Cerebral cortex

I. Cerebrum
II. Brain Stem
III. Cerebellum.
The Cerebral Cortex
A. Frontal lobe
1) Motor area (area 4):
Frontal lobe
parietal lobe
temporal lobe
occipital lobe

1. NOTE:
To change
the image
on this
slide,
select the
picture
and delete
it. Then
click the
Pictures
icon in the
placeholde
r to insert
your own
image.
Amr Hassan, M.D.
Associate professor of Neurology - Cairo
University

CEREBRAL CORTEX

2. CENTRAL NERVOUS SYSTEM
3/9/2017 2

3. INTRACRANIAL PART
3/9/2017 3
A.CEREBRUM
B.BRAIN STEM
C.CEREBELLUM

4. 3/9/2017 4

1.CEREBRUM

5. V. D.
3/9/2017
Neurology for physiotherapist by Dr Amr
Hasan El-Hasany
5
Left/Right halves communicate
via Corpus Callosum
Left brain controls right body
Left Brain: spoken/written
language, number &
scientific skills,
reasoning (the scientist)
Right Brain: music/art awareness,
3D forms, insight, imagination
( the artist)
Cerebrum

6. 3/9/2017 Neurology for physiotherapist by Prof.Dr Amr Hasan
6

7. 3/9/2017
Neurology for physiotherapist by Dr Amr Hasan El-Hasany
7

8. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
8

9. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
9

10. 3/9/2017 Neurology for physiotherapist by Dr Amr Hasan El-Hasany
10

11. The cerebrum is divided by a
longitudinal fissure into
2 hemispheres each containing 4
discrete lobes.
Frontal,
Temporal,
Parietal
Occipital

3/9/2017 11
Cerebrum

12. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
12

13. 3/9/2017 13

14. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
14

15. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
15

16. 3/9/2017 16

17. 3/9/2017 17

18. 3/9/2017 18

19. 3/9/2017 19

At the base of each cerebral hemisphere:There
are several groups of nuclei situated at various
levels within the white matter; they form The
basal ganglia.
Deinchephalon
Thalamus
 Hypothalamus.

20. 3/9/2017 20
CEREBRAL CORTEX

21. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
21

22. Frontal lobe
3/9/2017 22

The primary motor cortex.

Premotor area (area 6).

Area of voluntary conjugate eye movement( area 8).

Broca's area

23. Frontal lobe
3/9/2017 23

Exner’s area.

Prefrontal area.

Paracentral lobule.

24. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
24

The cerebral cortex
Primary motor area (4),Premotor area (6))
Prefrontal area ( area 9,10,11)
Primary sensory cortex ( areas
1,2,3)
21 22
37
Visual
sensory area
Auditory associative area
( area 21,22)

Auditory
sensory
area
( area
41,42)

Angular gyrus
Secondary sensory cortex
( areas 5,7,40)

5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

25. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
25

26. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
26

27. A. Frontal lobe

3/9/2017 27
Motor area (area 4):
Site: Floor of central sulcus & posterior part of precentral gyrus.
Function: Initiation of voluntary motor activity of the opposite
1
/
2 of the body
through the pyramidal (Δ) tract. In this area the body is represented upside
down (see fig.2), complex movements involving speech, face & hands are widely
represented in the lower part of this area.
Lesion:
Irritative: Contralateral motor Jacksonian fits: there are convulsions ,
involving the muscles of one side of the body; the fit has a focal onset either in the
thumb, angle of the mouth or big toe (depending on whether the irritative lesion
starts in the lower or upper part of the motor area); the fit spreads in a march
course e.g. thumb → arm → shoulder → trunk→ L.L.
Destructive: Contralateral paralysis usually affecting one limb (monoplegia).

28. 3/9/2017 28

29. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
29

30. Pyramidal pathway

32. A. Frontal lobe

3/9/2017 32
Premotor area (area 6):
Site: Anterior part of the precentral gyrus.
Function: Partly supplies Δ tract & gives extra A fibres. This area
inhibits the muscle tone & the deep reflexes on the opposite side of

the body.
Lesion: Contralateral hypertonia & exaggerated deep reflexes.

