Higher cortex function

1. HIGHER CORTEX FUNCTIONS,HIGHER CORTEX FUNCTIONS,
DEFEAT OF SEPARATED BRAINDEFEAT OF SEPARATED BRAIN
LOBES.LOBES.

2. Higher cortex functions are inherentHigher cortex functions are inherent
only to the cortex of large brain ofonly to the cortex of large brain of
manman..
They areThey are speech, praxis, gnosisspeech, praxis, gnosis
and etcand etc
These are located in a leftThese are located in a left
hemisphere (at peoplehemisphere (at people
with leading right arm)with leading right arm)

3. SpeechSpeech
 There areThere are expressiveexpressive andand impressiveimpressive
parts ofparts of speech.speech.
 By anBy an expressiveexpressive speech we expressspeech we express
opinions,opinions, impressiveimpressive – understand– understand
heard. In babies theheard. In babies the impressiveimpressive
speech develops fspeech develops firstlyirstly..
 Speech disordersSpeech disorders –– aphasia, dysartriaaphasia, dysartria
or anartria, mutism, undevelopmentor anartria, mutism, undevelopment
ofof speech - alalia.speech - alalia.

4. AphasiaAphasia
 Aphasia is a partial or complete loss ofAphasia is a partial or complete loss of
the ability to express or understandthe ability to express or understand
spoken or writtenspoken or written speechspeech because ofbecause of
damage thedamage the speechspeech areas of the brain.areas of the brain.
 The loss of motor or sensory function ofThe loss of motor or sensory function of
speech is namedspeech is named aphasiaaphasia (from greec.(from greec.
phases—speechphases—speech).).
Due to the classificationDue to the classification there arethere are
 motormotor
 sensorysensory
 amnesicamnesic
 total aphasiatotal aphasia

5. Motor aphasia -Motor aphasia - Broca's aphasiaBroca's aphasia
 The center of expressive (motor) speechThe center of expressive (motor) speech (the part(the part
of motion analyzer, related to the area forof motion analyzer, related to the area for
motions of tongue, lips, laryngesmotions of tongue, lips, larynges is located in theis located in the
back region of lower frontal gyrusback region of lower frontal gyrus (the Broka(the Broka
center) incenter) in a left hemisphere (at people witha left hemisphere (at people with
dominant right arm).dominant right arm).
 People suffering from damage of this area mayPeople suffering from damage of this area may
have a condition calledhave a condition called Broca's aphasiaBroca's aphasia
(sometimes known as(sometimes known as expressive aphasiaexpressive aphasia,, motormotor
aphasiaaphasia), which makes them unable to create), which makes them unable to create
grammatically-complex sentences: their speech isgrammatically-complex sentences: their speech is
often described asoften described as telegraphictelegraphic and very oftenand very often
there is missing of storages in speech.there is missing of storages in speech.
 Very often there isVery often there is speech embolusspeech embolus – repeating– repeating
the same syllable.the same syllable.

6. Broca's area is named after the 19thBroca's area is named after the 19th
century physiciancentury physician Paul BrocaPaul Broca

7. Motor aphasiaMotor aphasia A patientA patient can notcan not make articulation motions onmake articulation motions on
the taskthe task,, can notcan not reproduce motion exploringreproduce motion exploring. It. It
results in replacement of one articulations byresults in replacement of one articulations by
other, to replacement of sounds (in place of “k”other, to replacement of sounds (in place of “k”
-“h” or “t” is pronounced, in place of “l”—“n”). It-“h” or “t” is pronounced, in place of “l”—“n”). It
results in distortion of semantic value of words.results in distortion of semantic value of words.
Speech as difficult functional systemSpeech as difficult functional system
disintegratesdisintegrates..
 For example, in the following passage, a Broca'sFor example, in the following passage, a Broca's
aphasic patient is trying to explain how he cameaphasic patient is trying to explain how he came
to the hospital for dental surgery.to the hospital for dental surgery.
 "Yes... ah... Monday... er... Dad and Peter H... (his"Yes... ah... Monday... er... Dad and Peter H... (his
own name), and Dad.... er... hospital... and ah...own name), and Dad.... er... hospital... and ah...
Wednesday... Wednesday, nine o'clock... and oh...Wednesday... Wednesday, nine o'clock... and oh...
Thursday... ten o'clock, ah doctors... two... an'Thursday... ten o'clock, ah doctors... two... an'
doctors... and er... teeth... yah."doctors... and er... teeth... yah."

