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DisordersofhighercerebralfunctionZhouSaijun周赛君,DepartmentofNeurology,theFirstAffiliatedHospitalofWenzhouMedicalUniversity编辑课件cognitionfunctionourabilitytoperformcomplexintellectualbehaviorssuchasspeakingandwritingnavigatingourwayaroundourenvironmentrecognizingotherpeoplecomprehendingtime……编辑课件CerebralhemisphereCerebellumBrainstem编辑课件dominanthemisphereThesideofthebrainthatcontrolswritingandspeechiscalledthedominanthemisphereandtheothersideisthenon-dominanthemisphere.Thelefthemisphereisdominantinover90%ofright-handedpeopleandinabout60%ofleft-handedpeople.编辑课件FRONTALLOBE编辑课件1.primarymotorcortexthisislocatedinthepercentralgyrusandisconcernedwithmotorfunctionoftheoppositesideofthebody编辑课件Supplementarymotorandpremotorcorticestheseareasareconcernedwithcoordinatingandplanningcomplexmovements.编辑课件Symptomsfromlesionsofthe
motorcortexcontralateralmono-orhemiparesisandfacialweaknessSupplementarymotorandpremotorcorticesdisordersofcomplexmotorplanning.编辑课件2.Broca’sarea
themotororexpressivecentrefortheproductionsofspeech(dominanthemisphereonly).编辑课件Symptomsfromlesionsofthe
Broca’sareaexpressivedysphasia:Thiscomprisesnon-fluent,hesitantspeechwithintactcomprehension.Thepatientknowswhatheorshewantstosaybuthasdifficultyfindingthecorrectwords,oftenproducingthewrongword.Theabilitytorepeatwordsisbetterthanspontaneousspeech.Handwritingisalsooftenpoor.编辑课件3.Prefrontalcortextheanteriorandorbitalpartsofthefrontalcortexgovernpersonality,emotion,initiativeandtheabilitytoplan.编辑课件SymptomsfromlesionsofthePrefrontalcortex
causesalteredbehaviors,including:socialdisinhibitionlossofinitiativeandinterestinabilitytosolveproblemswithlossofabstractthoughtimpairedconcentrationandattentionwithoutintellectualormemorydecline编辑课件4.Thecorticalmicturitioncentre
thisregionliesintheparacentrallobuleandisinvolvedinthecorticalinhibitionofvoidingofthebladderandbowel.编辑课件Symptomsfromlesionsofthecorticalmicturitioncentre
Incontinenceofurineand/orfaecesMildersymptomsarefrequencyandurgencyofmicturition编辑课件5.Frontaleyefieldthisisinvolvedinmakingeyemovementstothecontralateralside.编辑课件Symptomsfromlesionsofthe
Frontaleyefieldgazeparesisimpairmentofeyemovementstothecontralateralside.Thisismostcommonlyseeninalargemiddlecerebralarterystrokeandcarriesaworseprognosis.rightwardgaze编辑课件PARIETALLOBE编辑课件1.Primarysomatosensorycortex
locatedinthepostcentralgyrusconcernedwithperceivingcomplexsomatosensorystimulifromthecontralateralsideofthefaceandbody编辑课件Symptomsfromlesionsofthe
Primarysomatosensorycortex
Discriminativesensoryimpairmentoftheoppositesideofthefaceandlimbs编辑课件3.Useofnumbers,e.g.calculation(dominanthemisphere)编辑课件Gerstmann’ssyndromeinabilitytodifferentiatetherightandleftsidesofthebody,inabilitytodistinguishthefingersofthehands(fingeragnosia),impairmentofcalculation(dyscalculia)impairmentofwriting(dysgraphia).dominanthemisphere编辑课件4.IntegrationofsensoryIntegrationofsomatosensory,visual,andauditoryinformationthisallowsawarenessofthebodyanditssurroundingsappropriatemovementofthebody,andconstructionalability.编辑课件Symptomsfromlesionsofthe
parietallobeApraxiathedominantparietallobe
Bilateralideomotorandideationalapraxia:thenon-dominantparietallobe
ConstructionalapraxiaDressingapraxia编辑课件Apraxia(thedominantparietallobe
)inabilitytocarryoutasequenceoftaskswhenthereisnormalcomprehensionandintactmotorandsensoryfunctionIdeomotorapraxiaoccurswhenapatientfailstocopyanaction,ideationalorconceptualapraxiaismoreprofound,e.g.thepatientfailstounderstanduseoftoolsandobjectsatabasiclevel.编辑课件Symptomsfromlesionsofthe
parietallobeTopographicaldisorientationthepatientcannotfindhisorherwayaroundnormallyfamiliarspacese.g.home.编辑课件Symptomsfromlesionsofthe
parietallobeContralateralsensoryinattention:neglectoftheoppositesideofthebodyForexample,ahemiplegicpatientmayignoretheparalysedsideortheremaybedenialofthehemiplegia(anosognosia).编辑课件TEMPORALLOBE编辑课件1.Wernicke’sareaintheposteriorpartofthesuperiortemporalgyrus,concernedwithcomprehensionofwrittenandspokenlanguage.编辑课件SymptomsfromlesionsoftheWernicke’sareareceptivedysphasia
impairedcomprehensionofspeechandwrittenlanguage.fluentbutwordsarereplacedwithpartlycorrectwordsandanincorrectwordrelatedtothewordintended(paraphasia)ornewlycreatedmeaninglesswords(neologisms)Thespeechdoesnotmakesenseandthepatienthaspoorinsightintotheproblem.编辑课件2.auditorycortices
Thedominanttemporallobeisimportantforthecomprehensionofspokenwordsthenon-dominantfortheappreciationofsoundsandmusic.编辑课件Symptomsfromlesionsofthe
auditorycortexAuditoryagnosia:inabilitytorecognizesoundse.g.ringingofabell,whistlingofakettle,amelody(non-dominanthemisphere).Corticaldeafness:bilaterallesionsoftheprimaryauditorycorticesandisuncommon.Auditoryhallucinationscanoccurintemporallobeepilepsy.编辑课件3.Thelimbicsystemtheolfactoryandgustatorycorticeslieinthemedialtemporallobe.Thelimbicsystemisimportantinmemory.learningandemotion.编辑课件Symptomsfromlesionsofthe
limbicsystemOlfactoryandgustatoryhallucinations:arisefromlesionswithinthemedialtemporallobe,particularlyduringseizures.Learningdifficulties:difficultieswithlearningauditoryinformationoccurindominanthemispherelesions.difficultieswithlearningvisualinformationoccurinnon-dominanthemispherelesions.编辑课件Symptomsfromlesionsofthe
limbicsystemMemoryimpairment:thehippocampusandparahippocampalgyrus.Bilateraldamageresultsinmarkedimpairmentofretentionofnewinformation.?50FirstDates
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