Cerebral cortex

Amr Hassan, M.D.
Associate professor of Neurology - Cairo
University
CEREBRAL CORTEX

CENTRAL NERVOUS SYSTEM
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INTRACRANIAL PART
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A. CEREBRUM
B. BRAIN STEM
C. CEREBELLUM

V. D.
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 Left/Right halves communicate
via Corpus Callosum
 Left brain controls right body
Left Brain: spoken/written
language, number &
scientific skills,
reasoning (the scientist)
Right Brain: music/art awareness,
3D forms, insight, imagination
( the artist)
Cerebrum

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The cerebrum is divided by a
longitudinal fissure into
2 hemispheres each containing 4
discrete lobes.
Frontal,
Temporal,
Parietal
Occipital
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Cerebrum

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At the base of each cerebral hemisphere:There
are several groups of nuclei situated at various
levels within the white matter; they formThe
basal ganglia.
 Deinchephalon
 Thalamus
 Hypothalamus.

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Frontal lobe
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 The primary motor cortex.
 Premotor area (area 6).
 Area of voluntary conjugate eye movement( area 8).
 Broca's area

Frontal lobe
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 Exner’s area.
 Prefrontal area.
 Paracentral lobule.

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The cerebral cortex
Primary motor area (4),Premotor area (6))
Prefrontal area ( area 9,10,11)
Primary sensory cortex ( areas
1,2,3)
21 22
37
Visual
sensory area
Auditory associative area
( area 21,22)
Auditory
sensory
area
( area
41,42)
Angular gyrus
Secondary sensory cortex
( areas 5,7,40)
5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

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A. Frontal lobe
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Motor area (area 4):
Site: Floor of central sulcus & posterior part of precentral gyrus.
Function: Initiation of voluntary motor activity of the opposite 1/2 of the body
through the pyramidal (Δ) tract. In this area the body is represented upside
down (see fig.2), complex movements involving speech, face & hands are widely
represented in the lower part of this area.
Lesion:
 Irritative: Contralateral motor Jacksonian fits: there are convulsions ,
involving the muscles of one side of the body; the fit has a focal onset either in the
thumb, angle of the mouth or big toe (depending on whether the irritative lesion
starts in the lower or upper part of the motor area); the fit spreads in a march
course e.g. thumb → arm → shoulder → trunk→ L.L.
 Destructive: Contralateral paralysis usually affecting one limb (monoplegia).

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A. Frontal lobe
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Premotor area (area 6):
 Site:Anterior part of the precentral gyrus.
 Function: Partly supplies Δ tract & gives extra A fibres.This area
inhibits the muscle tone & the deep reflexes on the opposite side of
the body.
 Lesion: Contralateral hypertonia & exaggerated deep reflexes.

A. Frontal lobe
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Area of voluntary conjugate eve movements (area 8):
 Site: Posterior part of middle frontal gyrus.
 Function:Voluntary conjugate eye movement to the opposite
side e.g. while reading the action of passing from the end of one
line to the beginning of the next line; this movement is usually
rapid & is termed "saccadic."
 Lesion:
Irritative: attacks of conjugate eye deviation to the opposite side
of the lesion.
Destructive: paralysis of conjugate eye movement to the
opposite side of the lesion.

A. Frontal lobe
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Broca's area (area 44):
 Site: Posterior part of inferior frontal gyrus of dominant hemisphere.
 Function: Motor centre for speech.
 Lesion: Motor (expressive) aphasia; the patient cannot express ideas in
spoken words.
Exner's area (area 45):
 Site:Adjacent to area 44 in the dominant hemisphere.
 Function: Center for writing.
 lesion : Agraphia ; the patient cannot express ideas in written words.

A. Frontal lobe
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Pre-frontal area (areas 9, 10 and 11):
Site:Anterior part of frontal lobe & its adjacent inferior surface.
Function:
 Higher centre for mentality, personality & behaviour.
 Inhibition of primitive reflexes which are present in the newborn, e.g. grasp, grope
reflexes.
Lesion:
 Mentality, personality & behavioural changes: lack of attention &
judgement, disinterest in people & surroundings, lack of personal hygiene,
ending in dementia.
 Reappearance of primitive reflexes.

A. Frontal lobe
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Paracentral lobule:
 Site: Medial surface of the superior frontal gyrus, adjacent to the foot & leg area.
 Function: Cortical inhibition (control) of bladder & bowel voiding.
 Lesion: Incontinence of urine & faeces.

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The cerebral cortex
1,2,3)
21 22
37
Visual
sensory area
( area 21,22)
Auditory
sensory
area
( area
41,42)
Angular gyrus
( areas 5,7,40)
5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

B. Parietal lobe
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1) Cortical sensory area (areas 1, 2, 3):
Site: Post-central gyrus.
Function: Perception of cortical sensations from the opposite ½ of the
body; like in the motor area, the body is represented upside down
(see fig.2)
Lesion:
 Irritative: contralateral sensory Jacksonian fits in the form of
numbness or tingling with focal onset & a march course; it may be
followed by a motor fit if the irritation extends to the adjacent motor
area.
 Destructive: contralateral cortical sensory loss.