8. Sensory aphasia -Sensory aphasia - Wernicke's aphasiaWernicke's aphasia
 The specialized region of analysis andThe specialized region of analysis and
synthesis of signals (that is impressivesynthesis of signals (that is impressive
speech) is concentrated near the auditoryspeech) is concentrated near the auditory
analyzer, in the back department ofanalyzer, in the back department of
overhead temporal gyrusoverhead temporal gyrus ((the Vernikethe Vernike
centercenter).).
 In case of damage of this center a patientIn case of damage of this center a patient
loses ability to know sounds andloses ability to know sounds and
understand words as other people, soon asunderstand words as other people, soon as
himself. The motor function of speech ishimself. The motor function of speech is
saved, however, patient’s speech is notsaved, however, patient’s speech is not
understanding.understanding.
 The contact with such sick in heavy case isThe contact with such sick in heavy case is
extraordinarily difficult.extraordinarily difficult.

9. Amnesic aphasiaAmnesic aphasia
 The Amnesic aphasiaThe Amnesic aphasia arises up at thearises up at the
defeat ofdefeat of temporal-parietal-occipitaltemporal-parietal-occipital
regionregion and is characterized by forgettingand is characterized by forgetting
of nouns and difficulties in the use ofof nouns and difficulties in the use of
difficult logic-grammatical structures.difficult logic-grammatical structures.
 PatientsPatients can freely socializecan freely socialize with people,with people,
theirtheir speech is clear, though poor byspeech is clear, though poor by
nounsnouns. Hiding the bug, patients replace. Hiding the bug, patients replace
the names of objects by their description:the names of objects by their description:
a pen – *it is to write*, a glass – *it is toa pen – *it is to write*, a glass – *it is to
drink*. It is usually enough is to promptdrink*. It is usually enough is to prompt
the first syllable of the word, forgotten bythe first syllable of the word, forgotten by
the patients, that it correctly made off it.the patients, that it correctly made off it.

10.  AlexiaAlexia (inability to read) arises up at(inability to read) arises up at
processes in an angular gyrusprocesses in an angular gyrus
(temporal lobe)(temporal lobe)
 AgraphiaAgraphia (inability to write) arises(inability to write) arises
up at the defeat of back region ofup at the defeat of back region of
middle frontal gyrus.middle frontal gyrus.
 AcalculiaAcalculia (violation of account)(violation of account)
comes at the defeat of temporal-comes at the defeat of temporal-
parietal-occipital regionparietal-occipital region

11. AlexiaAlexia
AgraphiaAgraphia AcalculiaAcalculia

12. Other types of speech disordersOther types of speech disorders
 It should be remembered that disorders ofIt should be remembered that disorders of
speech can appear at other defeats of thespeech can appear at other defeats of the
nervous system.nervous system.
 At paresis or paralysis of muscles ofAt paresis or paralysis of muscles of
articulation (tongue), speech becomesarticulation (tongue), speech becomes
illegible, indistinctillegible, indistinct (disartria)(disartria)..
 In heavy case the speech becomesIn heavy case the speech becomes
impossibleimpossible (anartria)(anartria)..
 At parkinsonismAt parkinsonism speech suffers also, it isspeech suffers also, it is
done poor expressed,done poor expressed, monotonousmonotonous. The. The
diseases ofdiseases of cerebellumcerebellum, attended with, attended with
ataxia, are characterized by theataxia, are characterized by the scannedscanned
speechspeech. Speech at people. Speech at people losing earlosing ear inin
babyhood isbabyhood is surdomutismsurdomutism..
 MutismMutism, i.e. inability to speak, can be at, i.e. inability to speak, can be at
hysteriahysteria..

13. Praxis is skills, acquired during thePraxis is skills, acquired during the
lifelife
 ApraxiaApraxia isis named to carry outnamed to carry out
different practical domestic anddifferent practical domestic and
professional motive skills, producedprofessional motive skills, produced
in the process of life, that appear inin the process of life, that appear in
spite of absence of paralysesspite of absence of paralyses,,
complete safety of muscles force,complete safety of muscles force,
deep sense and mechanisms ofdeep sense and mechanisms of
coordination.coordination.
 Next typesNext types of apraxia areof apraxia are
distinguished.distinguished.

