Clinically-Relevant-Functional-Neuroanatomy临床相关的功能性神经解剖学课件

1、Introduction to NeuroanatomyRussell M. Bauer, Ph.D.January 9, 2006Introduction to NeuroanatomyRuCaveatsWhat you need to know about anatomyChanges with each individual caseInvolves both local and global knowledgeDepends on your practice and referral questionWhat I can give you in 90 minutesConceptual

2、 understanding of organizationTools to think about deeper levels of analysisWays of decomposing deficitsCaveatsWhat you need to know aKey ConceptsFunctional Systems: patterns of connectivityLocalized damage has systemic effectsSegregated patterns of inputs and outputsExcitatory and inhibitory contro

3、lParallel vs. serial processingKey ConceptsFunctional Systems Cerebral Cortex CerebrHorizontal (Axial)SagittalCoronalDirections andPlanes of SectionHorizontal (Axial)SagittalCoroBlumenfeld, 2002Blumenfeld, 2002 The layer of gray matter covering the entire surface of cerebral hemisphere Migration of

4、neurons from inner mantle layer ofneural tube Accommodates enormous number of neurons - Large surface area accommodates more neurons than deep nuclei - Gyri and sulci also increase surface area - Laminar organization also accommodates enormous number of neuronsCerebral CortexWon Taek Lee, M.D., Ph.D

5、. The layer of gray matter cove Numerical Data Total surface area: 2200 cm2 (2.5 ft2) about 1/3 - surface area about 2/3 - hidden in the sulci Thickness: 1.5 mm (V I) - 4.5 mm (M I) Generally, thickest over the crest of the convolution and, thinnest in the depth of sulci Weight: 600 gm (40 % of tota

6、l brain weight) 180 gm - neurons 420 gm - glial cellsCerebral CortexWon Taek Lee, M.D., Ph.D. Numerical DataCerebral Co Numerical Data Number of neuronal cells in cerebral cortex neurons - 10-15 billion glial cells -50 billion Estimation of number of cortical neurons von Economo and Koskinas (1925)

7、14.0 billion Shariff (1953) 6.9 billion Sholl (1956) 5.0 billion Pakkenberg (1966) 2.6 billionCerebral CortexWon Taek Lee, M.D., Ph.D. Numerical DataCerebral Co Subdivision of Cerebral Cortex Allocortex Archicortex (hippocampal formation) Palaeocortex (Paleopallium) Isocortex Neocortex (Neopallium)

8、Won Taek Lee, M.D., Ph.D. Subdivision of Ce Isocortex typical 6 layered cortex I. Molecular Layer II. External Granular Layer III.External Pyramidal Layer IV.Internal Granular Layer V. Internal Pyramidal Layer VI. Polymorphic LayerWon Taek Lee, M.D., Ph.D. Isocortex typical 6 layered1. Pyramidal Cel

9、l2. Fusiform Cell 3. Granular (Stellate) Cell4. basket cell5. double bouquet cell 6. chandlier cell 7. neurogliform cell8. Horizontal Cell of Cajal 9. Cells of Martinottia: axonCerebral CortexWon Taek Lee, M.D., Ph.D.1. Pyramidal CellCerebral CortBlumenfeld, 2002Blumenfeld, 2002Blumenfeld, 2002Blume

10、nfeld, 2002 A. pyramidal neuron B. excitatorygranular cell C. inhibitorygranular cell 1. afferent fiber 2. efferent fiber 3.corticothalamic fiber Columnar Cortical Unit and Cortical CircuitryWon Taek Lee, M.D., Ph.D.Won Taek Lee, M.D., Ph.D. A. Homotypical isocortex-association cortex B. Heterotypic

11、al isocortex 1. granular cortex -primary sensory cortexV I (17), S I (3), A I (41) 2. agranular cortex -motor cortexM I (4), PM (6)Regional Variation of Cortical LaminationWon Taek Lee, M.D., Ph.D.Won Taek Lee, M.D., Ph.D.Brodmanns cytoarchitectorial map (Lateral surface)Brodmanns cytoarchitectorial

12、 Brodmanns cytoarchitectorial map (Medial surface)Brodmanns cytoarchitectorial Blumenfeld, 2002Blumenfeld, 2002Order of Cortical Maturation12333211Order of Cortical Maturation12Clinically-Relevant-Functional-Neuroanatomy临床相关的功能性神经解剖学课件Clinically-Relevant-Functional-Neuroanatomy临床相关的功能性神经解剖学课件 S I (3

