Functional neuroanatomy    of brain
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  • 1. FUNCTIONAL NEUROANATOMY OF BRAIN By: karrar husain Moderator: Dr. Piyush P singh
  • 2. • The brain, and the brain alone, is the source of our pleasures, joys, laughter, and amusement, as well as our sorrow, pain, grief, and tears. Hippocrates, ca. 400
  • 3. Development
  • 4. HUMAN BRAIN • Human brain  substantially greater in size (350g vs 1200g). • The prefrontal cortex  3.5 % of the total cortical volume in cats and 11.5% in monkeys but close to 30 % in humans brain. • Relative representation of other regions is decreased in the human brain; (primary visual cortex 1.5 percent of the total area in humans but its close to 17% in monkeys.
  • 5. CELLS • Human brain  1011 nerve cells • Neurons  four morphologically identified regions • 1) The cell body, or soma containing the nucleus; considered the metabolic center of the neuron. • 2) The dendrites, processes arising from the cell body, branch extensively; serve as the major recipient zones of input.
  • 6. • 3) The axon, a single process that arises from a specialized portion of the cell body (the axon hillock) and conveys information to other neurons • 4) The axon terminals, fine branches near the end of the axon that form contacts (synapses).
  • 8. Cerebrum - The largest division of the brain. It is divided into two hemispheres, each of which is divided into four lobes. Cerebrum Cerebrum Cerebellum
  • 9. Cerebral cortex • Cerebral Cortex  The outermost layer of gray matter covering cerebrum • several millimeters thick, consists of 22.5 billion neurons and 165 trillion synapses • 90% of cortex  neocortex, a six-layered structure • Rest is allocortex  paleocortex + archicortex, restricted to the base of the telencephalon and the hippocampal formation, respectively.
  • 10. Cerebral Cortex Cerebral Cortex
  • 11. Cerebral Features: • Gyri – Elevated ridges ―winding‖ around the brain. • Sulci – Small grooves dividing the gyri – Central Sulcus – Divides the Frontal Lobe from the Parietal Lobe • Fissures – Deep grooves, generally dividing large regions/lobes of the brain – Longitudinal Fissure – Divides the two Cerebral Hemispheres – Transverse Fissure – Separates the Cerebrum from the Cerebellum – Sylvian/Lateral Fissure – Divides the Temporal Lobe from the Frontal and Parietal Lobes
  • 12. Gyri (ridge) Sulci (groove) Fissure (deep groove)
  • 13. Specific Sulci/Fissures: Central Sulcus Longitudinal Fissure Sylvian/Latera l Fissure Transverse Fissure
  • 14. Lobes of the Brain • Frontal • Parietal • Occipital • Temporal * Note: Occasionally, the Insula is considered the fifth lobe. It is located deep to the Temporal Lobe.
  • 15. Lobes of the Brain - Frontal • The Frontal Lobe of the brain is located deep to the Frontal Bone of the skull. • It plays an integral role in the following functions/actions: - Memory Formation - Emotions - Decision Making/Reasoning - Personality
  • 16. Frontal Lobe - Cortical Regions • Primary Motor Cortex (Precentral Gyrus) – Cortical site involved with controlling movements of the body. • Broca’s Area – Controls facial neurons, speech, and language comprehension. Located on Left Frontal Lobe. – Broca’s Aphasia – Results in the ability to comprehend speech, but the decreased motor ability (or inability) to speak and form words. • Orbitofrontal Cortex – Site of Frontal Lobotomies * Desired Effects: - Diminished Rage - Decreased Aggression - Poor Emotional Responses * Possible Side Effects: - Epilepsy - Poor Emotional Responses - Perseveration (Uncontrolled, repetitive actions, gestures, or words) • Olfactory Bulb - Cranial Nerve I, Responsible for sensation of Smell
  • 17. Primary Motor Cortex/ Precentral Gyrus Broca’s Area Orbitofrontal Cortex Olfactory Bulb
  • 18. Lobes of the Brain - Parietal Lobe • The Parietal Lobe of the brain is located deep to the Parietal Bone of the skull. • It plays a major role in the following functions/actions: - Senses and integrates sensation(s) - Spatial awareness and perception (Proprioception - Awareness of body/ body parts in space and in relation to each other)
  • 19. Parietal Lobe - Cortical Regions • Primary Somatosensory Cortex (Postcentral Gyrus) – Site involved with processing of tactile and proprioceptive information. • Somatosensory Association Cortex - Assists with the integration and interpretation of sensations relative to body position and orientation in space. May assist with visuo-motor coordination. • Primary Gustatory Cortex – Primary site involved with the interpretation of the sensation of Taste.
