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Neuro – Higher Cortical Systems
Dr. Ampil
Cerebrum – use the cortical not the subcortical
Dr. Broadman – came up with the brain nomenclature
Wernikers -39, 40

Cerebral cortex – seat of higher intellectual functions
 4 general functional categories
o Sensory
o Motor
o Unimodal association cortex
o Multimodal association cortex
 Primary sensory areas
 Receive thalamocortical fibers except olfaction
o Ventral post complex of thalamus  Broadmann, 3, 1, 2 in postcentral gyrus
o Lateral geniculate nucleus 
Broadmans 17 or primary visual cortex
o Medial geniculate body  Broadman 41- 42 or primary auditory cortex in transverse temporal gyrus
 Cerebral cortex: unimodal
 Association cortices
o Adjacent to each primary association area
o Devoted to a higher level of information processing associated to the primary specific sensory modality
o Visual association cortices
o Broadmans area 18, 19
o Relates the visual information received by the primary visual area to past experiences to enable the
individual to recognize and appreaciate what he is seeing
 Cerebral Cortex: Unimodal
 Association cortex
o Auditory association cortex
o Posterior to primary auditory area in superior temporal gyrus (Brodmann 22)
o Receives fibers from primary, auditory area and thalamus
o Function
 Interpretation of sounds
 Association of auditory input with other sensory information
o Somatosensory association cortex
 Posterior postecntral gyrus
 Superior parietal lobe (5, 7)
 Function:
 Receive and integrate different sensory modalities
 Ex. differentiating coins by touch
 Cerebral Cortex: Multimodal association cortex
o Receives information from several different sensory modalities and create complete experiences of our
surroundings
o Critical to higher cortical functions
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 Language, reasoning, planning, etc
 Dominant hemisphere and language
o Dominant hemisphere in majority is left
 In 95% of cases lft hemisphere damage affects language
 Almost all rt handed and ½ lft handed are lft cerebral dominant
 Rt hemisphere is non dominant in majority
o Language
 Faculty of communication using symbols organized by a system of grammar to describe things
and events and to express ideas
 Linked to vision and audition but transcends any particular sensory system
 Ex. Blind and deaf person can be eloquent
 Aphasia
 Disturbance of the comprehension and formulation of language
 Not a disorder of hearing, vision, or motor control
 Motor speech area of broca
o Infoerior frontal gyrus
o Broadman 44, 45
o Lft or dominant hemisphere
o Motor output of speech
o Connections with primary motor area (muscles of larynx, mouth, tounge, soft palate, and respiratory
muscle)
 Broca aphasia
o Usually due to occlusion of branches of MCA
 Aphasia
 Contralateral motion
o Conscious about communication problem so frustration very prominent
o Expressive aphasia or nonfluent aphasia
 Lesion in inferior frontal gyrus of left hemisphere (Broadmans area 44, 45)
o Difficulty in turning a concept or thought into a sequence of meaningful sounds
o Telegraphic speech
 Labored and slow speech, poor enunciation, nonessential words omitted
o If severe, can lead to mutism
o Typically with difficulty with writing (agraohia) as with speaking
o During recovery, short habitual phrases first to return (hi, yes, thank you)
 Temporal lobe
o Sensory speech area of Wernicke
 Left dominant hemisphere, superior temporal gyrus with extension around posterior end of
lateral sulcus into parietal area
 Connected to Broca’s area by arcuate fasciculus
 Function:
 Understanding of the written and spoken language
 Enable person to read, understand, and say aloud
o Wernicke aphasia
 Receptive or fluent aphasia
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 Defect of comprehension
 Damage to supramarginal and angular gyri (Brodmann areas 37, 38, and 40) and the posterior
part of the superior temporal gyrus (Brodmann area 22) in the left hemisphere
 Usually due to occlusion of temporal and parietal branches of MCA or thalamic
hemorrhage/tumor with extension laterally and invasion of subcortical WM.
 Meyer loop involvement leads to contralateral Homonymous hemianopsia (optic
radiation)
 If severe leads to:
 Inability to understand what is said to them
 Inability to read
 Inability to write comprehensible language (argraphia)
 Poor awareness of extent of disability
 Less frustration and depression than patients with Broca aphasia
 Display of fluent paraphasic speech
 Clear, fluent and melodic but unintelligible because of frequent errors of word choice
(inappropriate) or use nonsense words
o Literal paraphasia: use of similar sounding words
 The cat has claws  “the cat has clads”
 “spoon” ”smoon”
o Verbal paraphasia: use of different, incorrect word;
 “the cat has tires”
 “spoon”  “snopel”
o Semantic paraphasia: use of categorically related words
 “spoon”  “cup”
o Conduction aphasia
 Interruption of connections linking the Brocas and wernike areas
 Arcuate fasiculus
 Normal comprehension, fluent expression
 Impaired repitiion
 Global aphasia
o Occlusion of left internal carotid or most proximal portion of the MCA
o Involves Broca and Wernicke areas
