VA Mid-Atlantic Health Care Network

Robin Hurley, MD, FANPAMIRECC Associate Director - EducationACOS/Research and Academic Affairs Service LineW.G. “Bill” Hefner VAMC, Salisbury NCProfessor, Psychiatry and RadiologyWake Forest School of Medicine

Katherine Taber, PhD, FANPAMIRECC Assistant Director - EducationResearch Health ScientistW.G. “Bill” Hefner VAMC, Salisbury NCResearch Professor, Div Biomedical SciencesEdward Via College of Osteopathic Medicine

Windows to the Brain:Introduction to Neuroanatomy

Overview

Lobes, Gyri & SulciGeneral FunctionsBrodmann’s AreasBasal Forebrain

SubcorticalStructuresSymptoms

Planes of SectionRadiographic PerspectiveMajor Divisions

Cortical

revised September 2019

CerebellumStructuresSymptoms

1

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Planes of Section

2

Ante

rior

Post

erio

r

Superior

Inferior

Lateral View

axial plane of section

coronal plane of section

sagittal plane of section

Medial

Lateral

Inferior (Bottom) View

Ante

rior

Post

erio

r

coronal plane of section

In medical practice the mostcommon way to view the brain isthe two dimensional sectionsprovided by magnetic resonanceimaging (MRI) and computedtomography (CT). While it ispossible to image the brain invirtually any orientation, the axialplane of section is used mostoften as it allows the entire brainto be captured in the fewestnumber of sections. Anatomistsprefer the coronal plane of sectionbecause many structures,particularly small ones, are moreeasily recognized. Note that boththe axial and sagittal planes ofsection go from the front (anterior)to the back (posterior) of the brain.Axial goes from one side to theother (medial to lateral). Sagittalgoes from top (superior) to bottom(inferior).

sagittal plane of section coronal plane of sectionaxial plane of section

R L R L[1] The left side of an axial or coronal brain image is the right side of the brain:

patient’sright

patient’sleft

viewer

viewer is at patient’s feetlooking toward thepatient’s head

patient is lying on his/her back (supine)

All radiographic images are displayed using a single set of conventions:

There are 2 key differences between the radiographic perspective and theanatomic perspective that are important to remember when viewing clinical brainimages.

[2] On axial images brainstem and spinal cord will be inverted compared to howthey are displayed in most teaching and reference materials:

Clinical images are displayed in the radiographic perspective. Most teaching andreference materials use the anatomic perspective.

Radiographic Perspective

3

patient’sright

patient’sleft

viewer

z

Midline Medial (Parasagittal) View Lateral View

4

Major Divisions

SecondaryDivisions

PrimaryDivisions

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Final Areas Formed

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*Taber KH, Salpekar J, Wong AHC, Hurley RA. J Neuropsychiatry Clin Neurosci 2011;23(1): 1-5.

Major Divisions

The 5 secondary divisions arecolor-coded onto magneticresonance images to provideoverall orientation.

The neural tube (illustrated in schematic form) expands locally to form the 3primary divisions or vesicles: forebrain (prosencephalon, yellow), midbrain(mesencephalon, green), and hindbrain (rhombencephalon, purple). These inturn form the 5 secondary divisions. The forebrain vesicle subdivides intotelencephalon (yellow) and diencephalon (light green). The hindbrain vesiclesubdivides into the metencephalon (blue) and myelencephalon (pink). *

ponspons

medulla

cerebellumcerebellum

medulla

midbrain

diencephaloncorpus callosum cerebral cortex

cerebral cortex

medulla

pons

cerebellum

cerebral cortex

Inferior (Bottom) View

temporal

frontal

frontal

parietal

parietal

occipital

occipital

temporal

Inferior (Bottom) View

frontaloccipital

temporal

frontal occipital

temporal

limbic parietal

limbic

Medial

Lateral

Medial Orbital

frontal

occipital

limbic

parietal

frontallimbic

parietal

occipital

temporal

The highly in-folded cerebral cortex isthe largest single division of thehuman brain. Anatomists commonlydivide it into four sections or lobes -the frontal, temporal, parietal andoccipital lobes. Some consider thelimbic areas of cortex to comprise afifth lobe, whereas others includethese areas in the frontal andtemporal lobes and diencephalon.Note that the medial and posteriorinferior surfaces of the temporal lobecan only be seen on the drawings ofthe medial and inferior surfaces of thebrain. This is because the brainstemand cerebellum have been omitted onthe drawings.