  • 20. Primary Somatosensory Cortex/ Postcentral Gyrus Somatosensory Association Cortex Primary Gustatory Cortex
  • 21. Lobes of the Brain – Occipital Lobe • The Occipital Lobe of the Brain is located deep to the Occipital Bone of the Skull. • Its primary function is the processing, integration, interpretation, etc. of VISION and visual stimuli.
  • 22. Occipital Lobe – Cortical Regions • Primary Visual Cortex – This is the primary area of the brain responsible for sight -recognition of size, color, light, motion, dimensions, etc. • Visual Association Area – Interprets information acquired through the primary visual cortex.
  • 23. Primary Visual Cortex Visual Association Area
  • 24. Lobes of the Brain – Temporal Lobe • The Temporal Lobes are located on the sides of the brain, deep to the Temporal Bones of the skull. • They play an integral role in the following functions: - Hearing - Organization/Comprehension of language - Information Retrieval (Memory and Memory Formation)
  • 25. Temporal Lobe – Cortical Regions • Primary Auditory Cortex – Responsible for hearing • Primary Olfactory Cortex – Interprets the sense of smell once it reaches the cortex via the olfactory bulbs. (Not visible on the superficial cortex) • Wernicke’s Area – Language comprehension. Located on the Left Temporal Lobe. - Wernicke’s Aphasia – Language comprehension is inhibited. Words and sentences are not clearly understood, and sentence formation may be inhibited or non-sensical.
  • 26. Primary Auditory Cortex Wernike’s Area Primary Olfactory Cortex (Deep) Conducted from Olfactory Bulb
  • 27. • Arcuate Fasciculus - A white matter tract that connects Broca’s Area and Wernicke’s Area through the Temporal, Parietal and Frontal Lobes. Allows for coordinated, comprehensible speech. Damage may result in: - Conduction Aphasia - Where auditory comprehension and speech articulation are preserved, but people find it difficult to repeat heard speech.
  • 28. Click the Region to see its Name
  • 29. Lobes and Structures of the Brain A. Central Sulcus B. Frontal Lobe C. Sylvian/Lateral Fissure A. (groove) D. Temporal Lobe G. B. F. E. Transverse Fissure F. Occipital Lobe G. Parietal Lobe C. (groove) D. E. (groove)
  • 30. A. Primary Motor Cortex/ Precentral Gyrus B. Broca’s Area C. Orbitofrontal Cortex Cortical Regions D. Primary Olfactory Cortex (Deep) E. Primary Auditory Cortex A. F. Wernike’s Area J. I. G. Primary Visual Cortex B. H. Visual Association Area H. G. I. Primary Gustatory Cortex J. Somatosensory Association Cortex K. Primary Somatosensory Cortex/ Postcentral Gyrus K. C. D. E. F.
  • 31. CURIOUS CASE OF PHINEAS GAGE • Phineas Gage: Phineas Gage was a railroad worker in the 19th century living in Cavendish, Vermont. One of his jobs was to set off explosive charges in large rock in order to break them into smaller pieces. • On one of these instances, the detonation occurred prior to his expectations, resulting in a 42 inch long, 1.2 inch wide, metal rod to be blown right up through his skull and out the top. The rod entered his skull below his left cheek bone and exited after passing through the anterior frontal lobe of his brain.
  • 32. Remarkably, Gage never lost consciousness, or quickly regained it (there is still some debate), suffered little to no pain, and was awake and alert when he reached a doctor approximately 45 minutes later. He had a normal pulse and normal vision, and following a short period of rest, returned to work several days later. However, he was not unaffected by this accident.
  • 33.  Gage’s personality, reasoning, and capacity to understand and follow social norms had been diminished or destroyed.  He illustrated little to no interest in hobbies or other involvements that at one time he cared for greatly  .‘After the accident, Gage became a nasty, vulgar, irresponsible vagrant. His former employer, who regarded him as "the most efficient and capable foreman in their employ previous to his injury," refused to rehire him because he was so different.’
