BRAIN

The image on the left is the outside of the brain, viewed from the side, showing the
major lobes (frontal, parietal, temporal and occipital) and the brain stem structures
(pons, medulla oblongata, and cerebellum).

The image on the right is a side-view showing the location of the limbic system
inside the brain. The limbic system consists of a number of structures, including the
fornix, hippocampus, cingulate gyrus, amygdala, the parahippocampal gyrus and
parts of the thalamus.

Amygdala – limbic structure involved in many brain functions, including emotion,

learning and memory. It is part of a system that processes "reflexive" emotions like
fear and anxiety.
Cerebellum – governs movement.
Cingulate gyrus – plays a role in processing conscious emotional experience.
Fornix – an arch-like structure that connects the hippocampus to other parts of the
limbic system.
Frontal lobe – helps control skilled muscle movements, mood, planning for the
future, setting goals and judging priorities.
Hippocampus – plays a significant role in the formation of long-term memories.
Medulla oblongata – contains centers for the control of vital processes such as
heart rate, respiration, blood pressure, and swallowing.
Limbic system – a group of interconnected structures that mediate emotions,
learning and memory.
Occipital lobe – helps process visual information.
Parahippocampal gyrus – an important connecting pathway of the limbic system.
Parietal lobe – receives and processes information about temperature, taste, touch,
and movement coming from the rest of the body. Reading and arithmetic are also
processed in this region.
Pons – contains centers for the control of vital processes, including respiration and
cardiovascular functions. It also is involved in the coordination of eye movements
and balance.
Temporal lobe – processes hearing, memory and language functions.
Thalamus – a major relay station between the senses and the cortex (the outer
layer of the brain consisting of the parietal, occipital, frontal and temporal lobes).
Divisions of the Brain
Mesencephalon- midbrain
Function:
Controls Responses to Sight,Eye Movement, Pupil Dilation, Body Movement,Hearing
Location:
The mesencephalon is the most rostral portion of the brainstem. It is located
between the forebrain and brainstem.
Structures:
The mesencephalon consists of the tectum and tegmentum.
Prosencephalon- forebrain
Function:
Chewing ,Directs Sense Impulses Throughout the Body, Equilibrium, Eye Movement,
Vision, Facial Sensation, Hearing, Phonation, Intelligence, Memory, Personality,
Respiration, Salivation,Swallowing , Smell, Taste
Location:
The prosencephalon is the most anterior portion of the brain. It is also called the
forebrain.
Structures:
The prosencephalon consists of the telencephalon, striatum, diencephalon, lateral
ventricle and third ventricle.
Diencephalon
Function:
Chewing , Directs Sense Impulses Throughout the Body, Equilibrium, Eye Movement,
Vision, Facial Sensation, Hearing, Phonation, Respiration, Salivation, Swallowing,
Smell, Taste

Location:
The diencephalon is located between the cerebral hemispheres and above the
midbrain.
Structures:
The diencephalon includes the thalamus, hypothalamus, the optic tracts, optic
chiasma, infundibulum, Ventricle III, mammillary bodies, posterior pituitary gland
and the pineal gland.
Thalamus
Function:
Motor Control,Receives Auditory, Somatosensory, Visual Sensory Signals, Relays
Sensory Signals to the Cerebral Cortex
Location:
The thalamus is a large, dual lobed mass of grey matter cells located at the top of
the brainstem, superior to the hypothalamus.
Telencephalon
Function:
Determines Intelligence, Determines Personality, Interpretation of Sensory Impulses,
Motor function, Planning and Organization, Sense of Smell, Touch Sensation
Location:
The telencephalon is the anterior portion of the brain, rostral to the midbrain.
Structures:
The telencephalon consists of the cerebral cortex, basal ganglia, corpus striatum
and olfactory bulb.
Basal ganglia
Function:
Controls Cognition, Movement Coordination, Voluntary Movement
Location:
The basal ganglia is located deep within the cerebral hemispheres in the
telencephalon region of the brain. It consists of the corpus stratium, subthalamic
nucleus and the substantia nigra.
Rhombencephalon
Function:
Attention and Sleep, Autonomic Functions, Complex Muscle Movement, Conduction,
Pathway for Nerve Tracts, Reflex Movement, Simple Learning
Location:
The rhombencephalon is the inferior portion of the brainstem.
Structures:
The rhombencephalon is comprised of the metencephalon, the myelencephalon,
and the reticular formation.
Myelencephalon
Function:
Autonomic Functions, Breathing, Conduction Pathway for Nerve Tracts, Digestion,
Heart Rate, Swallowing, Sneezing
Location:
The myelencephalon is the most inferior portion of the brainstem.
Structures:
The myelencephalon is composed of the medulla oblongata.