5

Cerebral Cortex - Lobes

Midline Medial (Parasagittal) View Lateral View

UncusParahippocampal

Inferior Temporal

Fusiform

Gyrus RectusMedial Orbital

LateralOrbital

Posterior Orbital

AnteriorOrbital

Inferior TemporalFusiform

UncusParahippocampal

Gyrus RectusMedial Orbital

LateralOrbital

PosteriorOrbital

AnteriorOrbital

Inferior (Bottom) View

Sylvian Fissure(Lateral Sulcus)

Medial

Lateral

Central(Rolandic)

Sulcus

Postc

entra

l

Prec

entra

l

Occipital

Inferior Temporal

Middle Temporal

Superior Temporal

Infer

ior

Fron

talSu

perio

r Frontal

Mid

dle Fr

ontal

Orbital

Supramarginal

AngularSubcentral

SuperiorParietal

Lobule

Orbital

Sylvian Fissure(Lateral Sulcus)

Infer

ior

Fron

talSu

perio

r Frontal

Mid

dle Fr

ontal

Subcentral

Postc

entra

l

Prec

entra

l

Angular

Superior

Parietal Lobule

Supramarginal

Inferior TemporalMiddle Temporal

Superior Temporal Occipital

Central(Rolandic)

Sulcus

Sylvian Fissure(Lateral Sulcus)

Lateral View

Lingual

Cuneus

Paracentrallobule

PrecuneusCingulate

Gyrus Rectus

Supe

rio

r Frontal

Central (Rolandic) Sulcus

CalcarineSulcus

ParietooccipitalSulcus

Gyrus Rectus

Lingual

Cuneus

Paracentrallobule PrecuneusCingulate

Supe

rio

r Frontal

Fusiform

Uncus

Subcallosal(Paraolfactory)

Area Hippocampus

Central (Rolandic) Sulcus

Parahippocampal

Inferior Temporal

CalcarineSulcus

ParietooccipitalSulcus

Midline Medial (Parasagittal) View

An outfolding of the cerebralcortex is called a gyrus(plural is gyri), an infolding iscalled a sulcus (plural issulci). Some very large sulciare called fissures. Althoughmajor gyri and sulci arepresent in all normal brains,they can vary considerably inboth extent and location.Many areas haveconsiderable normalvariation in the foldingpatterns.