  • 34. FUNCTIONAL BRAIN SYSTEMS • The relations between the organizational principles and the structural components of the human brain are illustrated in three functional systems: the thalamocortical, basal ganglia, and limbic systems
  • 35. Thalamocortical Systems • Thalamus: Group of nuclei located medial to the basal ganglia • serves as the major synaptic relay station for the information reaching the cerebral cortex • the thalamic nuclei can be divided into six groups: anterior, medial, lateral, reticular, intralaminar, and midline nuclei
  • 36. BASAL GANGLIA • Collection of nuclei that have been grouped together on the basis of their interconnections • play an important role in regulating movement and in certain disorders of movement eg chorea ,dyskinesia, athetosis, tremors • include the caudate nucleus, the putamen, the globus pallidus (referred to as the paleostriatum or pallidum), the subthalamic nucleus, and the substantia nigra
  • 37. • striatum  caudate nucleus + the putamen together; • corpus striatum  caudate nucleus + putamen + globus pallidus; • lentiform nucleus  putamen + globus pallidus
  • 38. FUNCTIONAL CIRCUITS OF BASAL GANGLIA • INPUTS: • The striatum is the major recipient of the inputs to the basal ganglia. Three major afferent systems are known to terminate in the striatum: the corticostriatal, nigrostriatal, and thalamostriatal afferents. • Disruption of the input pathways of the basal ganglia has been associated with some movement disorders, such as Parkinson's disease
  • 41. • The intrinsic circuitry of the basal ganglia is disrupted by a severe loss of neurons in the striatum in Huntington's disease. This autosomal-dominant disorder is characterized by progressive chorea and dementia
  • 42. • Outputs • globus palllidus provides a projection to the ventral lateral and ventral anterior nuclei of the thalamus and to the intralaminar thalamic nuclei, particularly the central median nucleus • The pars reticulata of the substantia nigra also provides a projection to the ventral anterior and ventral lateral thalamic nuclei. • the basal ganglia are able to indirectly influence the output of the primary motor cortex through thalamic nuclei.
  • 43. OUTPUTS
  • 44. • Functions of basal ganglia: • important in the control of movement • recent studies of the connections of the basal ganglia in nonhuman primates also support a role for these structures in cognitive functions.
  • 45. APPLIED ANATOMY BASAL GAGLIA • MOVEMENT DISORDER 1- athetosis: lesion of globus pallidus 2- hemiballismus: lesion of subthalamic nuclei 3- chorea: multiple small lesion in putamen 4- parkinsonism disease: destruction of substantia nigra 5- hutingtons disease: loss of cell bodies of GABA secreting neurons in caudate nucleus and putamen
  • 46. • NEUROPSYCHIATRIC DISORDER • Impairment in cognition • Depression • Personality changes • Poor judgment • Impaired concentration • Social withdrawl • Agitation
  • 47. LIMBIC SYSTEM • the cingulate and parahippocampal gyri (limbic cortex), • the hippocampal formation,(dentate gyrus, the hippocampus, and the subicular complex) • the amygdala, • the septal area, the hypothalamus, and • related thalamic and cortical areas.
  • 48. FUNCTIONS OF LIMBIC SYSTEM • Integration of olfactory, visceral, somatic impulses • Control of activities necessary survival of species • Emotional behaviour • Retention of recent memory
  • 49. • In 1937, James Papez postulated, primarily on the basis of anatomical data, that these cortical regions were linked to the hippocampus, mammillary body, and anterior thalamus in a circuit that mediated emotional behavior
  • 51. • However, over the last 40 years, it has become clear that some limbic structures (for example, the hippocampus) are also involved in other complex brain processes, such as memory • Other cognitive processes with the hypothalamus and its output pathways that control autonomic, somatic, and endocrine functions
  • 52. • LIMBIC CORTEX • composed of two general regions, the cingulate gyrus and the parahippocampal gyrus • ENTORHINAL CORTEX (Brodmann’s area no 28) • Receive projections from olfactory bulb
  • 53. • HIPPOCAMPAL FORMATION • Three distinct zones—the dentate gyrus, the hippocampus, and the subicular complex—constitute the hippocampal formation, which is located in the floor of the temporal horn of the lateral ventricle • These zones are composed of adjacent strips of cortical tissue • On the basis of differences in the cytoarchitecture and connectivity, the hippocampus can be divided into three distinct fields, which have been labeled CA3, CA2, and CA1.
