reduced ability to understand and appreciate humor
o Loss of prosody appreciation
o Inappropriate cheerfulness
o Lack of concern for and awareness of illness implications
Apraxia
o Damage in parietal association cortex, premotor cortex, supplementary motor cortex
o Not due to weakness of extremities
o Not able to carry out a complex task
o Blow out a match, sniff a flower, Comb your hair, brush your teeth
Agnosia
o Damage in modality specific area of sensory association cortex
o Disorder of sensory perception, not a visual problem
o Difficulty in recognizing complex sensory stimuli
Visual agnosia
Faces, objects, and letters
Auditory agnosia
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Sounds, voices, or spoken words
Tactile agnosia (asterognosis)
Somatosensory type
Inability to recognize a common object using the sense of touch alone
Olfactory agnosia
Gustatory agnosia
Color agnosia
Prefrontal cortex: Plans for future operation
o Distinct human intellectual traits
Judgement
Foresight
Sense of purpose
Sense of responsibility
Sense of social propriety
The case of Phineas Gage
o Foreman in railroad construction
o 3.5 ft long iron rod struck just beneath the left eye and exiting top of his head, destroying most of his
PFC
o Good physical recovery
o No paralysis, language and memory disorder
o Radical personality change
o the balance between his intellectual faculties and animal propensities seems to have been destroyed.
He is fitful, irreverent, indulging at times in the grossest profanity, manifesting but little difference for
his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously
obstinate, yet capricious and vacillating, devising many plans for future operation, which are no sooner
arranged than they are abandoned his friends and acquaintances said that he was no longer the
same
Bilateral Damage of prefrontal cortex: Constellation of deficits
o Highly distractible
Novelty of new stimulus irresistible
Lack of consistenct of purpose
o Lack of foresight
o Unable to anticipate or predict future events on the basis of past events or present conditions
o Unusually stubborn
o Perseveration
o Lack of ambition
o Loss of sense of responsibility
o Loss of social propriety
Prefrontal Cortex: Executive Function
o Planning, initiating, sequencing and monitoring behavior; Cognitive flexibility
o Dorsolateral prefrontal dysfunction



Dorsolateral
prefrontal cortex
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o Abstraction
Table and chair
Apple and orange
o Differences
Lie and mistake
o Idiom and proverb interpretation
level headed
People who live in glasshouses shouldnt throw stones
o Set Shifting
Flexibility from one cognitive set to another
Prefrontal Lobotomy
o 1930s, by neurosurgeon Egas Moniz
o Treat severe , intractable mental problems
o Tranquilizer discovery in 1950s provided more effective method of treatment with fewer undesireable
side effects
o Eventually abandoned
Higher Cerebral Functions
o Left Hemisphere: Language
o Right hemisphere: Visuospatal function
o Prefrontal cortex: executive function
o Gnosis and praxis: function of different association areas in the brain

Caudate
(Dorsolateral)
Globus pallidus
(Lateral dorsomedial)
Thalamus (VA and
MD)