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


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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.

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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

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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.

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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 Sshaped curve that form the sigmoid sinuses which go on to form the two jugular veins.

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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

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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).

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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).

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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.

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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

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