  • 54. • The major input to the hippocampal formation arises from neurons in layers II and III of the entorhinal cortex
  • 55. hippocampal formation and the path of the fornix
  • 56. AMYGDALA • Almond shaped • Involved in Central regulation of ANS connection to hypothalamus • Controls survival fight-or-flight response of ANS • Emotional & visceral responses
  • 57. • AMYGDALA • Several group of nucleus • B/w inferior horn of lateral ventricle & lentiform nucleus • Two divisions :- -dorsomedial -ventrolateral – Basolateral - central
  • 58. • Functional Circuits of limbic system • The major structures of the limbic system are interconnected with each other and with other components of the nervous system • sensory information from the cingulate, the orbital and temporal cortices, and the amygdala is transmitted to the entorhinal cortex of the parahippocampal gyrus and then to the hippocampal formation.
  • 59. • After traversing the intrinsic circuitry of the hippocampal formation, information is projected through the fornix either to the anterior thalamus, which, in turn, projects to the limbic cortex, or to the septal area and the hypothalamus. • These latter two regions provide feedback to the hippocampal formation through the fornix. • In addition, the mammillary bodies of the hypothalamus project to the anterior thalamus. • Finally, the hypothalamus and the septal area project to the brainstem and the spinal cord
  • 60. Functional circuit b/w hippocampul formation, Thalamus,cerebral cortex and hypothalamus
  • 61. • Sensory information, primarily from the association regions of the prefrontal and temporal cortices, projects to the amygdala. • Output from the amygdala is conducted through two main pathways . • A dorsal route, the stria terminalis, project primarily to the septal area and the hypothalamus..
  • 62. • The second major output route, the ventral amygdalofugal pathway, terminate in the septal area, the hypothalamus, and the medial dorsal thalamic nucleus. • The medial dorsal nucleus, in turn, projects heavily to prefrontal and some temporal cortical regions
  • 63. Functional circuit b/w amygdala,hypothalamus Prefrontal and temporal ass. cortices
  • 64. • Both of these pathways reveal how the limbic system is able to integrate the highly processed sensory and cognitive information content of the cerebral cortical circuitry with the hypothalamic pathways that control autonomic and endocrine systems
  • 65. • the ventral amygdalofugal pathway also projects to the nucleus accumbens (ventral striatum), • the area where the head of the caudate nucleus fuses with the putamen. • This region sends efferents to the ventral palladium, an extension of the globus pallidus. • This area, in turn, projects to the medial dorsal thalamic nucleus.
  • 66. • The pathway indicates that the functions of the basal ganglia extend beyond the regulation of motor activities • and shows the necessity of considering the function or dysfunction of particular brain regions in the context of all aspects of their circuitry.
  • 67. Functional circuits b/w basal ganglia and limbic system
  • 68. APPLIED ANATOMY OF LIMBIC SYSSTEM Kluver Bucy syndrome • complete removal of both temporal lobes, amygdaloid body, hippocampal formation • Amygdaloid body lesion, Lesion of hippocampi • Docility(flexibility or tractability), lack of emotional responses, increased sexual activity (perverted), visual agnosia
  • 69. • Memory disorders • transient global amnesia • anterograde amnesia • Severe amnesia • Due to lesion of hippocampus and fornix
  • 70. • Alzheimer’s disease • Loss of cholinergic neurons of substantia innominata which project to hippocampus • Degenerative changes in entorhinal cortex, hippocampus, extensive neocortical atrophy • amnesia for recently occurred events as mechanism for retention of new memory not operating
  • 72. Schizophrenia • Lateral and third ventricular enlargement • Reduced volumes of cortical gray matter • Reduced symmetry in the temporal, frontal, and occipital lobes • Decrease in the size the amygdala, the hippocampus, and the parahippocampal gyrus. • Functionally abnormal hippocampus as indicated by disturbances in glutamate transmission.