STRUCTURES OF THE BRAIN

CEREBRAL CORTEX LOBES

Structure:
Frontal Lobes
Function:
Motor Functions, Higher Order Functions, Planning, Reasoning, Judgement, Impulse,
Control, Memory
Location:
The frontal lobes are the anterior portion of the cerebral cortex.
Occipital Lobes
Function:
Controls Vision, Color Recognition
Location:
The occipital lobes are the most caudal portion of the cerebral cortex.
Parietal Lobes
Function:
Cognition, Information Processing, Pain and Touch Sensation, Spatial Orientation,
Speech, Visual Perception
Location:
The parietal lobes are superior to the occipital lobes and posterior to the central
sulcus (fissure) and frontal lobes.
Temporal Lobes
Function:
Emotional Responses,Hearing, Memory, Speech
Location:
The temporal lobes are anterior to the occipital lobes and lateral to the Fissure of
Sylvius.
Insula
Function:
Associated With Visceral Functions, Integrates Autonomic Information
Location:
The insula is located within the cerebral cortex, beneath the frontal, parietal and
temporal opercula.
Broca's Area
Function:
Controls Facial Neurons, Controls Speech Production, Understanding Language
Location:
Broca's area is located in the left frontal lobe, around the opercular and triangular
sections of the inferior frontal gyrus.
Wernicke's Area
Function:
Language Comprehension
Location:
Wernicke's area is located in the left temporal lobe, posterior to the primary
auditory complex.
Brainstem
Function:
Alertness, Arousal, Breathing, Blood Pressure, Contains Most of the Crainal Nerves,
Digestion, Heart Rate, Other Autonomic Functions, Relays Information Between the
Peripheral Nerves and Spinal Cord to the Upper Parts of the Brain
Location:
The brainstem is located at the juncture of the cerebrum and the spinal column. It
consists of the midbrain, medulla oblongata, and the pons.
Cerebellum
Function:
Controls Fine Movement Coordination, Balance and Equilibrium, Muscle Tone
Location:
The cerebellum is located just above the brainstem, beneath the occipital lobes at
the base of the skull
Cerebral Cortex
Function:
Determines Intelligence, Determines Personality, interpretation of Sensory Impulses,
Motor Function, Planning and Organization, Touch Sensation
Location:
The cerebral cortex is the outer portion (1.5mm to 5mm) of the cerebrum. It is
divided into lobes: frontal, parietal, temporal and occipital. The insula is also found
in this region of the brain.
Cerebrum
Function:
Determines Intelligence, Personality, Interpretation of Sensory Impulses, Motor
Function
Planning and Organization, Touch Sensation
Location:
The cerebrum is located in the anterior portion of the forebrain. It is divided into two
hemispheres that are connected by the corpus callosum.

Corpus Callosum
Function:
Connects the Left and Right Hemispheres
Location:
The corpus callosum is a thick band of fibers located between the cerebral
hemispheres.
Cranial Nerves
Function:
Directs Sense Impulses Throughout the Body, Chewing, Equilibrium, Eye Movement,
Vision, Facial Sensation, Hearing, Phonation, Respiration, Salivation, Swallowing,
Smell
Taste
Location:
The olfactory, optic, oculomotor and trochlear cranial nerves are located in the
anterior portion of the brain. The trigeminal, abducens, and facial nerves arise in
the pons. The vestibulocochlear nerve arises in the inner ear and goes to the pons.
The glossopharyngeal, vagus, accessory and hypoglossal nerves are attached to the
medulla oblongata.
Fissure of Sylvius (Lateral Sulcus)
Function:
The fissure of sylvius is the large deep groove or indentation that separates the
parietal and temporal lobes.
Medulla Oblongata
Function:
Controls Autonomic Functions
Relays Nerve Signals Between the Brain and Spinal Cord
Location:
The medulla oblongata is the lower portion of the brainstem. It is inferior to the
pons and anterior to the cerebellum.
Pons
Function:
Arousal, Assists in Controlling Autonomic Functions, Relays Sensory Information
Between the Cerebrum and Cerebellum, Sleep
Location:
The pons is the portion of the brainstem that is superior to the medulla oblongata.