14. Efferent (kinetic), or dynamic, apraxiaEfferent (kinetic), or dynamic, apraxia
 arises up at the damage ofarises up at the damage of motor areas ofmotor areas of
cortexcortex. It is characterized by violation of. It is characterized by violation of
сосоmplex motions, skills.mplex motions, skills.
 Disintegration of necessary set ofDisintegration of necessary set of
motions arises up, a patient can notmotions arises up, a patient can not
fasten the button, to inflame a match, tofasten the button, to inflame a match, to
pour water in glass or patient tries to dopour water in glass or patient tries to do
it by a healthy hand.it by a healthy hand.
 This form of apraxia arises up moreThis form of apraxia arises up more
frequent at the defeat of left hemispherefrequent at the defeat of left hemisphere

15. Structural apraxiaStructural apraxia
 arising up at the defeat ofarising up at the defeat of supramarginalsupramarginal
gyrusgyrus, is characterized by violation of, is characterized by violation of
those motions, which require safety ofthose motions, which require safety of
spatial orientation.spatial orientation.
 Patients become confused in the directionPatients become confused in the direction
of motion (go to the left, if it is needed toof motion (go to the left, if it is needed to
the right), can not correctly get dressed,the right), can not correctly get dressed,
mixing up a right and left sleeve, right andmixing up a right and left sleeve, right and
left boot, can not make a figure from itsleft boot, can not make a figure from its
elements, become confused in the decisionelements, become confused in the decision
of position of part of body.of position of part of body.
 For example, we ask to do a square fromFor example, we ask to do a square from
matches…matches…

17. Ideatoric apraxiaIdeatoric apraxia
 arising up at the defeat ofarising up at the defeat of angularangular
gyrusgyrus, is characterized by violation, is characterized by violation
of idea of motions, that is correctof idea of motions, that is correct
plan of complex motion.plan of complex motion.
 For example, we ask to smokeFor example, we ask to smoke
sigarette…sigarette…

18. Gnosis -Gnosis - the ability tothe ability to recognizerecognize objectsobjects
byby theirtheir sensory perceptionsensory perception
....
 Violation of recognition ofViolation of recognition of
irritants, signals acting from anirritants, signals acting from an
external environment is namedexternal environment is named
agnosiaagnosia..
 There are next kindsThere are next kinds..

19. Agnosia of superficial and deepAgnosia of superficial and deep
sensationsensation
 is observed at the defeat ofis observed at the defeat of
departments, that are located neardepartments, that are located near
post-central gyrus.post-central gyrus.
 The difficult types of sensitivenessThe difficult types of sensitiveness
are thus violated — sense ofare thus violated — sense of
localization, discriminations, two-localization, discriminations, two-
and three-spatial senses.and three-spatial senses.
 AstereognosiaAstereognosia – it’s impossible to– it’s impossible to
determine objects by touch.determine objects by touch.

20. Violation of chart of bodyViolation of chart of body
 At the defeat of the right hemisphere of parietalAt the defeat of the right hemisphere of parietal
lobe.lobe. There areThere are --
 AnosognosiaAnosognosia — no awareness of paralysis of— no awareness of paralysis of
extremities. The paralysis is not noticed. Theextremities. The paralysis is not noticed. The
patients assure that can move, to move by thepatients assure that can move, to move by the
paralyzed extremities, but don’t “want” to do itparalyzed extremities, but don’t “want” to do it
only.only.
 AutotopagnosiaAutotopagnosia — no recognition of parts of own— no recognition of parts of own
body. Such patients can not find the certain partbody. Such patients can not find the certain part
of body or show other parts of body.of body or show other parts of body.
 PsevdopolymeliaPsevdopolymelia — the feeling of false— the feeling of false
extremities. More frequent the patients feel theextremities. More frequent the patients feel the
third hand.third hand.
 It should be noted that all these originalIt should be noted that all these original
symptoms quite often arise up at patients with asymptoms quite often arise up at patients with a
more or less safe psyche, at presence of correctmore or less safe psyche, at presence of correct
orientation in time, environment.orientation in time, environment.

21. Auditory agnosiaAuditory agnosia
 *Heartfelt deafness**Heartfelt deafness* arises up at thearises up at the
defeat ofdefeat of temporal lobetemporal lobe..
 It consists in the loss of ability toIt consists in the loss of ability to
know objects on soundsknow objects on sounds
characteristic for them (clock — oncharacteristic for them (clock — on
ticking, machine — on the hum ofticking, machine — on the hum of
motor.motor.

22. The damage of internal surfaceThe damage of internal surface
of temporal gyres causesof temporal gyres causes
olfactory and taste agnosiaolfactory and taste agnosia..

23. Visual agnosiaVisual agnosia
 *Heartfelt blindness**Heartfelt blindness* can arise up atcan arise up at
the defeat ofthe defeat of outward surface ofoutward surface of
occipital gyresoccipital gyres..
 PatientsPatients throw away the opportunitythrow away the opportunity
to know and understand visibleto know and understand visible, that, that
brings them over to completebrings them over to complete
disorientation.disorientation.