  • 73. • Anatomical abnormalities in the prefrontal cortex • volume shrinkage or neuronal loss in thalamus
  • 74. Mood disorders • Most consistent abnormality  increased frequency of abnormal hyperintensities in subcortical regions (periventricular regions, the basal ganglia, and the thalamus) • reduced hippocampal or caudate nucleus volumes • increase in blood flow and neuronal activity in the thalamus and medial PFC. • decreased anterior brain metabolism, which is generally more pronounced on the left side
  • 75. • Global reduction of anterior cerebral metabolism, • Increased glucose metabolism has been observed in several limbic regions, • particularly with relatively severe recurrent depression and a family history of mood disorder
  • 76. ANXIETY DISORDERS • Increased activity in the septohippocampal pathway • Increased activity in the cingulate cortex in ocd. • increased blood flow & metabolism in frontal lobe • damage to rt medial prefrontal cortex cause HOARDING • compulsive hoarding or disposophobia is the excessive acquisition of possessions, even if the items are worthless, hazardous, or unsanitary.
  • 77. ADHD  General reduction of brain volume ,but proportionally great reduction of lt prefrontal cortex  Delayed development of frontal cortex, temporal lobe & fast maturity of motor cortex  this contributes slow behavioural control &advanced motor development leads to fidgetiness, that is characteristic of ADHD  pet shows low perfusion and metabolism of frontal area
  • 79. • Neuropsychological Assessment provides an objective evaluation of cognitive and structural functioning • Areas of neurological assessment: • Abstract reasoning/compensation(e.g. problem solving, executive functions) • Activities of daily living(eg toiletting, dressing,feeeding) • Attention • Emotional/psychological distress(depression, impulsivity)
  • 80. • Language skills • Motor • Orientation • Sensation/perception • Visuospatial
  • 81. Neuropsychological tests • Intelligence • Ammons Quick Test • National Adult Reading Test (NART) • Wechsler Adult Intelligence Scale (WAIS) • Wechsler Intelligence Scale for Children (WISC) • Wechsler Preschool and Primary Scale of Intelligence (WPPSI) • Wechsler Test of Adult Reading (WTAR)
  • 82. • Memory • California Verbal Learning Test • Doors and People • MCI Screen • Memory Assessment Scales (MAS) • Rey Auditory Verbal Learning Test • Test of Memory and Learning (TOMAL) • Wechsler Memory Scale (WMS) • Test of Memory Malingering (TOMM) •
  • 83. • Language • Boston Diagnostic Aphasia Examination • Boston Naming Test • Comprehensive Aphasia Test (CAT) • Lexical decision task • Multilingual Aphasia Examination
  • 84. • Executive function • Continuous Performance Task (CPT) • Delis-Kaplan Executive Function System (D-KEFS) • Hayling and Brixton tests • Paced Auditory Serial Addition Test (PASAT) • Pediatric Attention Disorders Diagnostic Screener • • • • • (PADDS) Test of Variables of Attention (T.O.V.A.) Tower of London Test Trail-Making Test (TMT) or Trails A & B Wisconsin Card Sorting Test (WCST) Test of Everyday Attention (TEA)
  • 85. • Visuospatial • Clock Test • Hooper Visual Organisation Task (VOT) • Rey-Osterrieth Complex Figure
  • 86. Batteries assessing multiple neuropsychological functions • There are some test batteries which combine a range of tests to provide an overview of cognitive skills. • These are usually good early tests to rule out problems in certain functions and provide an indication of functions which may need to be tested more specifically.
  • 87. Goals of Neuropsychological Assessment • Diagnose the presence of cortical damage and localize it if possible • Facilitate patient care • Identify mild disturbances • Identify unusual brain organization • Identify the cause of disorders • Rehabilitation • Help the patient and their family understand the disorder
  • 88. PRIMITIVE REFLEXES • These are newborn reflexes disappear or inhibited by Frontal lobe during normal development,which are not being suppressed in frontal lobe injury causes frontal release signs.  WALKING/STEPPING REFLEX  ROOTING REFLEX  SUCKING REFLEX  TONIC NECK REFLEX  PALMAR GRASP REFLEX  PLANTAR REFLEX  GALANT REFLEX  SWIMMING REFLEX  BABKIN REFLEX
  • 90. How Radiology Can Aid Psychiatry • Structural brain changes can be seen on CT • MRI studies in patients can confirm significant differences in brain volume and structure • Functional chemical changes can be seen on PET, SPECT and fMRI • altered blood flow and metabolism • PET and SPECT studies have demonstrated treatment receptor occupancy and treatment progression • Radiological studies of psychiatric populations add to available knowledge on the biological aspects of psychiatry.