B. Parietal lobe
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2) Secondary sensory, or sensory association areas (areas 5,7,
40):
 Site: Behind the post-central gyrus.
 Function: Capable of more detailed discrimination and analysis than is
the primary sensory area.They might, for example, be involved in
sensing how hot or cold something is rather than simply identifying it
as hot or cold. Information is first processed in the primary sensory
area and is then sent to the secondary sensory areas.

B. Parietal lobe
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3) Angular gyrus (area 39):
 Site: In the postero-inferior part of the parietal lobe.
 Function: In the dominant hemisphere, it is concerned
with reading & recognition of visual symbols.
 Lesion: Alexia; the patient who could read before the
lesion, becomes unable to do so.

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The cerebral cortex
1,2,3)
21 22
37
Visual
sensory area
( area 21,22)
Auditory
sensory
area
( area
41,42)
Angular gyrus
( areas 5,7,40)
5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

C. Temporal lobe
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1) Auditorv sensory area (area 41. 42):
 Site: Superior temporal gyrus.
 Function:Auditory sensory area.
 Lesion:
 Irritative: auditory hallucinations.
 Destructive: slight hearing impairment, never
deafness as hearing is bilaterally represented.

C. Temporal lobe
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2) Auditory associative area ( area 21,22)
(wernicke’s area):
 Site:Adjacent to areas 41 & 42.
 Function: Recognition & recall of sounds.
 Lesion: Auditory agnosia: the patient hears but
does not understand (recognize) what he hears

C. Temporal lobe
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3) Supramarainal gyrus (area 37):
 Site:The posterior-inferior part of the temporal lobe.
 Function: In the dominant hemisphere it is concerned
with storage & recall of ideas of speech & ideas of
complex voluntary motor activity.
 Lesion:
Jargon's aphasia (word salad).
Apraxia: inability to perform complex voluntary motor
activity in absence of paralysis, incoordination or
sensory loss.

C. Temporal lobe
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4)The limbic system :
 Site: Uncus & hippocampus in the medial & inferior
suifaces of the temporal lobe.
 Function: Concerned with smell (uncus), mood &
memory.
 Lesion:
Uncinate fits with olfactory hallucinations, usually
unpleasant. .
 Temporal lobe epilepsy.
Anterograde amnesia (loss of memory for recent
events).

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The cerebral cortex
1,2,3)
21 22
37
Visual
sensory area
( area 21,22)
Auditory
sensory
area
( area
41,42)
Angular gyrus
( areas 5,7,40)
5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

D. Occipital lobe
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1)Visual sensory area (area 17): For the reception of visual images
2)Visual associative area (area 18,19):
 Site:Anterior to area 17.
 Function:
 Centre for reflex conjugate eye movement to the opposite side e.g.
While reading, following the words of a line, one after the
other; this movement is usually slow & is termed "pursuit''.
 Recognition & recall of images.
 Lesion:
 Irritative: Unformed visual hallucinations e.g. sparks, lines, flashes that
occur in occipital lobe epilepsy.
 Destructive:
 Homonymous hemianopia with or without macular sparing.
 Visual agnosia: the patient sees (e.g. a familiar face) but does not recognize what he sees.

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The cerebral cortex
1,2,3)
21 22
37
Visual
sensory area
( area 21,22)
Auditory
sensory
area
( area
41,42)
Angular gyrus
( areas 5,7,40)
5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

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2.BRAIN STEM

II. Brain Stem
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It is formed of:
 Midbrain
 Pons
 Medulla.
 It is connected to the cerebral hemispheres by 2 cerebral
peduncles and to the cerebellum, on each side, by the
superior, middle & inferior cerebellar peduncles.
 It contains groups of nerve cells (gray matter) intermingled
with several ascending and descending fibres (white matter).

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Spinal cord
•The spinal cord is an extension of the brain that runs through a long, hollow
canal in the column of vertebrae called the spinal canal & ends at the lower
border of the 1st lumbar vertebra (see fig.4,5).
•The meninges, cerebrospinal fluid, fat, and a network of veins
and arteries surround, nourish, and protect the spinal cord.
•It is formed of gray matter (cells) surrounded by white matter.
•In a transverse section the gray matter resembles the letter H (2 anterior & 2
posterior horns).
•The spinal cord is consisted of 31 segments (8 cervical segments, 12 dorsal
segments , 5 lumbar segments , 5 sacral segments).
•Thirty-one pairs of nerve roots emerge from the spinal cord through spaces in
each vertebra.
•The lowermost 3 segments of the spinal cord (S3, 4, 5) are known
anatomically as the conus medullaris while the above 4 segments (L4, 5, S1, 2)
are known anatomically as the epiconus.

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Cerebral cortex

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