This document provides an overview of the central nervous system including the cerebrum, brain stem, cerebellum, and spinal cord. It describes the major anatomical structures and regions of the cerebrum including the frontal, parietal, temporal, and occipital lobes. It discusses the functions of key areas such as the motor cortex, sensory cortex, Broca's area, Wernicke's area, and others. It also reviews the structures that make up the brain stem, cerebellum, and spinal cord. The document appears to be lecture notes on neuroanatomy for physiotherapists.

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

2. CENTRAL NERVOUS
SYSTEM
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3. INTRACRANIAL
PART
A. CEREBRUM
B. BRAIN
STEM
C. CEREBELLU
M
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4. 1.CEREBRUM
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5. 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,
Cerebrum

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8. Neurology for physiotherapist by Prof.Dr
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11. 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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19. At the base of each cerebral
hemisphere:There are several groups
of nuclei situated at various levels
within the white matter; they form The
basal ganglia.
 Deinchephalon
 Thalamus
 Hypothalamus.
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20. CEREBRAL CORTEX
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22. Frontal
lobe
 The primary motor cortex.
 Premotor area (area 6).
 Area of voluntary conjugate eye
movement( area 8).
 Broca's area
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23. Frontal
lobe
 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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27. A. Frontal
lobe
Motor area (area 4):
Site: Floor of central sulcus & posterior part of
precentral gyrus.
Function: Initiation of voluntary motor activity of the
opposite
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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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30. Pyramidal
pathway

32. A. Frontal
lobe
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.
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33. A. Frontal
lobe
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.
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34. A. Frontal
lobe
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
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35. A. Frontal
lobe
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.
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36. A. Frontal
lobe
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
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

38. B. Parietal
lobe
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.
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39. B. Parietal
lobe
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.
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40. B. Parietal
lobe
3) Angular gyrus (area 39):
 Site: In the postero-inferior part of the parietal
lobe.
 Function: Inthe 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
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

42. C. Temporal
lobe
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.
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43. C. Temporal
lobe
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
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44. C. Temporal
lobe
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.
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45. C. Temporal
lobe
4) The limbic system :
 Site:Uncus & hippocampus inthe
medial & inferior suifaces of the temporal
lobe.
 Function: Concerned with
smell (uncus), mood & memory.
 Lesion:
Uncinatefits with olfactory hallucinations,
usually unpleasant. .
 Temporal lobe epilepsy.
Anterograde amnesia (lossof
memory for recent events).
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46. Neurology for physiotherapist by Prof.Dr Ahmed
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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

47. D. Occipital
lob
e
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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

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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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2.BRAIN
STEM

50. 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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53. 3.CEREBELL
UM
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54. 3.Spinal
cord
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56. 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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Thank
yo
u