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Overview of Brain Anatomy and function

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Overview of
Brain Anatomy and
function
Wei-Ching Lee, M.D.
INTRODUCTION
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Lobes
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Frontal
Parietal
Temporal
Occipital
Brainstem
Anatomy
Anatomy
Homunculus Man
Circle of Willis
Gold: ACA
Pink: MCA
Blue: PCA
Frontal Lobe
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Conscientiousness
Judgments
How we initiate activity in response to our environment.
Controls our emotional response.
Controls our expressive language.
Assigns meaning to the words we choose (abstract
thought)
Attention span
Involves word associations (language planning)
Memory for habits and motor activities (short term
memory)
Motor cortex—Voluntary movement
Impulse control
Perseverance
Frontal Lobe Deficit—Problems
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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).
Loss of spontaneity in interacting with others.
Loss of flexibility in thinking.
Persistence of a single thought (Perseveration).
Inability to focus on task (Attending).
Mood changes (Emotionally Labile).
Changes in social behavior.
Changes in personality.
Difficulty with problem solving.
Inablility to express language (Broca's Aphasia).
Parietal Lobe Function
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Location for visual attention.
Location for touch perception.
Goal directed voluntary movements.
Manipulation of objects.
Integration of different senses that allows for
understanding a single concept.
Parietal Lobe—Problems resulting
from deficit
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Inability to attend to more than one object at a time.
Inability to name an object (Anomia).
Inability to locate the words for writing (Agraphia).
Problems with reading (Alexia).
Difficulty with drawing objects.
Difficulty in distinguishing left from right.
Difficulty with doing mathematics (Dyscalculia).
Lack of awareness of certain body parts and/or
surrounding space (Apraxia) that leads to difficulties
in self-care.
Inability to focus visual attention.
Difficulties with eye and hand coordination.
Temporal Lobe Function
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Hearing ability
Memory acquisition
Some visual perceptions
Categorization of objects.
Temporal Lobe Deficits—Problems
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Difficulty in recognizing faces (Prosopagnosia).
Difficulty in understanding spoken words
(Wernicke's Aphasia).
Disturbance with selective attention to what we see
and hear.
Difficulty with identification of, and verbalization
about objects.
Short-term memory loss.
Interference with long-term memory
Increased or decreased interest in sexual behavior.
Inability to catagorize objects (Catagorization).
Right lobe damage can cause persistant talking.
Increased aggressive behavior.
Occipital Lobe Function
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Vision
Occipital Lobe Deficits--Problems
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Defects in vision (Visual Field Cuts).
Difficulty with locating objects in environment.
Difficulty with identifying colors (Color
Agnosia).
Production of hallucinations
Visual illusions - inaccurately seeing objects.
Word blindness - inability to recognize words.
Difficulty in recognizing drawn objects.
Inability to recognize movement of an object
(Movement Agnosia).
Difficulties with reading and writing.
Cerebellum Function
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Coordination of voluntary movement
Balance and equilibrium
Some memory for reflex motor acts.
Cerebellum Deficits—Problems
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Loss of ability to coordinate fine movements.
Loss of ability to walk.
Inability to reach out and grab objects.
Tremors.
Dizziness (Vertigo).
Slurred Speech (Scanning Speech).
Inability to make rapid movements.
Brainstem
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Midbrain
Pons
Medulla
Brainstem Function
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Breathing
Heart Rate
Swallowing
Reflexes to seeing and hearing (Startle
Response).
Controls sweating, blood pressure, digestion,
temperature (Autonomic Nervous System).
Affects level of alertness.
Ability to sleep.
Sense of balance (Vestibular Function).
Brainstem Deficits—Problems
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Decreased vital capacity in breathing,
important for speech.
Swallowing food and water (Dysphagia).
Difficulty with organization/perception of the
environment.
Problems with balance and movement.
Dizziness and nausea (Vertigo).
Sleeping difficulties (Insomnia, sleep apnea).
Midbrain
Function:
пЃ® Body posture
пЃ® Equilibrium
пЃ® Autonomic Nervous System
пЃ® Blood pressure
пЃ® Temperature
пЃ® Emotional influence
пЃ® Reg appetite and hormones
пЃ® Nuclei of CN III and IV
Midbrain lesion
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Variable LOC
Abnormal extensor tone
Hyperventilation
CN III and IV deficits
пЃ® CN IV nerve lesion: head tilted away from
lesion
пЃ® CN IV nucleus lesion: head tiled towards lesion
пЃ® CN III: innervates all eyes muscles except LR6
and SO4, eye deviated laterally and downward
with eyelid down (levator palpebrae)
Pons
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Function
Respiration
Chewing
Taste
Arousal, wakefulness, alertness
Nuclei of CN V, VI, VII, VIII
Pons lesion
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Semi-coma
Abnormal extensor tone
Apneusis
Withdrawal
CN V,VI, VII (facial colliculus syndrome)
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CN V: ipsi jaw deviation upon opening
VI: diplopia, paralysis of ipsi LR but also inablity
to turn contra eye medially
VII: can’t close eye or smile
Medulla
Function:
пЃ® Life-sustaining control center: controls hear,
respiration, vasomotor
пЃ® Cough, gag, swallow, vomit, digest
пЃ® Nuclei of CN VIII, IX, X, XI, XII
Medulla Lesion
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Comatose
Abnormal breathing
Ataxic
Absent gag reflex
Absent cough
CN VIII, IX, X, XI, XII deficits
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VIII: ipsi stumbling but contra nystagmus
IX, X, XI: absent gag reflex, contra uvula deviation,
dysphonia, dysphagia
XII: ipsi tongue deviation and atrophy
Function of Hemispheres
Right Hemisphere
пЃ® judging the position of things in space
пЃ® knowing body position
пЃ® understanding and remembering things we do and see
пЃ® putting bits of information together to make an entire
picture
пЃ® controls the left side of the body
Left Hemisphere
пЃ® understanding and use of language (listening, reading,
speaking and writing)
пЃ® memory for spoken and written messages
пЃ® detailed analysis of information
пЃ® controls the right side of the body
Online references
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http://www.wisconline.com/objects/index_tj.asp?objid=OTA502
http://www.neuroskills.com/edu/ceufunction1.shtml
http://www.hopkinshospital.org/health_info/Neurolog
ical%20Diseases/Reading/brain_anatomy.html
http://training.seer.cancer.gov/ss_module00_bbt/unit0
2_sec04_c_brain.html
SAE
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Findings commonly seen after right
hemisphere stroke include
A)
Right hemiplegia
Aphasia
Visual-Perceptual deficits
Agraphia
B)
C)
D)
SAE
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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.
SAE
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A)
B)
C)
D)
In TBI, MRI is preferred to CT scan in the
Eval of acute brain injury
Detection of SAH
Detection of epidural hematomas
Eval of diffuse axonal injury
SAE
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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
SAE
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A)
B)
C)
D)
E)
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
Diazepam 2.5mg tid
Neurolytic block to median nerve
Botulinum toxin injection to forearm flexors
Static muscle stretch
Baclofen 5mg qid
SAE
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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.
SAE
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A)
B)
C)
D)
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:
Benign positional vertigo
Cerebellar contusion
Unilateral vestibular paresis
Bilateral vestibular paresis
SAE
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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.
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