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CORTICAL FUNCTION

dr. Paulus Anam Ong Sp.S
dr. Yustiani Dikot Sp.S(K)
Bagian I.P. Saraf RSHS FKUP

Susunan saraf pusat

Cerebral
hemispheres

Batang otak Cerebellum
Brainstem

Spinal chord

Lobes of human cerebral cortex

PARIETAL
FRONTAL LOBE
LOBE OCCIPITAL LOBE

TEMPORAL
LOBE

Neuron axon soma Neuron Neuron Synapse dendrit .

CEREBRUM / FOREBRAIN p CONSIST OF 2 HEMISPHERE WHICH IS NOT SYMETRICAL IN SHAPE AND FUNCTION p THE LARGEST PART OF THE HUMAN BRAIN p COVERED BY GRAY MATTER CALLED CORTEX WHICH WAS FOLDED MADE GYRI AND SULCI .

Part Of Cerebral Cortex .

INTEGRATION AND MEMORY FUNCTION p PERCEPTION p MOTIVATION p MOVEMENT . MOTOR FUNCTION. THE THICHNESS VARIES IN DIFFERENT REGIONS p VIEWED LATERALLY COMPOSED OF FOUR LOBES. BROODMAN DEVIDED IN 47 AREAS WHICH SPECIFIC PART RESPECT FOR A CERTAIN ASPECT OF FUNCTION p FUNCTION ARE INTEGRATION IN DISCRIMINATIVE AND COGNITIVE PROCESSES RELATING TO AFFECTIVE BEHAVIOR.CEREBRAL CORTEX p CONSIST OF SIX LAYERS. SOMATOSENSORY PERCEPTION.

Functional Areas of The Cerebrum .

INTEGRATION FIBRES p INTEGRATION IN ONE HEMISPHERE ASSOCIATION FIBRES p INTEGRATION BETWEEN TWO HEMISPHERE COMMISURE FIBRES/CORPUS CALLOSUM p INTEGRATION WITH OTHER PART OF CNS PROJECTION FIBRES .

Right and Left Hemisphere Function .

Right and Left Hemisphere Function .

THE 47 AREAS Consist of p PRIMARY / PRINCIPLE RECEPTIVE AREA p ASSOCIATION AREA p INTEGRATION WITH OTHER PART OF THE HEMISPHERE / BRAIN .

Homonculus Cerebri .

The Lateral Aspect of Cerebrum .

The Medial Aspect of Cerebrum .

Frontal Lobe Parts .

BROCA’S AREA (DOMINANT HEMISPHERE) • Expressive centre for speech 3. arm. trunk 2. leg. SUPPLEMENTORY MOTOR AREA • Contralateral head and eye turning 4. PREFRONTAL AREAS • Personality and Initiative 5. PRECENTRAL LOBULE • Cortical Inhibition of bladder and bowel voiding . PRECENTRAL GYRUS (MOTOR CORTEX) • Contralateral movement face. FRONTAL LOBE FUNCTION 1.

IMPAIREMENT OF FRONTAL LOBE FUNCTION 1. BROCA’S AREA Broca’s dysphasia 3. PRECENTRAL GYRUS Incontinence of urine and fecal Loss of cortical inhibition . SUPPLEMENTARY MOTOR AREA Paralysis of head and eye movement to opposite site 5. PRECENTRAL GYRUS Monoplegia or hemiplegia depending on extent of damage 2.

Primitive reflexes (gasp. PREFRONTAL AREAS Change personality with antisocial behavior / loss of inhibition A. Resistance to passive movements of the limbs (paratonia) . Poor judgement 2. etc. 4. MEDIAL FRONTAL SYNDROME p Akinetic p Incontinent p Sparse verbal output Associated with : 1.ORBITOFRONTAL SYNDROME 1. FRONTAL CONVEXITY SYNDROME p Apathy p Indifference p Poor abstract thought C. Disinhibition 3. Disturbance of gait (gait apraxia) 3.pout. Emotional lability B.) 2.

Parietal Lobe Parts .

SUPRAMARGINAL AND ANGULAR GYRI • DOMINANT HEMISPHERE • Angular gyrus (Broadmann 39): Integration of auditory and visual aspects comprehension • Skill of handling numbers/calculation • NON-DOMINANT HEMISPHERE • Concept of body imaged and the awareness of the external environment • Ability to construct shape . PARIETAL LOBES FUNCTION 1. touch and passive movement 2. POSTCENTRAL GYRUS (Sensory Cortex) • Receives afferent pathways for appreciation of posture.

