MORPHOLOGY

OF THE BRAIN
• Brain hemsipheres are formed of an outer layer called
the cerebral cortex and inner mass of white matter

• Embedded in the white matter of the brain are the

diencephalon and the nuclei called the basal ganglia
• Right and left hemispheres are partially seperated by
the longitudinal fissure
– Falx cerebri extends in this fissure

• Transverse fissure lies between the cerberum and

cerebellum
– Tentorium cerebelli extends in this fissure
• Elevations on the outer surface are called the gyri, which are
sperated by the depressions called the sulci

• The main sulci are

– Central sulcus
– Parieto-occipital sulcus
– Lateral sulcus

• The above sulci divide the brain into its lobes

– Frontal
– Parietal
– Temporal
– Occipital
– Insula
CEREBRAL
CORTEX
• Cerebral cortex is the most outer layer of the cerebral
hemispheres and formed of grey matter

• There are also nerve fibers running at right angles or

parallel to the cortical surface

• Grey matter of the cerebral cortex is organized in six

different histologic layers

• Cerebral cortex is the highest level of the nervous

system

• Responses of the cerebral cortex are influenced both

by inherited programs and acquired programs learned
during life
• By evaluating the organization of the neurons
and nerve fibers, Brodmann (1909) identified
50 different areas of cerebral cortex

• These are called Brodmann areas

 FUNCTIONAL AREAS OF THE
CEREBRAL CORTEX

• Our knowledge on the functional areas of the

cortex are gathered mostly by clinical
evaluation of the patients, research carried on
animals, electrophysiologic studies, EEG,
PET, MRI

• Functional significance of many cortical areas

still remains to be identified
• Cortical areas are classified as sensory areas, motor
areas and association areas

• Association areas occupy a large amount of space

(prefrontal, posterior parietal and temporal
association regions)
– Functions such as thinking, planning, evaluating,
interpreting, drawing conclusions are mostly carried out in
the association areas
– Association areas, receive and integrate different sensory
modalities, evaluate the information with recalling the
appropriate memories and create behavior and attitude of
the individual
Clinical note

• Patients having lesions in certain association areas experience

agnosia
• There is no primary sensory loss
• Patients can not evaluate the sensory information
• Agnosia is a general term indicating indicating inabilities such as
– identifying the objects by touching
– recognizing objects in the visual field
– interpreting the sound
 SENSORY AREAS

• Primary sensory areas receive specific sensory

information mainly through thalamocortical fibers
• At this level sensations reach our consciousness
• It is suggested that some of the sensation could be
perceived at the thalamus
• After the primary evaluation of the sensory impulses
they are conveyed to the secondary sensory areas for
further evaluation
Primary sensory areas

Identified primary sensory areas

• Primary somesthetic area, (Brodmann 3, 1, 2)

• Primary visual area (Brodmann 17)
• Primary auditory area (Brodmann 41, 42)
• Taste area (Brodmann 43) are the
• Primary olfactory area is described as the pyriform cortex and
periamygdaloid cortex (was not numbered by Brodmann) –
involves part of Brodman 48 and its anterior part
Secondary sensory areas

• Secondary sensory areas lie in the close vicinity of the

primary sensory areas
• These are higher level of assessment and interpretation of
specific sensory information
• Most of their afferent fibers originate from the primary
sensory areas
Primary somesthetic area (S 1)

• Related with general somatic sensation (touch, pain, pressure,

temperature, conscious proprioception)
• Lie in the postcentral gyrus (Brodmann areas 3, 1 and 2)
• Receives projection fibers from VPL ve VPM nuclei of
thalamus
• Receives information from the contralateral half of the body
Secondary somesthetic area (S 2)

• Lies in the parietal operculum (below S1)

• Receives bilateral fibers from S1 of each side
• Functional significance is not fully known – probably higher
degree of evaluation of the sensory information
Clinical note

• Lesions of the primary somesthetic area cause contralateral

disturbances such as,
– Problems in perceiving two point discrimination, sense of position,
vibration
– Astereognosia (inability to recognize the objects by feeling)
– Loss of tactile sensation, pain and temperature are partial (it is believed
that some of these sensations reach consciousness at the level thalamus)
– But patients can not locate such sensory information

• Isolated lesions of S2 does not cause significant sensory loss.