 Characteristics of the aphasia syndromes (chart)
Syndrome Fluency Comprehension Repetition Localization in lft
Hemisphere
Wernicke’s Fluent Impaired Impaired Posterior Superior
temporal
Conduction Fluent Intact Impaired Arcuate fasiculus
Broca’s Nonfluent Intact Impaired Inferior frontal
Global Nonfluent Impaired Impaired Wernicke’s and
Broca’s area’s
(large perisylvian)
 Language: important points
o Damage to the left head of the caudate is association with the langage disorder of wernike aphasia type
o Nonverbal language can be affected
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 Ex. Understanding and performing sign language
o Nondominat hemisphere (parietal area) important with prodsody of speech
 Vocal inflections portray emotional content and affect meaning of spoken sentence
 Pareital association cortex: Space and attention
o Nondominat hemisphere
 Parietal association cortex most highly lateralized in the brain
o Attention deficit
 Leads to contralateral neglect
 Unaware of objects and events in the left half of his or her surrounding space
o Visuospatial dysfunction
o Constructional Apraxia
 Parietal Assiociation cortex: Contralateral neglect
o Tendency to ignore things on the left side of the patient’s surroundings
o In extreme cases, not able to recognize left side of own body (asomatognosia)
 Ignoring left side when dressing (dressing apraxia)
 Claims left side of body is different and not his
 Parietal Assiociation cortex: Visuospatial Dysfunction
o Inability to function successfully within the spatial surroundings
 Route from one area to another
 Drawing and visualizing floor plan of an area (ex. House)
 Navigating from an area to another
 Parietal Assiociation cortex: Manipulate Objects in Space
o Constructional apraxia
 Unable to duplicate a simple block construction while looking at a model
 Not due to a visual or motor problem
 Due to an inability to internalize and duplicate images
 Parietal Assiociation cortex: Other deficits
o Disorder of affect
 Reduced ability to understand and appreciate humor
o Loss of prosody appreciation
o Inappropriate cheerfulness
o Lack of concern for and awareness of illness implications
 Apraxia
o Damage in parietal association cortex, premotor cortex, supplementary motor cortex
o Not due to weakness of extremities
o Not able to carry out a complex task
o “Blow out a match”, “sniff a flower”, “Comb your hair”, brush your teeth
 Agnosia
o Damage in modality specific area of sensory association cortex
o Disorder of sensory perception, not a visual problem
o Difficulty in recognizing complex sensory stimuli
 Visual agnosia
 Faces, objects, and letters
 Auditory agnosia
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 Sounds, voices, or spoken words
 Tactile agnosia (asterognosis)
 Somatosensory type
 Inability to recognize a common object using the sense of touch alone
 Olfactory agnosia
 Gustatory agnosia
 Color agnosia
 Prefrontal cortex: Plans for future operation
o Distinct human intellectual traits
 Judgement
 Foresight
 Sense of purpose
 Sense of responsibility
 Sense of social propriety
 The case of Phineas Gage
o Foreman in railroad construction
o 3.5 ft long iron rod struck just beneath the left eye and exiting top of his head, destroying most of his
PFC
o Good physical recovery
o No paralysis, language and memory disorder
o Radical personality change
o “the balance between his intellectual faculties and animal propensities seems to have been destroyed.
He is fitful, irreverent, indulging at times in the grossest profanity, manifesting but little difference for
his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously
obstinate, yet capricious and vacillating, devising many plans for future operation, which are no sooner
arranged than they are abandoned… his friends and acquaintances said that he was “no longer the
same”
 Bilateral Damage of prefrontal cortex: Constellation of deficits
o Highly distractible
 Novelty of new stimulus irresistible
 Lack of consistenct of purpose
o Lack of foresight
o Unable to anticipate or predict future events on the basis of past events or present conditions
o Unusually stubborn
o Perseveration
o Lack of ambition
o Loss of sense of responsibility
o Loss of social propriety
 Prefrontal Cortex: Executive Function
o Planning, initiating, sequencing and monitoring behavior; Cognitive flexibility
o Dorsolateral prefrontal dysfunction



Dorsolateral
prefrontal cortex
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o Abstraction
 Table and chair
 Apple and orange
o Differences
 Lie and mistake
o Idiom and proverb interpretation
 “level headed”
 “People who live in glasshouses shouldn’t throw stones”
o Set Shifting
 Flexibility from one cognitive set to another
 Prefrontal Lobotomy
o 1930’s, by neurosurgeon Egas Moniz
o Treat severe , intractable mental problems
o Tranquilizer discovery in 1950’s provided more effective method of treatment with fewer undesireable
side effects
o Eventually abandoned
 Higher Cerebral Functions
o Left Hemisphere: Language
o Right hemisphere: Visuospatal function
o Prefrontal cortex: executive function
o Gnosis and praxis: function of different association areas in the brain

Caudate
(Dorsolateral)
Globus pallidus
(Lateral dorsomedial)
Thalamus (VA and
MD)