大脑高级皮层功能障碍课件

Disordersofhighercerebralfunction

ZhouSaijun,DepartmentofNeurology,theFirstAffiliatedHospitalofWenzhouMedicalUniversitycognitionfunctionourabilitytoperformcomplexintellectualbehaviorssuchasspeakingandwritingnavigatingourwayaroundourenvironmentrecognizingotherpeoplecomprehendingtime……CerebralhemisphereCerebellumBrainstemFRONTALLOBE1.primarymotorcortexthisislocatedinthepercentralgyrusandisconcernedwithmotorfunctionoftheoppositesideofthebodySupplementarymotorandpremotorcorticestheseareasareconcernedwithcoordinatingandplanningcomplexmovements.Symptomsfromlesionsofthe

motorcortexcontralateralmono-orhemiparesisandfacialweaknessSupplementarymotorandpremotorcorticesdisordersofcomplexmotorplanning.Symptomsfromlesionsofthe

Broca’sareaexpressivedysphasia:Thiscomprisesnon-fluent,hesitantspeechwithintactcomprehension.Thepatientknowswhatheorshewantstosaybuthasdifficultyfindingthecorrectwords,oftenproducingthewrongword.Theabilitytorepeatwordsisbetterthanspontaneousspeech.Handwritingisalsooftenpoor.SymptomsfromlesionsofthePrefrontalcortex

causesalteredbehaviors,including:socialdisinhibitionlossofinitiativeandinterestinabilitytosolveproblemswithlossofabstractthoughtimpairedconcentrationandattentionwithoutintellectualormemorydeclineSymptomsfromlesionsofthecorticalmicturitioncentre

Incontinenceofurineand/orfaecesMildersymptomsarefrequencyandurgencyofmicturition5.Frontaleyefieldthisisinvolvedinmakingeyemovementstothecontralateralside.Symptomsfromlesionsofthe

Frontaleyefieldgazeparesisimpairmentofeyemovementstothecontralateralside.Thisismostcommonlyseeninalargemiddlecerebralarterystrokeandcarriesaworseprognosis.rightwardgazePARIETALLOBE1.Primarysomatosensorycortex

locatedinthepostcentralgyrusconcernedwithperceivingcomplexsomatosensorystimulifromthecontralateralsideofthefaceandbody3.Useofnumbers,e.g.calculation(dominanthemisphere)Gerstmann’ssyndromeinabilitytodifferentiatetherightandleftsidesofthebody,inabilitytodistinguishthefingersofthehands(fingeragnosia),impairmentofcalculation(dyscalculia)impairmentofwriting(dysgraphia).dominanthemisphereSymptomsfromlesionsofthe

parietallobeApraxiathedominantparietallobe

Bilateralideomotorandideationalapraxia:thenon-dominantparietallobe

ConstructionalapraxiaDressingapraxiaApraxia(thedominantparietallobe

)inabilitytocarryoutasequenceoftaskswhenthereisnormalcomprehensionandintactmotorandsensoryfunctionIdeomotorapraxiaoccurswhenapatientfailstocopyanaction,ideationalorconceptualapraxiaismoreprofound,e.g.thepatientfailstounderstanduseoftoolsandobjectsatabasiclevel.Symptomsfromlesionsofthe

parietallobeContralateralsensoryinattention:neglectoftheoppositesideofthebodyForexample,ahemiplegicpatientmayignoretheparalysedsideortheremaybedenialofthehemiplegia(anosognosia).TEMPORALLOBE1.Wernicke’sareaintheposteriorpartofthesuperiortemporalgyrus,concernedwithcomprehensionofwrittenandspokenlanguage.2.auditorycortices

Thedominanttemporallobeisimportantforthecomprehensionofspokenwordsthenon-dominantfortheappreciationofsoundsandmusic.Symptomsfromlesionsofthe

auditorycortexAuditoryagnosia:inabilitytorecognizesoundse.g.ringingofabell,whistlingofakettle,amelody(non-dominanthemisphere).Corticaldeafness:bilaterallesionsoftheprimaryauditorycorticesandisuncommon.Auditoryhallucinationscanoccurintemporallobeepilepsy.3.Thelimbicsystemtheolfactoryandgustatorycorticeslieinthemedialtemporallobe.Thelimbicsystemisimportantinmemory.learningandemotion.Symptomsfromlesionsofthe

limbicsystemOlfactoryandgustatoryhallucinations:arisefromlesionswithinthemedialtemporallobe,particularlyduringseizures.Learningdifficulties:difficultieswithlearningauditoryinformationoccurindominanthemispherelesions.difficultieswithlearningvisualinformationoccurinnon-dominanthemispherelesions.Symptomsfromlesionsofthe

limbicsystemMemoryimpairment:thehippocampusandparahippocampalgyrus.Bilateraldamageresultsinmarkedimpairmentofretentionofnewinformation.《50FirstDates》Emotionaldisturbances:canincludeaggressionrage,apathyhyperoralityandhypersexuality.OCCIPITALLOBE

VisualcortextheperceptionofvisionrecognitionofwhateverisvisualizedSymptomsfromlesionsoftheoccipitallobeContralateralhomonymoushemianopicfielddefectCorticalblindnessbilateraloccipitallesionsrenderthepatientblindVisualagnosiaimpairmentofrecognitionoffacesa