Primary visual area

• Lies in the occipital lobe (Brodmann 17), also known as striate

cortex
• Calcarine sulcus divides it into two parts
– Cuneus and lingual gyrus

• Primary visual area receive afferent fibers from the lateral

geniculate body through optic radiation
– Lateral geniculate bodies receive from each retina through the optic
nerve

• Receive visual information from the cotraletaral half of the

visual field
Secondary visual areas

• Brodmann areas 18, 19 and according to some authors also

part of 39
• Higher level integration of visual information takes place in
secondary visul areas
– Evaluates the information coming from the primary visual area
– Analyses the forms of the objects
– Detects the moving objects in the visual field
– Interprets the tones of the same colors etc.
Clinical note

• Lesions of primary visual area produce various types of partial

blindness of the visual field according to the location of the
lesion
• Lesions of secondary visual area produce problems in
recognizing the drawings, objects, faces, colors and movements
of the objects
Primary auditory area

• Comprises Brodmann area 41 – includes 42 according to some authors

• Receives afferent fibers from the medial geniculate body through auditory
radiation
– Medial geniculate body receives auditory information incoming with lateral
lemniscus
– Lateral lemniscus is the ascending pathway carrying auditory information
coming from inner ear via the cochlear nuclei
• Some of the afferent fibers from medial geniculate body projects also to
the Brodmann area 42 which is generally accepted to be an association
area for hearing
• Primary auditory area receives bilateral auditory information, though
contralateal fibers are dominating
• The area surrounding the primary auditory area is accepted as the
secondary auditory area (parts of 22 and 40)
Clinical note

• Lesions of the primary auditory area produce bilateral partial

deafness which is more prominent on the opposite site
• Patients experience problems in localizing the sounds
Taste area

• Lies in the parietal operculum (Brodmann 43)

• Receives afferent fibers related with taste coming from the
VPM nucleus of the thalamus
Vestibular areas

• Could not be defined exactly in human

• Thought to lie posterior to the postcentral gyrus (area 5 and
part of 7)
• Stimulation of the parts of the superior temporal gyrus
produced vertigo or vestibular related sensations
 MOTOR AREAS

• So called corticofugal fibers, originate from all areas

of cerebral cortex, projects to the lower centers of the
neuroaxis and they are related with motor functions
• Pyramidal cells of internal pyramidal layer
(ganglionic layer) of the cortex are the principal
efferent neurons of the cerebral cortex
– All of these neurons are activators influencing the motor
functions and all use glutamate as neurotransmitter
There are three main motor areas within the cerebral cortex
• Primary motor area (Brodmann 4)
• Premotor area (lower part of Brodman 6)
• Supplementary motor area (upper part of Brodman 6)

• There is another motor are known as the frontal eye field

which is specificly responsible for the voluntary movements
of the eyes
• Stimulation of the primary motor area produce simple motor
movements on the contralateral side
• Stimulation of the premotor and supplementary motor areas
produce more complex movements
• Stronger stimulation is needed to produce movement for the
premotor and supplementary motor areas
• Fibers originating from the motor areas of the cortex are
conveyed to the lower levels with the corticospinal and
corticonuclear fibers
– These fibers influence the activity of the motor neurons of the spinal
cord and brainstem respectively
– These pathways are direct pathways that manipulate the voluntary
muscle movement

• There are also indirect pathways that influence the voluntary

muscle movement
– i.e. some fibers originating from the cerebral cortex are relayed at the
reticular nuclei of the brinstem and influence motor activity through
the reticulospinal pathway
20-30 % of the fibers in the corticospinal tract
originate from the primary motor area
– These fibers terminate in the close vicinity of the motor
neurons of the anterior horn
– Fibers originating from the other cortical areas mostly
terminate in the posterior horn and exert their influence on
the anterior horn cells through a number of internuncial
neurons
– Therefore, the influence of the primary motor area on the
anterior horn motor neurons are more direct and higher
Afferents of the motor areas mainly originate
from three sources
– Afferents conveying information from periphery
• from primary somesthetic area and thalamus to primary
motor area
• from association areas to premotor area

– Basal ganglia to supplementary motor area

– Cerebellum to primary and premotor areas

Primary motor area

• Lies in the precentral gyrus and paracentral

lobule (Brodmann 4)

• In the primary motor area contralateral half of

the body is represented
MOTOR HOMONCULUS
Premotor area

• Lower part of Brodmann 6 (according to some

authors parts of 8, 44 and 45 are also included)

• This area is stimulated by auditory, visual and

somesthetic senses

• Its activity decreases with the onset of movement,

therefore, suggesting that it has a role in planning and
starting a voluntary movement in response to specific
sensory stimuli
Supplementary motor area

• Lies on the medial surface of hemisphere within the

anterior and upper parts of Brodmann’s area 6

• Function in motor activity is ill defined

• Lesions produce mostly akinesia and symptoms

resembling the dysfunction of the basal ganglia (note
that it recieves its afferents from the basal ganglia)
Clinical note

• Research carried in chimpanzees showed that isolated unilateral

lesions of the primary motor area produce flaccid paralysis and
hypotonia (decrease of muscle tone) on the contralateral half of
the body associated with loss of deep tendon reflexes
• However, after a certain period, reflexes return in an augmented
manner and muscle spasticity is evident
• Distal muscles are more seriously affected and more skilled
movements suffers most
Clinical note