Cerebral blood flow or CBF

• It is the blood supply to the brain in a given time.

• The amount of blood that the cerebral circulation carries.

• 750 ml/min or 15% of the cardiac output

• It is equal to the cerebral perfusion pressure (CPP) divided by the

cerebrovascular resistance (CVR)
• CBF = CPP / CVR

• It is tightly regulated to meet the brain's metabolic demands, and on the

average must be maintained at a flow of 50 milliliters of blood per 100 grams
of brain tissue per minute in adult humans.
• It must be maintained within narrow limits because too much blood can raise
intracranial pressure (ICP), which can compress and damage delicate brain
tissue, and too little blood causes ischemia, or inadequate blood supply.
• An excess of 55 to 60 ml per 100 g per minute, called hyperemia, is more
than the brain needs and can contribute to an increase in intracranial
pressure.
• It is determined by a number of factors, such as viscosity of blood, how
dilated blood vessels are, and the net pressure of the flow of blood into the
brain, known as cerebral perfusion pressure, which is determined by the
body's blood pressure and intracranial pressure.
• Functional magnetic resonance imaging (MRI) and positron emission
tomography (PET) are neuroimaging techniques that can both be used to
measure CBF.
 Cerebral circulation

The brain, though representing 2% of the total body weight, it receives one fifth of
the resting cardiac output. This blood supply is carried by the two internal carotid
arteries (ICA) and the two vertebral arteries that anastomose at the base of the
brain to form the circle of Willis.

Carotid arteries and their branches (referred to as the anterior circulation) supply
the anterior portion of the brain while the vertebrobasilar system (referred to as
posterior circulation) supplies the posterior portion of the brain.

• The movement of blood through the network of blood vessels supplying the
brain.
• The arteries deliver oxygenated blood, glucose and other nutrients to the
brain and the veins carry deoxygenated blood back to the heart, removing
carbon dioxide, lactic acid, and other metabolic products.
 • The cerebral circulatory system has many safeguards. Since the brain is very
vulnerable to compromises in its blood supply, failure of these safeguards
results in cerebrovascular accidents, commonly known as strokes.

Cerebral arteries
• There are four cerebral arteries.

• The largest are the two internal carotid arteries, the left and right branches of
the common carotid arteries in the neck which enter the skull, as opposed to
the external carotid branches which supply the facial tissues.
• The two smaller arteries are the vertebral arteries, which branch from the
subclavian arteries which primarily supply the shoulders, lateral chest and
arms.
• Within the cranium, which houses the brain, the two vertebral arteries fuse
into the basilar artery, which is located underneath, and primarily supplies,
the brainstem.
• Both internal carotid arteries, within and along the floor of the cerebral vault,
are interconnected via the anterior communicating artery.
• Both internal carotid arteries are interconnected with the basilar artery via
bilateral posterior communicating arteries.
• The Circle of Willis considered to be an important anatomic vascular
formation, it provides backup circulation to the brain. In case one of the
supply arteries is occluded, the Circle of Willis provides interconnections
between the internal carotid arteries and basilar artery along the floor of the
cerebral vault, providing blood to tissues that would otherwise become
ischemic.

Cerebral venous drainage

• The venous drainage of the cerebrum can be separated into two subdivisions:
• Superficial system
 a) It is composed of dural venous sinuses, which have wall composed of
dura mater as opposed to a traditional vein.

• Deep system

a) It is primarily composed of traditional veins inside the deep structures

of the brain, which join behind the midbrain to form the Vein of Galen

• The dural sinuses are, therefore located on the surface of the cerebrum.