13、, 1, 2 ; postcentral gyrus) afferents: ventrobasal complex (VPLc, VPM) discrimination of position and intensity of sensation S II (superior bank of lateral fissure) Somesthetic Association Cortex (5, 7; parietal lobe, precuneus) afferents: S I, LP of thalamus integration of general sensation with pa

14、st experience tactile agnosia, astereognosisSomesthetic Area S I (3, 1, 2 ; postcentralSensory HomunculusSensory HomunculusThalmocortical connection (VPLc S I)Central region - cutaneous (3b, 1)Peripheral region - deep (3a, 2)PrimarySomestheticAreaThalmocorticalPrimarySecondarySomesthetic Area (SII)

15、superior bank of lateral fissureSecondarysuperior bank of Kaas JH & Catania, KC (2002). How do features of sensory representations develop? Bioessays, 24, 334-343.Kaas JH & Catania, KC (2002). primary Motor Area (M I)Premotor Area (PM) Supplementary Motor Area (SMA)Frontal Eye Field Motor AreasMotor

16、 AreasMotor HomunculusMotor HomunculusBlumenfeld, 2002Blumenfeld, 2002Brodmanns Map of Motor and Sensory AreasBrodmanns Map of Motor and Se Language Areas: 22, 39, 40, 44, 45 Posterior Parietal Association Area: 5, 7 (39, 40)body image Temporal Association Area: 20, 21, 37, 38 (22) multisensory inte

17、gration, conceptual ideation Prefrontal Association Area: 9, 10, 11, 12, 46, 47 (44,45) executive skills, judgment, planning, emotion-regulation Association Areas Language Areas: 22, 39, 40, Clinically-Relevant-Functional-Neuroanatomy临床相关的功能性神经解剖学课件Unimodal and Polymodal AssociationUnimodal and Poly

18、modal AssociaNeuropsychological Manifestations of Temporal Lobe LesionsLateral (20,21,38,37)A) Posterior: visual recognition disturb-ances (severity depends on whether unilateral or bilateralB) Anterior: anomia for objects (left), anomia for facial expressions (right), full-blown anomia, retrograde

19、memory disturbance (bilateral)Mesial (27,28 and limbic structures)Anterograde amnesia for verbal (left) or nonverbal (right) material; bilateral lesions produce severe material non-specific defectTranel, 1992Neuropsychological ManifestatiNeuropsychological Manifestations of Occipital Lobe LesionsDor

20、sal(17,18,19,39,7)Partial or mild Balints syndrome (unilateral), severe Balints syndrome (bilateral), defective motion perception, astereopsis, severe visuospatial disturbance, simultanagnosiaVentral (17,18,19)Hemiachromatopsia (unilateral), pure alexia (left), apperceptive visual agnosia (unilatera

21、l, RL), defective imageryBilateral lesions produce severe agnosia, prosopagnosiaBilateral lesions of Area 17 produce cortical blindness (may be transient or evolving)Tranel, 1992Neuropsychological ManifestatiNeuropsychological Manifestations of Parietal Lobe LesionsTemporoparietal Junction (includin

22、g posterior superior temporal gyrus, 22, inferior 39,40)A) Left: Wernickes aphasiaB) Right: Amusia, defective music recognition, phonagnosiaC) Bilateral: auditory agnosiaInferior Parietal Lobule (39,40)A) Left: Conduction aphasia, tactile agnosiaB) Right: neglect, anosognosia, tactile agnosia, anoso

23、diaphoriaC) Balints syndromeTranel, 1992Neuropsychological ManifestatiNeuropsychological Manifestations of Frontal Lesions IFrontal Operculum (44,45,47)A) Left: Brocas aphasiaB) Right: expressive aprosodiaSuperior Mesial (mesial 6, 24)A) Left: akinetic mutismB) Right: akinetic mutismBilateral lesion

24、s of mesial SMA (6) and anterior cingulate (24) produce more severe form of akinetic mutismTranel, 1992Neuropsychological ManifestatiNeuropsychological Manifestations of Frontal Lobe Lesions IIInferior Mesial RegionA) Orbital Region (10, 11)Lesions in this region produce disinhibition, altered socia

25、l conduct, “acquired sociopathy”, and other disturbances due to impairment in fronto-limbic relationshipsB) Basal Forebrain (posterior extension of inferomesial region, including diagonal band of Broca, nucleus accumbens, septal nuclei, substantia innominataLesions here produce prominent anterograde amnesia with confabulation (mate