• Combined lesions of the primary and secondary motor areas

produce spastic paralysis
• Spastic paralysis is due to the loss inhibitory influence of
extrapyramidal pathways on the muscles

secondary motor area functions in close association with the

basal ganglia and the reticular formation and constitute the basis
of the so called extrapyramidal system which tends to decrease
the muscle tone
Frontal eye field
• Mostly in the lower part of Brodmann’s area 8
• Functions in the voluntary conjugated eye movements to the
opposite side in order to focus on a moving object
• Stimulation results in conjugated deviation of the eyes to the
opposite side
• Lesions lead to deviation of the eyes to the side of the lesion
and inability to move the eyes to the opposite side
• An eye field also exists in the occipital cortex which functions
in involuntary conjugated eye movements
 CEREBRAL DOMINANCE

• Right and left hemispheres have functional differences and

certain functions are carried by one of the two hemispheres
which is called the dominant hemisphere

• Speech, perception of language, handedness are controlled by

the dominant hemisphere

• In most of the population the left hemisphere is dominant and

these individuals are tended to use their right hands better

• Dominant hemisphere is generally related with language and

analytic functions, whereas the non-dominant hemisphere
deals with musical abilities, recognition of faces, and certain
aspects of emotions
• The dominant hemisphere is mainly responsible for
language, calculation and speech, and verbal,
numerical and graphic symbolism
• On the other hand, the non – dominant hemisphere is
important in the appreciation of spatial dimensions,
totality of a scene (including recognition of faces),
and nonverbal symbolism
• A lesion to the parietal lobe of the nondominant
hemisphere results in amorphosynthesis – neglect
syndrome (denial of the existence of the contralateral
half of the body)
• Due to the loss of information transfer
between the hemispheres, certain disturbances
were observed in the patients who underwent
commissurotomy (surgical section of corpus
callosum performed for epilepsy treatment in the
past)

• The resulting symptoms are called the disconnection

syndrome
Clinical note

Disconnection syndrome
• The effects of disconnection are related to dominance of the
hemispheres for specific functions
• For instance, a patient with disconnection syndrome can
recognize an unseen object placed in the right hand, and can
verbally describe that object
• However, that same patient would be unable to recognize or
verbally describe the same object when it is placed in the left
hand
• This is because the tactile information is transferred to the
right hemisphere, which is disconnected from the speech
producing region of the left hemisphere
 ASSOCIATION AREAS

• These areas are generally accepted as the centers of

integration of different sensory modalities and
planning of motor activity

• Association areas are well developed in human when

compared to other mammals

• Functions attributed to these areas include awareness,

thought, planning, interpreting, drawing conclusions,
memory, certain aspects of behavior
• There are three main association areas
– Posterior parietal
– Prefrontal
– Anterior temporal
• Posterior parietal association areas
involve Brodmann's areas 5, 7, 39 ve 40
Clinical note

Neglect syndrome

• Due to the lesion of posterior parietal

association areas in the non-dominant
hemisphere
• Patients neglect their contraletaral body parts an
unaware of the environment in the opposite side
• Note that there is no sensory or motor loss on
the neglected side
• Prefrontal association areas involve the
regions of the frontal lobe located rostral to
the Brodmann's area 6
• These regions are involved in interpreting the
experiences and produce abstract ideas,
emotional feelings and personality
Clinical note

• Lesions of the prefrontal association areas

produce emotional changes (tendency to
euphoria), and difficulty in making decisions,
planning and problem solving
• Parts of Brodmann's areas 44 and 45 are
recognized as the motor speech area of Broca

• It is located in the dominant hemisphere

Clinical note

• Disturbances of recognition and expression of

spoken and written language is called aphasia
• Lesions of motor speech area produce motor
aphasia (expressive aphasia, Broca's aphasia)
• Temporal association areas comprise the
regions of the temporal lobe outside the
primary auditory area
• These areas are generally related with
memory
• Brodmann's area 22 – especially the posterior parts –
(Wernicke's area, sensory speech area) is an
important association area for speech
• Receives visual information as well as auditory
information
• This center functions in the recognition and
interpretation of spoken and written language
• It is located in the dominant hemisphere
• Wernicke’s area is connected to the Broca’s area by
the fibers conveyed in the arcuate fasciculus
Clinical note

• Lesions of Brodmann's area 22 produce sensory

aphasia (receptive aphasia, Wernicke's aphasia)
• Although there is no hearing loss , such patients can
not understand the spoken language
• Patient fluentlu speaks but does not know the
meanings of the words they use, they use incorrect
and/or nonexistent words
• They are unaware of their problem
Clinical note

• Lesions of arcuate fasciculus produce conduction

aphasia
• Patients can understand the spoken language, they are
aware of what they want to say but unable to talk
properly
• Lesions involving Brodmann's area 22 together with
39 and 40 produce alexia (inability to understand the
written language) and agraphia (inability to write)