大脑高级皮层功能障碍ppt课件

1、Disorders of higher cerebral function Zhou Saijun, Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University1;.2cognition functionour ability to perform complex intellectual behaviors such as speaking and writing navigating our way around our environment recognizing other

2、people comprehending time 3Cerebral hemisphereCerebellumBrain stem4dominant hemisphere The side of the brain that controls writing and speech is called the dominant hemisphere and the other side is the non-dominant hemisphere.The left hemisphere is dominant in over 90% of right-handed people and in

3、about 60% of left-handed people . 5FRONTAL LOBE61.primary motor cortexthis is located in the percentral gyrus and is concerned with motor function of the opposite side of the body 7Supplementary motor and premotor corticesthese areas are concerned with coordinating and planning complex movements .8S

4、ymptoms from lesions of the motor cortexcontralateral mono-or hemiparesis and facial weakness Supplementary motor and premotor cortices disorders of complex motor planning.92. Brocas area the motor or expressive centre for the productions of speech (dominant hemisphere only ).10Symptoms from lesions

5、 of the Brocas area expressive dysphasia :This comprises non-fluent, hesitant speech with intact comprehension.The patient knows what he or she wants to say but has difficulty finding the correct words ,often producing the wrong word. The ability to repeat words is better than spontaneous speech. Ha

6、ndwriting is also often poor.113.Prefrontal cortexthe anterior and orbital parts of the frontal cortex govern personality ,emotion, initiative and the ability to plan.12Symptoms from lesions of the Prefrontal cortex causes altered behaviors, including :social disinhibition loss of initiative and int

7、erestinability to solve problems with loss of abstract thought impaired concentration and attention without intellectual or memory decline 134.The cortical micturition centre this region lies in the paracentral lobule and is involved in the cortical inhibition of voiding of the bladder and bowel.14S

8、ymptoms from lesions of the cortical micturition centre Incontinence of urine and/or faeces Milder symptoms are frequency and urgency of micturition155.Frontal eye fieldthis is involved in making eye movements to the contralateral side.16Symptoms from lesions of the Frontal eye fieldgaze paresis imp

9、airment of eye movements to the contralateral side.This is most commonly seen in a large middle cerebral artery stroke and carries a worse prognosis.rightward gaze17PARIETAL LOBE181.Primary somatosensory cortex located in the postcentral gyrus concerned with perceiving complex somatosensory stimuli

10、from the contralateral side of the face and body19Symptoms from lesions of the Primary somatosensory cortex Discriminative sensory impairment of the opposite side of the face and limbs 203. Use of numbers, e.g. calculation( dominant hemisphere)21Gerstmanns syndromeinability to differentiate the righ

11、t and left sides of the body, inability to distinguish the fingers of the hands(finger agnosia),impairment of calculation (dyscalculia) impairment of writing (dysgraphia).dominant hemisphere224.Integration of sensoryIntegration of somatosensory ,visual,and auditory information this allows awareness

12、of the body and its surroundings appropriate movement of the body, and constructional ability. 23Symptoms from lesions of the parietal lobeApraxiathe dominant parietal lobe Bilateral ideomotor and ideational apraxia: the non-dominant parietal lobe Constructional apraxia Dressing apraxia 24Apraxia(th

13、e dominant parietal lobe )inability to carry out a sequence of tasks when there is normal comprehension and intact motor and sensory function Ideomotor apraxia occurs when a patient fails to copy an action, ideational or conceptual apraxia is more profound ,e.g.the patient fails to understand use of

14、 tools and objects at a basic level.25Symptoms from lesions of the parietal lobeTopographical disorientationthe patient cannot find his or her way around normally familiar spaces e.g.home.26Symptoms from lesions of the parietal lobeContralateral sensory inattention: neglect of the opposite side of t

15、he body For example ,a hemiplegic patient may ignore the paralysed side or there may be denial of the hemiplegia(anosognosia).27TEMPORAL LOBE281. Wernickes areain the posterior part of the superior temporal gyrus, concerned with comprehension of written and spoken language.29Symptoms from lesions of

16、 the Wernickes areareceptive dysphasia impaired comprehension of speech and written language . fluent but words are replaced with partly correct words and an incorrect word related to the word intended (paraphasia)or newly created meaningless words (neologisms)The speech does not make sense and the

17、patient has poor insight into the problem.302. auditory cortices The dominant temporal lobe is important for the comprehension of spoken words the non-dominant for the appreciation of sounds and music. 31Symptoms from lesions of the auditory cortex Auditory agnosia: inability to recognize sounds e.g

18、. ringing of a bell ,whistling of a kettle ,a melody (non-dominant hemisphere).Cortical deafness: bilateral lesions of the primary auditory cortices and is uncommon. Auditory hallucinations can occur in temporal lobe epilepsy.323.The limbic system the olfactory and gustatory cortices lie in the medi

19、al temporal lobe. The limbic system is important in memory. learning and emotion.33Symptoms from lesions of the limbic systemOlfactory and gustatory hallucinations :arise from lesions within the medial temporal lobe ,particularly during seizures. Learning difficulties: difficulties with learning aud

20、itory information occur in dominant hemisphere lesions .difficulties with learning visual information occur in non-dominant hemisphere lesions.34Symptoms from lesions of the limbic system Memory impairment: the hippocampus and parahippocampal gyrus. Bilateral damage results in marked impairment of retention of new information.50 Fir