33. A. Frontal lobe

3/9/2017 33
Area of voluntary conjugate eve movements (area 8):
Site: Posterior part of middle frontal gyrus.
Function: Voluntary conjugate eye movement to the opposite
side e.g. while reading the action of passing from the end of one
line to the beginning of the next line; this movement is usually
rapid & is termed "saccadic."
Lesion:
Irritative: attacks of conjugate eye deviation to the opposite side
of the lesion.
Destructive: paralysis of conjugate eye movement to the
opposite side of the lesion.

34. A. Frontal lobe

3/9/2017 34
Broca's area (area 44):
Site: Posterior part of inferior frontal gyrus of dominant hemisphere.
Function: Motor centre for speech.
Lesion: Motor (expressive) aphasia; the patient cannot express ideas in
spoken words.


Exner's area (area 45):
Site: Adjacent to area 44 in the dominant hemisphere.
Function: Center for writing.
lesion : Agraphia ; the patient cannot express ideas in written words.

35. A. Frontal lobe

3/9/2017 35
Pre-frontal area (areas 9, 10 and 11):
Site: Anterior part of frontal lobe & its adjacent inferior surface.
Function:
Higher centre for mentality, personality & behaviour.
Inhibition of primitive reflexes which are present in the newborn, e.g. grasp, grope
reflexes.
Lesion:
Mentality, personality & behavioural changes: lack of attention &
judgement, disinterest in people & surroundings, lack of personal hygiene,
ending in dementia.
Reappearance of primitive reflexes.

36. A. Frontal lobe

3/9/2017 36
Paracentral lobule:
Site: Medial surface of the superior frontal gyrus, adjacent to the foot & leg area.
Function: Cortical inhibition (control) of bladder & bowel voiding.
Lesion: Incontinence of urine & faeces.

37. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
37

The cerebral cortex
Primary motor area (4),Premotor area (6))
Prefrontal area ( area 9,10,11)
Primary sensory cortex ( areas
1,2,3)
21 22
37
Visual
sensory area
Auditory associative area
( area 21,22)

Auditory
sensory
area
( area
41,42)

Angular gyrus
Secondary sensory cortex
( areas 5,7,40)

5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

38. B. Parietal lobe

3/9/2017 38
1) Cortical sensory area (areas 1, 2, 3):
Site: Post-central gyrus.
Function: Perception of cortical sensations from the opposite ½ of the
body; like in the motor area, the body is represented upside down
(see fig.2)
Lesion:
Irritative: contralateral sensory Jacksonian fits in the form of
numbness or tingling with focal onset & a march course; it may be
followed by a motor fit if the irritation extends to the adjacent motor
area.
Destructive: contralateral cortical sensory loss.

39. B. Parietal lobe

3/9/2017 39
2) Secondary sensory, or sensory association areas (areas 5,7,
40):
Site: Behind the post-central gyrus.
Function: Capable of more detailed discrimination and analysis than is
the primary sensory area. They might, for example, be involved in
sensing how hot or cold something is rather than simply identifying it
as hot or cold. Information is first processed in the primary sensory
area and is then sent to the secondary sensory areas.

40. B. Parietal lobe

3/9/2017 40
3) Angular gyrus (area 39):
Site: In the postero-inferior part of the parietal lobe.
Function: In the dominant hemisphere, it is concerned
with reading & recognition of visual symbols.
Lesion: Alexia; the patient who could read before the
lesion, becomes unable to do so.

41. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
41

The cerebral cortex
Primary motor area (4),Premotor area (6))
Prefrontal area ( area 9,10,11)
Primary sensory cortex ( areas
1,2,3)
21 22
37
Visual
sensory area
Auditory associative area
( area 21,22)

Auditory
sensory
area
( area
41,42)

Angular gyrus
Secondary sensory cortex
( areas 5,7,40)

5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

42. C. Temporal lobe

3/9/2017 42
1) Auditorv sensory area (area 41. 42):
Site: Superior temporal gyrus.
Function: Auditory sensory area.
Lesion:
 Irritative: auditory hallucinations.
 Destructive: slight hearing impairment, never
deafness as hearing is bilaterally represented.