• Superior saggital sinus the most prominent sinus in which flows in the
saggital plane under the midline of the cerebral vault, posteriorly and
inferiorly to the torcula, forming the Confluence of sinuses, where the
superficial drainage joins with the sinus the primarily drains the deep venous
system.
• Two transverse sinuses bifurcate and travel laterally and inferiorly in an S-
shaped curve that form the sigmoid sinuses which go on to form the two
jugular veins.
• In the neck, the jugular veins parallel the upward course of the carotid
arteries and drain blood into the vena cava.
• This vein merges with the Inferior saggital sinus to form the Straight sinus
which then joins the superficial venous system.

Cerebral perfusion pressure or CPP

• The net pressure of blood flow to the brain.

• It must be maintained within narrow limits because too little pressure could
cause brain tissue to become ischemic (having inadequate blood flow), and
too much could raise intracranial pressure (ICP).
• CPP = MAP − ICP

• It is regulated by two balanced, opposing forces:

 1. Mean arterial pressure, or MAP
The arithmetic mean of the body's blood pressure, is the force that
pushes blood into the brain, and intracranial pressure is the force that keeps it
out.

• Increase MAP raises CPP.

• Increase ICP lowers CPP (this is one reason that increasing ICP in traumatic
brain injury is potentially deadly).
• CPP= MAP minus ICP, is normally between 70 and 90 mmHg in an adult, and
cannot go below 70 mmHg for a sustained period without causing ischemic
brain damage.
• Children require pressures of at least 60 mmHg.

Autoregulation

• It is a process wherein the brain maintains proper CPP.

• To lower pressure, blood vessels in the brain called arterioles dilate, or widen,
creating more room for the blood, and to raise pressure they constrict, or
narrow.
• Changes in the body's overall blood pressure do not normally alter cerebral
perfusion pressure drastically.
• At their most constricted, blood vessels create a pressure of 150 mmHg, and
at their most dilated the pressure is about 60 mmHg.
• Pressure-passive flow is a situation When pressures are outside the range of
50 to 150 mmhg, the blood vessels' ability to autoregulate pressure through
dilation and constriction is lost, and cerebral perfusion is determined by blood
pressure alone.
• Factors that can cause loss of autoregulation include:
 a. free radical damage
b.nervous stimulation, and
c.alterations in blood gas content

• Amounts of carbon dioxide and oxygen in the blood affect constriction and
dilation even in the absence of autoregulation: excess carbon dioxide can
dilate blood vessels up to 3.5 times their normal size, lowering CPP, while
high levels of oxygen constrict them.
• Hypoxia, or inadequate oxygen, also dilates blood vessels and increases
blood flow
• Blood vessels also dilate in response to low pH.

• Activity in a given region of the brain is heightened, the increase in CO2 and
H+ concentrations causes cerebral blood vessels to dilate and deliver more
blood to the area to meet the increased demand.
• Stimulation of the sympathetic nervous system raises blood pressure and
blocking it lowers pressure.

Anatomy of the cerebral circulation

The brain receives its blood supply from the heart by way of the aortic arch that
gives rise to the brachiocephalic (innominate) artery, left common carotid artery
(CCA) and the left subclavian artery.

A. Carotid Arterial System

1. Common Carotid artery (CCA):

The left CCA arises from the aortic arch while the right arises from the
bifurcation of the innominate artery.

2. External carotid artery (ECA)

It starts at the CCA bifurcation. Its branches supply the jaw, face, neck and
meninges. The bulk of the meningeal circulation is supplied by the middle
meningeal artery, the most important branch of the maxillary artery which is one of
the two terminal branches of the ECA (the other terminal branch is the superficial
temporal artery). These two terminal branches in addition to the occipital artery can
serve as collateral channels for blood supply to the brain in instances of obstruction
of the ICA. The ascending pharyngeal artery can serve as a source of blood in
instances of occlusion of the ICA.

3. Internal carotid artery (ICA)

It starts at the carotid sinus at bifurcation of CCA at the level of the upper border of
the thyroid cartilage at the level of the fourth cervical vertebra. It ascends just
behind and lateral to the hypopharynx where it can be palpated. It passes up the
neck without any branches to the base of the skull where it enters the carotid canal
of the petrous bone. It then runs through the cavernous sinus in an S-shaped curve
(the carotid siphon), then it pierces the dura (beginning its subarachnoid course)
and exits just medial to the anterior clinoid process and then ascends to bifurcate
into anterior cerebral artery and the larger middle cerebral artery.