temporalfrontal occipital limbicparietal

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Major Gyri & Sulci

Naming

Smell Social Conduct,Insight &Judgment

VisuospacialRecognition

VisualOrientation,Guidance &

Scanning

Motor

Leg

Foot

Seeing, Color Vision,& W hole Object

Imaging

Somatosensory

Sensory Integration &Recognition

Focused Attention,Nonverbal Intellect& NonverbalMemoryManagement

Initiation& Synchronizationof Speech& ComplexMovements

Visual Orientation,Guidance & Scanning

VisuospacialRecognition

Naming

Focused Attention,Nonverbal Intellect

& NonverbalMemory

Management

Initiation& Synchronization

of Speech& ComplexMovements

SpeechProsody &GesturingHearing

Music & VoiceRecognition

AudiovisualAwareness &

Deficit Recognition

Hip

Arm

Hand

Face

Tongue

Hand

Face

Seeing

SensoryIntegration &

Recognition

Social Conduct,Insight & Judgment

MotorSomatosensory

SocialConduct,Insight &JudgmentSmell

RetrogradeEpisodicMemory

NonverbalMemory

& Emotion

VisuospacialRecognition

&W hole Object

Imaging

Seeing,Color Vision,

Naming

Medial

Lateral

Lateral ViewMedial (Parasagittal) View

FocusedAttention,

Verbal Intellect& VerbalMemory

Management

Social Conduct,Insight &Judgment

Initiation &Synchronization

of Speech& ComplexMovement

Naming

Smell

Leg

Foot

Motor Somatosensory

Leg

Foot Sensory Integration& Recognition

VisualOrientation,Guidance &

Scanning

VisualRecognition

Seeing, Color Vision &W hole Object Imaging

SmoothVisual

Pursuit

VisualRecognition

Naming

SpeakingHearing

Sensory Integration& Recognition

Hip

Arm

Hand

Face

Tongue

Hand

Face

HandHand

Face

FaceUndersta

nding

VerbalRepetition

Writing ToDictation

Reading AloudSpelling

Speech

FocusedAttention,

Verbal Intellect& VerbalMemory

Management

Visual Orientation,Guidance & Scanning

SeeingSocial

Conduct,Insight &Judgment

Motor SomatosensoryInitiation &

Synchronizationof Speech& ComplexMovement

SocialConduct,Insight &Judgment Smell

Verbal Memory& Emotion

VisuospacialRecognition

&W hole Object

Imaging

Seeing,Color Vision

Naming

Medial

Lateral

Right Hemisphere - In mostindividuals, the processing ofnonverbal information, such asmusic or visuospatial information,occurs primarily in the righthemisphere.

Left Hemisphere - In mostindividuals, the processing ofverbal information, includinglanguage, occurs primarily in theleft hemisphere.

temporalfrontal occipital limbicparietal

8

Major Functions

Inferior (Bottom) View

temporalfrontal occipital limbicparietal

Right Hemisphere

Left HemisphereLateral ViewMedial (Parasagittal) View

Inferior (Bottom) View

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Lateral Viewtemporal frontaloccipitallimbic parietal

In the early part of the 20th century, Brodmann defined cortical areas based upon featuressuch as the size, shape and distribution of neurons (cytoarchitecture). An approximation ofthese areas are provided in the illustrations below. Versions of this system are still widelyused. While useful, it is important to always keep in mind that Brodmann’s work was basedupon analysis of a single brain. Brains vary greatly in size, shape, and infolding patterns.Research has shown that there is a wide range in the extent of a specific Brodmann areawhen compared across individuals. Thus, such maps should be used only as extremelygeneral guides.

temporalfrontal occipital limbicparietal

9

Brodmann’s Areas

Medial (Parasagittal) View

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The basal forebrain area contains many cholinergic neurons in the basal nucleusof Meynert, nucleus of the diagonal band and septal nuclei. The general location

10

Basal Forebrain

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Coronal Brain Sections

Sagittal Brain Sectionof this important regionand its projections tocortex are approximatedon sagittal and coronalmagnetic resonanceimages. The basalforebrain cholinergicneurons project to cortexvia both medial andlateral routes. Fiberstravel to hippocampusvia the fornix, olfactorycortex via the olfactorytract and amydala viastria terminalis and theventral amygdalofugalpathway.

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Caudate - apathy, disinhibition, disorganization, executive dysfunction,depression, memory loss, atypical aphasia, psychosis, personality changes,and predisposition for delirium.

Putamen - most commonly language and behavioral deficits (i.e., atypicalaphasia, obsessive - compulsive traits, executive dysfunction); hemineglect,depression, and memory loss have also been reported.

Globus pallidus - anxiety, depression, apathy, psychosis, and central pain;less often reported symptoms include amnesia and cognitive deficits.

Fornix - memory deficits include impaired recent memory, syndrome oftransitory amnesia, and long-term anterograde amnesia.

Thalamus - (left) deficits in language, verbal intellect, and verbal memory(right) deficits in visuospatial and nonverbal intellect and visual memory,(bilateral) severe memory impairment (“thalamic amnesia”) as well asdementia; damage to the anterior and medial thalamus can also result indisturbances of autonomic functions, mood, and the sleep/waking cycle.

Amygdala - passivity or aggression, hypersexuality, hyperorality,hyperphagia, decreased fear, anxiety or startle, and decreased link betweenemotion and memory.

Hippocampal formation - primarily memory deficits includinganterograde and retrograde amnesia, inability to form new memories, andtemporally graded amnesia.

Mammillary body - memory deficits and psychosis.

Substantia nigra - primarily behavioral and emotional deficits (i.e.,apraxia, ataxia, aggression, and depression), with less frequent reports ofmemory and cognitive deficits.

Hypothalamus - aggression, violence, anorexia, depression, impairedshort-term memory, dementia, gelastic seizures, and altered sleep/wake cycle.

A brief guide to neuropsychiatric symptoms associated with injury to each of themajor subcortical structures is color-coded to match the illustration on theprevious page.

12

Major Subcortical Structures