24. Symptoms of defeatSymptoms of defeat
of separate cortex lobesof separate cortex lobes

26. Agraphia
Broca’s aphasia
central
paralyses
on the opposite
half of body
Center of turning of head and eyes to the opposite side
Extrapyramidal
disorders
Frontal ataxia
Motor apraxia
Grabbing reflex
Frontal psyche

27. Frontal lobe.Frontal lobe.
 Defeat of precentral gyrus -Defeat of precentral gyrus - there arethere are
central paralyses on the opposite part ofcentral paralyses on the opposite part of
body, which carry a monoplegic character,body, which carry a monoplegic character,
spreading on a hand or leg depending onspreading on a hand or leg depending on
the place of defeat of precentral gyrus.the place of defeat of precentral gyrus.
 Defeat of back departments of medianDefeat of back departments of median
frontal gyrus -frontal gyrus - there is the turn of headthere is the turn of head
and eyes toward a nidus.and eyes toward a nidus.
 Frontal ataxiaFrontal ataxia which shows up, mainly, bywhich shows up, mainly, by
disorders of walking and placed. A patientdisorders of walking and placed. A patient
cann’t stay in vertical position and fallcann’t stay in vertical position and fall
(astasia) and can not walk (abasia).(astasia) and can not walk (abasia).
 Agraphia, Broca’s aphasia, motor apraxiaAgraphia, Broca’s aphasia, motor apraxia..
 Grabbing reflex, frontal psycheGrabbing reflex, frontal psyche,,
untidiness, no ended motion.untidiness, no ended motion.

28. Frontal lobe.Frontal lobe.
 Extrapyramidal disordersExtrapyramidal disorders
If the defeat is located on the basalIf the defeat is located on the basal
surface of frontal lobe –surface of frontal lobe –
 AnosmiaAnosmia (homolateral loss s(homolateral loss smellmell).).
 AmavrosAmavros (homolateral blindness).(homolateral blindness).
 Foster-Cennedy’ symptom (inFoster-Cennedy’ symptom (in
tumor)– homolateral atrophy of thetumor)– homolateral atrophy of the
visual nerve disk and heterolateralvisual nerve disk and heterolateral
stagnation of this.stagnation of this.
If there is the defeat ofIf there is the defeat of
corticobulbar tracts in two sidescorticobulbar tracts in two sides
 Suprabulbar syndromeSuprabulbar syndrome

29. Anosmia
Amavros
n. opticus

30. Bulbar and Suprabulbar syndromsBulbar and Suprabulbar syndroms
1. Bulbar syndrom occurs in the defeat of nuclears1. Bulbar syndrom occurs in the defeat of nuclears
of IX, X, XII cranial nerves.of IX, X, XII cranial nerves.
2. Suprabulbar syndrome occurs in the defeat of2. Suprabulbar syndrome occurs in the defeat of
corticobulbar tracts in two sides.corticobulbar tracts in two sides.
Similar symptomsSimilar symptoms
 DysartriaDysartria
 DysphagiaDysphagia
 DysphoniaDysphonia
DistinctionsDistinctions
 1. – there are loss of pharyngeal (or gag) and1. – there are loss of pharyngeal (or gag) and
uvular (or palatal) reflexesuvular (or palatal) reflexes
-- atrophy and fibrillations of tongueatrophy and fibrillations of tongue

2. -2. - there are saving of reflexes, no atrophythere are saving of reflexes, no atrophy
- positive symptoms of oral automatism,- positive symptoms of oral automatism,
violent weeping, laughterviolent weeping, laughter

31. Parietal lobeParietal lobe
 Defeat of postcentral gyrusDefeat of postcentral gyrus - t- the loss ofhe loss of
all types of sensation on the oppositeall types of sensation on the opposite
part of body. In connection with a strictpart of body. In connection with a strict
somatotopic representative office in thesomatotopic representative office in the
cortex of postcentral gyrus a sensationcortex of postcentral gyrus a sensation
is violated in the proper parts of body.is violated in the proper parts of body.
 Agnosia of superficial and deepAgnosia of superficial and deep
sensation+asteregnosis.sensation+asteregnosis.
 Violation of chart (scheme) of bodyViolation of chart (scheme) of body
(defeat is in the right hemisphere)(defeat is in the right hemisphere)

32. Anesthesia on the opposite part of body
Agnosia
of superficial
and deep
sensation+
asteregnosis
Violation of chart of body (in right hemisphere)
Alexia
Acalculia
Apraxia