Branches of the ICA include:

1. Ophthalmic artery

It arises in the cavernous sinus as the first major branch of the ICA. It passes
through the optic canal to supply the eye and other structures of the orbit. Central
artery of the retina is its most important branch. It ends by supplying a patch of skin
on the medial aspect of the forehead.

2. Posterior communicating artery (PoCA)

It arises just before the termination of the ICA and passes backward to join the first
part of the posterior cerebral artery (PCA). This connection can be a vital link to one
or the other in instances of disease. Unfortunately, in over twenty per cent of cases
the artery on one or the other side is small and can not serve this function. It
supplies the optic tract, chiasma, the thalamus, hypothalamus and the midbrain.
3. Anterior choroidal artery

It originates occasionally from the PoCA or the middle cerebral artery (MCA), the
anterior choroidal artery usually arises from the ICA just beyond the origin of the
PoCA. It supplies the choroid plexus of the lateral ventricle, the optic tract, the
internal capsule, medial parts of the basal ganglia, the medial parts of the temporal
lobe, the thalamus, the lateral geniculate body, the proximal optic radiation and the
midbrain. The anterior and posterior choroidal arteries join the carotid and the
vertebrobasilar systems.

4. Anterior cerebral artery (ACA)

It passes anteromedially via the horizontal plane to enter the interhemispheric

fissure, anastomoses with the contralateral ACA via the anterior communicating
artery (ACoA) forming the anterior portion of the circle of Willis. It supplies the
anterior and the medial parts of the cerebral hemispheres. Small branches (medial
striate arteries) also supply parts of the optic nerve and chiasma, hypothalamus,
anterior basal ganglia and internal capsule. One of these branches is of sufficient
size to be named: the recurrent artery of Heubner, which supplies the anterior limb
of the internal capsule.

5. Middle cerebral artery (MCA)

It is the largest branch of ICA and appears almost as its direct continuation. It
passes laterally entering the Sylvian fissure and divides into two to four branches
supplying the lateral parts of the cerebral hemispheres. It supplies most of the
hemisphere including the bulk of the convexity except for thin superior and inferior
strips. From its main stem, a medial and lateral group of tiny lenticulostriate arteries
pass upwards to penetrate the base of the brain and supply the basal ganglia and
the superior portion of the anterior and posterior limbs of the internal capsule.

B. Vertebrobasilar System

1. Vertebral artery
It arises from the proximal subclavian artery and ascends through the transverse
foramina of the first cervical vertebra. It then passes posteriorly around the articular
process of the atlas to enter the skull through the foramen magnum. The two
vertebral arteries join each other at the level of the pontomedullary junction to form
the basilar artery. The vertebral artery gives rise to anterior and posterior spinal
arteries, the posterior inferior cerebellar artery and branches to the medulla.

2. Basilar artery

It is formed by the two vertebral arteries joining each other in the midline. It
ascends along the ventral aspect of the pons. It ends at the ponto-midbrain junction
where it divides into two posterior cerebral arteries. It gives rise to anterior inferior
cerebellar artery, superior cerebellar artery and numerous paramedian, short and
long circumferential penetrators. The internal auditory (labyrinthine) artery arises
from the basilar artery in about 20 % of the population whereas in the remainder it
arises from the anterior inferior cerebellar artery.

3. Posterior cerebral artery (PCA)

The basilar artery ends by dividing into the two posterior cerebral arteries. They
encircle the midbrain close to the occulomotor nerve at the level of tentorium
cerebelli and supply the inferior part of the temporal lobe and the occipital lobe.
Soon after their origin, they anastomose with the posterior communicating arteries
to complete the circle of Willis. Many small perforating arteries arise from PCA to
supply the midbrain, the thalamus, hypothalamus and geniculate bodies. In fifteen
per cent of the population, the PCA is a direct continuation of the PoCA, its main
blood supply then comes from the ICA rather than from the vertebrobasilar system