大脑高级皮层功能障碍

Disordersofhighercerebralfunction

ZhouSaijun周赛君,DepartmentofNeurology,theFirstAffiliatedHospitalofWenzhouMedicalUniversitycognitionfunctionourabilitytoperformcomplexintellectualbehaviorssuchasspeakingandwritingnavigatingourwayaroundourenvironmentrecognizingotherpeoplecomprehendingtime……CerebralhemisphereCerebellumBrainstemdominanthemisphereThesideofthebrainthatcontrolswritingandspeechiscalledthedominanthemisphereandtheothersideisthenon-dominanthemisphere.Thelefthemisphereisdominantinover90%ofright-handedpeopleandinabout60%ofleft-handedpeople.FRONTALLOBE1.primarymotorcortexthisislocatedinthepercentralgyrusandisconcernedwithmotorfunctionoftheoppositesideofthebodySupplementarymotorandpremotorcorticestheseareasareconcernedwithcoordinatingandplanningcomplexmovements.Symptomsfromlesionsofthe

motorcortexcontralateralmono-orhemiparesisandfacialweaknessSupplementarymotorandpremotorcorticesdisordersofcomplexmotorplanning.2.Broca’sarea

themotororexpressivecentrefortheproductionsofspeech(dominanthemisphereonly).Symptomsfromlesionsofthe

Broca’sareaexpressivedysphasia:Thiscomprisesnon-fluent,hesitantspeechwithintactcomprehension.Thepatientknowswhatheorshewantstosaybuthasdifficultyfindingthecorrectwords,oftenproducingthewrongword.Theabilitytorepeatwordsisbetterthanspontaneousspeech.Handwritingisalsooftenpoor.3.Prefrontalcortextheanteriorandorbitalpartsofthefrontalcortexgovernpersonality,emotion,initiativeandtheabilitytoplan.SymptomsfromlesionsofthePrefrontalcortex

causesalteredbehaviors,including:socialdisinhibitionlossofinitiativeandinterestinabilitytosolveproblemswithlossofabstractthoughtimpairedconcentrationandattentionwithoutintellectualormemorydecline4.Thecorticalmicturitioncentre

thisregionliesintheparacentrallobuleandisinvolvedinthecorticalinhibitionofvoidingofthebladderandbowel.Symptomsfromlesionsofthecorticalmicturitioncentre

Incontinenceofurineand/orfaecesMildersymptomsarefrequencyandurgencyofmicturition5.Frontaleyefieldthisisinvolvedinmakingeyemovementstothecontralateralside.Symptomsfromlesionsofthe

Frontaleyefieldgazeparesisimpairmentofeyemovementstothecontralateralside.Thisismostcommonlyseeninalargemiddlecerebralarterystrokeandcarriesaworseprognosis.rightwardgazePARIETALLOBE1.Primarysomatosensorycortex

locatedinthepostcentralgyrusconcernedwithperceivingcomplexsomatosensorystimulifromthecontralateralsideofthefaceandbodySymptomsfromlesionsofthe

Primarysomatosensorycortex

Discriminativesensoryimpairmentoftheoppositesideofthefaceandlimbs3.Useofnumbers,e.g.calculation(dominanthemisphere)Gerstmann’ssyndromeinabilitytodifferentiatetherightandleftsidesofthebody,inabilitytodistinguishthefingersofthehands(fingeragnosia),impairmentofcalculation(dyscalculia)impairmentofwriting(dysgraphia).dominanthemisphere4.IntegrationofsensoryIntegrationofsomatosensory,visual,andauditoryinformationthisallowsawarenessofthebodyanditssurroundingsappropriatemovementofthebody,andconstructionalability.Symptomsfromlesionsofthe

parietallobeApraxiathedominantparietallobe

Bilateralideomotorandideationalapraxia:thenon-dominantparietallobe

ConstructionalapraxiaDressingapraxiaApraxia(thedominantparietallobe

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

parietallobeTopographicaldisorientationthepatientcannotfindhisorherwayaroundnormallyfamiliarspacese.g.home.Symptomsfromlesionsofthe

parietallobeContralateralsensoryinattention:neglectoftheoppositesideofthebodyForexample,ahemiplegicpatientmayignoretheparalysedsideortheremaybedenialofthehemiplegia(anosognosia).TEMPORALLOBE1.Wernicke’sareaintheposteriorpartofthesuperiortemporalgyrus,concernedwithcomprehensionofwrittenandspokenlanguage.SymptomsfromlesionsoftheWernicke’sareareceptivedysphasia

impairedcomprehensionofspeechandwrittenlanguage.fluentbutwordsarereplacedwithpartlycorrectwordsandanincorrectwordrelatedtothewordintended(paraphasia)ornewlycreatedmeaninglesswords(neologisms)Thespeechdoesnotmakesenseandthepatienthaspoorinsightintotheproblem.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.《50First