33. Temporal gyrusTemporal gyrus
The defeat of outward surface of temporalThe defeat of outward surface of temporal
lobelobe..
 Auditory agnosiaAuditory agnosia
 Feeling of falling, instability, attacks ofFeeling of falling, instability, attacks of
dizzinessdizziness
 Wernicke's aphasiaWernicke's aphasia
The defeat of medial surface of temporalThe defeat of medial surface of temporal
gyrusgyrus..
 Taste, smell agnosiaTaste, smell agnosia
The defeat of white matter.The defeat of white matter.
 Homonym quadrant hemianopsiaHomonym quadrant hemianopsia
(overhead – if the defeat is in low part,(overhead – if the defeat is in low part,
lower – if the defeat is in above part oflower – if the defeat is in above part of
Graciole bunch)Graciole bunch)

34. Auditory agnosia
Wernicke'sWernicke's
aphasiaaphasia
Feeling of falling,
instability,
attacks of dizziness

35. taste, smell agnosia

36. Occipital gyrusOccipital gyrus
 The defeat of median surface of occipitalThe defeat of median surface of occipital
gyrusgyrus in area ofin area of sulcus calcarinussulcus calcarinus
(calcareous)(calcareous) is accompanied by quadrantis accompanied by quadrant
hemianopsia on opposite side.hemianopsia on opposite side.
 At the isolated damage of the areas ofAt the isolated damage of the areas of
cortex, located in the overhead (cuneus)cortex, located in the overhead (cuneus)
or lower (gyrus linguales (lingual)or lower (gyrus linguales (lingual)
department ofdepartment of sulcus calcarinussulcus calcarinus, arises, arises
up lower or overhead homonym quadrantup lower or overhead homonym quadrant
hemianopsia.hemianopsia.
The defeat of outward surface of occipitalThe defeat of outward surface of occipital
gyrusgyrus
 Visual agnosiaVisual agnosia

37. Lower
homonym quadrant
hemianopsia
Overhead
homonym quadrant
hemianopsia

38. Symptoms of irritationsSymptoms of irritations
 The irritation of precentral gyrusThe irritation of precentral gyrus by aby a
pathological process is accompanied bypathological process is accompanied by
the attacks ofthe attacks of Jackson motor epilepsyJackson motor epilepsy
(they are the aura of epileptic attack),(they are the aura of epileptic attack),
expressed in the clonic or tonic-clonicexpressed in the clonic or tonic-clonic
cramps of the limited muscles groupscramps of the limited muscles groups
proper to the annoyed area of cortex -proper to the annoyed area of cortex -
cramps arise up on side, opposite to thecramps arise up on side, opposite to the
pathological nidus in a brain, and are notpathological nidus in a brain, and are not
accompanied by the loss of consciousness.accompanied by the loss of consciousness.
 The irritation of motor area in medialThe irritation of motor area in medial
frontal gyrusfrontal gyrus results in combinationresults in combination turnturn
of head and eyesof head and eyes aside of theaside of the pathol.pathol. nidus.nidus.
 The irritation of opercular part of lowerThe irritation of opercular part of lower
frontal gyrusfrontal gyrus causes the attacks ofcauses the attacks of
rhythmicrhythmic masticatorymasticatory motionsmotions, smacking,, smacking,
lickinglicking..

39. Symptoms of irritationsSymptoms of irritations
 The irritation by the pathological process ofThe irritation by the pathological process of
postcentral gyruspostcentral gyrus results in appearance ofresults in appearance of
paresthesia in the areas of body, proper to theparesthesia in the areas of body, proper to the
annoyed regions of cortex. They areannoyed regions of cortex. They are JacksonJackson
sensor epilepsysensor epilepsy (the aura of epileptic attack).(the aura of epileptic attack).
 At the irritation of middle part of overheadAt the irritation of middle part of overhead
temporal gyrustemporal gyrus, where the cortex representation, where the cortex representation
of auditory analyzer is located, there areof auditory analyzer is located, there are auditoryauditory
hallucinationshallucinations (noise, ringing, sing).(noise, ringing, sing).
 The irritation of parahyppocamp gyrusThe irritation of parahyppocamp gyrus, especialy, especialy
its hook conduces to the origin ofits hook conduces to the origin of olfactory, smellolfactory, smell
and taste hallucinationsand taste hallucinations..
 The irritation of cortex in theThe irritation of cortex in the medial surface ofmedial surface of
occipital gyrusoccipital gyrus can result in appearance ofcan result in appearance of simplesimple
hallucinationshallucinations (photopsia) in the halves of(photopsia) in the halves of
eyeshot opposed to the nidus.eyeshot opposed to the nidus.
 The irritation of cortex in theThe irritation of cortex in the outward surface ofoutward surface of
occipital gyrusoccipital gyrus can result in appearance ofcan result in appearance of
complex hallucinationscomplex hallucinations (pictures, films).(pictures, films).