  • 91. Neuroimaging and Mental Illness Structural – Computerized Tomography (CT) – Magnetic Resonance Imaging (MRI) Functional – Positron Emission Tomography (PET) – Single Photon Emission CT (SPECT) – functional MRI (fMRI) – MR spectroscopy – EEG & Event-Related Potentials (ERP) – Magnetoencephalography (MEG) – near infrared spectroscopy (NIRS)
  • 92. Neuroimaging and Mental Illness Structural – Computerized Tomography (CT) – Magnetic Resonance Imaging (MRI) Functional – Positron Emission Tomography (PET) – Single Photon Emission CT (SPECT) – functional MRI (fMRI) – MR spectroscopy – EEG & Event-Related Potentials (ERP) – Magnetoencephalography (MEG) – near infrared spectroscopy (NIRS)
  • 93. Functional MRI (fMRI) • Observation of active brain areas at a given time • Blood-oxygen-level dependent or BOLD fMRI • Increased blood flow releases oxygen to active neurons at a greater rate than to inactive neurons • Increased blood flow to active areas creates the magnetic signal variation that can be detected by an MRI • Comparisons can be made of brain activity • during rest • scripted thoughts • patterned actions • controlled experiences
  • 94. Advantages of fMRI Noninvasively record brain signals without risks of radiation It can record on a spatial resolution in the region of 3-6 millimeters. Disadvantages of fMRI BOLD signal is an indirect measure of neural activity It is susceptible to influence by non-neural changes in the body BOLD signals are most strongly associated with the input to a given area rather than with the output. The temporal response of the blood supply is poor relative to the electrical signals that define neuronal communication.
  • 95. Healthy Controls fMRI Depression group
  • 96. Healthy Controls fMRI Schizophrenia group
  • 97. Psychotherapy vs Drug Treatment In Depression Interpersonal psychotherapy fMRI Venlafaxine Copyright restrictions may apply.
  • 98. Positron Emission Tomography • A PET scan is a radionuclide scan that produces a 3-D image or map of functional processes such as blood flow, oxygen use and blood sugar (glucose) metabolism. • Glucose is often combined with a radioactive substance (radiotracer) fluorodeoxyglucose (FDG), that's injected into the patient • PET tracer emits positrons which annihilate with electrons up to a few millimeters away, causing two gamma photons to be emitted in opposite directions. A PET scanner detects these emissions as "coincident" in time • Different tissues in your body take up different radionuclides at different rates. • The number of positrons emitted by an organ or area of tissue indicates the amount of radioactive substance • Intense color = high uptake = hot spots • Less intense color = low uptake of radioactive substance = cold spots.
  • 99. PET Radiotracers • Dopamine • Benzodiazepine • Serotonin • Histamine • Muscarinic cholinergic • Amyloid • Protein kinase C • Monoamine oxidase
  • 100. PET scan Increased loss of gray matter in adolescence between the ages of 12-16 compared to healthy adolescence. Red—Gray Matter Gain Blue—Gray Matter Loss
  • 101. PET scan of Schizophrenics participating in the Wisconsin card sorting task
  • 102. PET Scan Obsessive Compulsive Disorder
  • 103. Not Depressed Depressed
  • 104. PET scans of a 45 year old woman with recurrent depression pre and post treatment.
  • 105. PET Scan ADHD vs. Normal ADHD Normal White, Red, Orange = higher glucose metabolism Blue, Green, Purple = lower glucose metabolism
  • 106. Single photon emission computed tomography (SPECT) • SPECT is very similar to PET • Uses a radioactive tracer material and detects gamma rays. • In contrast with PET, the tracer used emits gamma radiation that is measured directly. • SPECT have lower resolution than a PET scan. • SPECT scans are significantly less expensive.
  • 107. SPECT Images Not Depressed Depressed
  • 108. REFERENCES • Kaplan and sadock’s ;Comprehensive Textbook of Psychiatry • Functional neuro-anatomy by stuart butler • Gray’s anatomy ,39th Edition • Stahl’s Psychopharmacology • Mayo’s foundation for medical education and research
  • 109. Thank you