43. C. Temporal lobe

3/9/2017 43
2) Auditory associative area ( area 21,22)
(wernicke’s area):
Site: Adjacent to areas 41 & 42.
Function: Recognition & recall of sounds.
Lesion: Auditory agnosia: the patient hears but
does not understand (recognize) what he hears

44. C. Temporal lobe

3/9/2017 44
3) Supramarainal gyrus (area 37):
Site: The posterior-inferior part of the temporal lobe.
Function: In the dominant hemisphere it is concerned
with storage & recall of ideas of speech & ideas of
complex voluntary motor activity.
Lesion:
Jargon's aphasia (word salad).
Apraxia: inability to perform complex voluntary motor
activity in absence of paralysis, incoordination or
sensory loss.

45. C. Temporal lobe

3/9/2017 45
4) The limbic system :
Site: Uncus & hippocampus in the medial & inferior
suifaces of the temporal lobe.
Function: Concerned with smell (uncus), mood &
memory.
Lesion:
Uncinate fits with olfactory hallucinations, usually
unpleasant. .
 Temporal lobe epilepsy.
Anterograde amnesia (loss of memory for recent
events).

46. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
46

The cerebral cortex
Primary motor area (4),Premotor area (6))
Prefrontal area ( area 9,10,11)
Primary sensory cortex ( areas
1,2,3)
21 22
37
Visual
sensory area
Auditory associative area
( area 21,22)

Auditory
sensory
area
( area
41,42)

Angular gyrus
Secondary sensory cortex
( areas 5,7,40)

5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

47. D. Occipital lobe

3/9/2017 47
1) Visual sensory area (area 17): For the reception of visual images
2) Visual associative area (area 18,19):
Site: Anterior to area 17.
Function:
Centre for reflex conjugate eye movement to the opposite side e.g.
While reading, following the words of a line, one after the
other; this movement is usually slow & is termed "pursuit''.
Recognition & recall of images.
Lesion:
Irritative: Unformed visual hallucinations e.g. sparks, lines, flashes that
occur in occipital lobe epilepsy.
Destructive:
Homonymous hemianopia with or without macular sparing.
Visual agnosia: the patient sees (e.g. a familiar face) but does not recognize what he sees.

48. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
48

The cerebral cortex
Primary motor area (4),Premotor area (6))
Prefrontal area ( area 9,10,11)
Primary sensory cortex ( areas
1,2,3)
21 22
37
Visual
sensory area
Auditory associative area
( area 21,22)

Auditory
sensory
area
( area
41,42)

Angular gyrus
Secondary sensory cortex
( areas 5,7,40)

5
7
Supramarginal
gyrus
Broca’s area (44)
Exner’s area (45)
44
45
Visual
association
areas18,19

49. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
49
2.BRAIN STEM

50. II. Brain Stem
3/9/2017 50
It is formed of:
Midbrain
Pons
Medulla.
It is connected to the cerebral hemispheres by 2 cerebral
peduncles and to the cerebellum, on each side, by the
superior, middle & inferior cerebellar peduncles.
It contains groups of nerve cells (gray matter) intermingled
with several ascending and descending fibres (white matter).

51. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
51

52. 3/9/2017
Neurology for physiotherapist by Dr Amr Hasan El-Hasany
52

53. 3/9/2017 53
3.CEREBELLUM

54. 3/9/2017 54
3.Spinal cord

55. 3/9/2017 55

56. 3/9/2017 56
Spinal cord
•The spinal cord is an extension of the brain that runs through a long, hollow
canal in the column of vertebrae called the spinal canal & ends at the lower
border of the 1st lumbar vertebra (see fig.4,5).
•The meninges, cerebrospinal fluid, fat, and a network of veins
and arteries surround, nourish, and protect the spinal cord.
•It is formed of gray matter (cells) surrounded by white matter.
•In a transverse section the gray matter resembles the letter H (2 anterior & 2
posterior horns).
•The spinal cord is consisted of 31 segments (8 cervical segments, 12 dorsal
segments , 5 lumbar segments , 5 sacral segments).
•Thirty-one pairs of nerve roots emerge from the spinal cord through spaces in
each vertebra.
•The lowermost 3 segments of the spinal cord (S3, 4, 5) are known
anatomically as the conus medullaris while the above 4 segments (L4, 5, S1, 2)
are known anatomically as the epiconus.

57. 3/9/2017 57

58. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
58

59. 3/9/2017
Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
59

60. 3/9/2017 60
Thank you