Neurologic Disorders Caused by Lesions in

Particular Parts of the Cerebral Cortex

Zhu Hong-can M.D.

Department of Neurology ， the First Affiliated Hospital

of Zhengzhou University
Anatomic Consideration

The surface of the cerebral hemispheres is gray

substance (or called cerebral cortex), inside is white
substance.

The cerebral hemispheres is divided into the frontal,

temporal, parietal, occipital, insula.
 There is no definite
anatomic boundary between
the temporal lobe and the
occipital or posterior part of
the parietal lobe, but the
angular gyrus serves as a
landmark for the latter.
The Parietal lobe lying
behind the central sulcus and
The frontal lobe lie anterior to the
above the lateral fissure, the
central sulcus and superior to the
parieto-occipital sulcus marks
lateral fissure.
the posterior border(Occipital
The lateral fissure separates the
lobe).
superior surface of each temporal
The insula lobe lying in
lobe from the frontal lobe and
deep of the temporal lobe .
anterior parts of the parietal lobe.
 Language center is always in the left hemisphere,

but sometimes in the right hemisphere when someone

often uses left hand to do something.So we called left

hemisphere dominant hemisphere.

Clinical effects of frontal lobe lesions

Anatomy

The frontal lobe lie anterior to the central sulcus and

superior to the lateral fissure.
 Brodmann´s areas 4, 6, 8, and 44 relate

specifically to motor activities.

Area 4, 6 is located in precentral gyrus, area

8 is located in the middle frontal gyrus, area 44

is located in the posterior part of inferior frontal

gyrus.
Area 4 is primary motor cortex; Area 6 is
supplementary motor cortex.

Local lesion: contralateral limb hemiparalysis (stroke).

Local stimulation: contralateral limb convulsion

Jackson epilepsy: convulsion occured and spread to

contiguous regions of the motor cortex, for example,
contralateral limb thumb-wrist-elbow-shoulder.
Area 8 is concerned with cooperate
motor of eyeball.

Local lesion: gaze to ipsilateral,(stroke)

Local stimulation: gaze to contralateral.

(epilepsy)
Lesions of the dominant hemisphere
area 44 and 45 can cause Broca
aphasia.

Lesions of the posterior part of

middle frontal gyrus can cause
agraphia.
Lesions of the prefrontal areas give rise to
psychonosema:

(1) loss of judgement, loss of drive, impairment of

consecutive planning, inability to maintain serial
relationships of events and to shift easily from one
mental activity to another.

(2) In emotional sphere: anhedonia, apathy, loss of

self-control,etc.
 Lesions of the prefrontal
areas give rise to Ataxia of
contralateral limb.
Paracentral lobule

Paracentral lobule is the quadrilateral gyrus

around the end of the central sulcus on the
medial surface of hemisphere.

Lesion : bilateral leg palsy ; stool and urine

abnormal( many incontinence)
 Clinical effects of
temporal lobe lesions
Anatomy

The lateral fissure separates the superior surface of

each temporal lobe from the frontal lobe and anterior
parts of the parietal lobe.

There is no definite anatomic boundary between the

temporal lobe and the occipital or posterior part of
the parietal lobe, but the angular gyrus serves as a
landmark for the latter.
Lesions of the posterior part of superior temporal
gyrus can cause Wernicke’s aphasia
(word deafness - auditory verbal agnosia)

Lesions of the posterior part of middle and inferior

temporal gyrus can cause dysnomia or amnesic
aphasia （命名性失语） .
Homonymous upper quadrantanopia
(because the inferior part of optical
radiation passing this field. But the
visual field is inverted.)
Uncinate seizures :
Auditory, visual, olfactory, and gustatory
hallucinations.(epilepsy)

Emotional and behavioral changes

Effects of bilateral disease

Amnesic defect (hippocampal

formations)
Apathy and placidity.
Clinical effects of parietal lobe lesions

Anatomy

This part of the cerebrum, lying behind the central

sulcus and above the lateral fissure, the parieto-
occipital sulcus marks the posterior border.
Large acute lesions of white

matter can cause hemianesthesia.

But if lesions of cortex can cause cortical sensory
impairment:

loss of ability to localize tactile, to distinguish objects

by their size, shape, and texture(astereognosis);

loss of ability to recognize figures written on the

skin;

loss of ability to distinguish between single and

double contacts (two-point discrimination) sense.
 If stimulating focus, contralateral
limb acmesthesia, electricity or pain
seizure.
Disturbance of body image

(1) Autotopagnosis:
This term denotes the inability to
recognize part of one’s body. The patients
always used the right hand to do something
(dressing, etc.), and didn’t think the left hand
existed, or didn’t think the left hand is
himself. Right angular gyrus lesions.
(2) Anosognosia

The patients didn't aware of the

paralysis. Right supramarginal
gyrus lesions.
Apraxia :

Common implements and tools can no

longer be used, either in relation to the
patient's body or in relation to objects in
the environment.
For example: use match, lighter
Dressing and constructional apraxias:

Patients with dominant supramarginal gyrus

of parietal lobe lesions who exhibit no defects
in motor or sensory function lose the ability
to perform learned motor skills on command
or by imitation. For example: dressing, toy
bricks.
Gerstmann syndrome:

The lesion can be placed in the angular gyrus or

subjacent white matter of the hemisphere.

The characteristic features are inability to designate or

name the different fingers of the two hands(finger
agnosia), confusion of the right and left sides of the
body, and inability to calculate (dyscalculia) and to write
(dysgraphia). One or more of these manifestations may
be associated with word blindness(alexia).
Homonymous hemianopia or inferior
quadrant-anopia:

A lesion deep to the inferior part of

the parietal lobe, at its junction with
the temporal lobe, because the superior
part of optical radiation passing this
field. But the visual field is inverted.
Clinical effects of
occipital lobe lesions
The occipital lobe lying behind the
parieto-occipital.

Cortical blindness (pupils reaction):

With unilateral lesions of the occipital

lobes (destruction of area 17 of both
hemispheres), they loss sight, but
pupils reaction is normal.
Visual anosognosia(Anton Syndrome):

The main characteristic is denial of blindness by a

patient who obviously cannot see. The patient acts
as though he can see, and when attempting to walk,
collides with objects, even to the point of injury. He
may offer excuses for his difficulties: “I lost my
glasses,” “The light is dim,”etc.

The lesions in cases of negation of blindness extend

beyond the striate cortex to involve the visual
association areas.
Agnosia
The patients can see the things,
but can't recognize the things.
Lesions in the left parieto-
occipital region.

Stimulation:
visual hallucinations
The End !