PARIETAL LOBE IMPAIRMENT 1. this area involve in Wernicke Aphasia NON-DOMINANT • Anosognosia. Geographical apraxia.42). DISTURBED • Postural sensation • Sensation of passive movement • Accurate localisation of light touch • Two point discrimination 2. Agraphia . Dressing apraxia. As part of lesion extension from Wernicke language area (posterior region of left superior temporal gyri /Broadman area 21. Finger agnosia. Acalculation. Constructional apraxia DOMINANT : (Gertman’s Syndrome) • Right and left limbs disorientation.

Temporal Lobe Parts .

adjacent to Hesch’s gyrus. THE LIMBIC LOBE • Sensation of olfaction • Emosional • Affective behavior 5. THE MIDDLE AND INFERIOR TEMPORAL GYRI • Learning and Memory 4. rhythm and music 2. AUDITORY CORTEX (Heschl’s gyrus) • Dominant è Hearing of Language • Non-Dominant è Hearing of sound. The superior temporal Gyrus. § auditory comprehension/ association area (left hemisphere: Wernicke Language area/Broadmann are 21. 42) 3. VISUAL PATHWAY . LOBUS TEMPORAL FUNCTION 1.

Left posterior region of superior gyri (BA 21. AUDITORY CORTEX (Cortical deafness) • DOMINANTè Difficulty in hearing spoken sounds • NON-DOMINANT è Amusia • Auditory hallucinations 2. OPTIC RADIATION • Upper homonymous qudrantanopia . LIMBIC LOBE • Olfactory hallucination with complex partial seizures • Aggressive or antisocial behavior • Inability to establish new memories 5. MIDDLE AND INFERIOR TEMPORAL GYRI • Disturbed memory / learning 4. Lesion may extend to angular gyri of left temporal lobe/BA 39) 3.42): Wernicke aphasia. TEMPORAL LOBE IMPAIRMENT 1.

Occipital Lobe Parts .

OCCIPITAL LOBE FUNCTION p Concerned with the perception of vision (The visual cortex) n Lies along the banks of the calcarine sulcus p The Striate cortex èPrimary visual cortex p Parastriate cortex è Association visual cortex .

ANTON’S SYNDROME • Involvement of both the striate and the parastriate cortices affects the interpretation of vision • Unaware of the visual loss and denies its presence 4. HOMONIMOUS HEMIANOPSIA 2. CORTICAL BLINDNESS • Extensive bilateral cortical lesions of the striate cortex 3. VISUAL ILLUSIONS (Non-dominant) • Micropsia / macropsia • Disappearance of colour 7. OCCIPITAL LOBE IMPAIRMENT 1. VISUAL HALLUCINATIONS • Elementary – unformed – appearing as patterns 6. BALINT’S SYNDROME • Simultanagnosia 5. PROSOPAGNOSIA • Able to see a familiar face but cannot named it .

Mental Status .

Language 4. concentration) 2. Memory 5. Higher cortical function . Arousal Mechanism ( alertness. Orientation 3. attention.5 basic element that build mental status 1.

1997) Memory Language • Arousal mechanism • Bahasa & memori: well developed and localized basic element elemen Concentration • Higher cortical function: depend on the 3 basic Attentioni element Arousal .Mayer.Basic element of mental status Higher cortical function Basic element of cogntion (Marshall.

g verbal memory test. oral calculation.Language p The basic tool of human communication and crucial in assessing most cognitive abilities p Must be establish early in the course of mental status testing due to most of the mental test are verbal oriented e. proverb test .

comprehension & word choice) is intact p Dysprosody: an interruption of speech melody (inflection and rhyme) that caused monotonal.Terminology p Dysarthria: specific disorder of articulation in which basic language (grammar. can at times mimic a foreign accent p Aphasia: a true deficit of higher integrative language processing. halting. patient produces errors of grammar and word choice or has a defect in comprehension .

Specifically refers to errors of language and not to problem with the actual formation of letter or poor handwriting .Terminology p Alexia: loss of (any level of) reading ability in previously literate person. p Dyslexia: a specific developmental learning disorders of children who have normal intelligence. yet experience unusual difficult in learning to read p Agraphia: an acquired disturbance in writing.

but also written language both comprehension (alexia) and production (agraphia) .Aphasia p Def: an acquired language impairment due to damage to language areas of the brain (left hemisphere) p Characterized by defects of: n Word selection n language production n language comprehension p Affect not only spoken.

n Trauma p Slowly progressive: n brain tumor n Degenerative process: Alzheimer disease.Etiology of aphasia p Acute n ischemic stroke (embolic/ thrombotic) in the distribution of middle cerebral artery n Cerebral hemorhage (hipertension. epileptic seizures . Aneurysm. Primary Progressive Aphasia p Transient: TIA. AVM.

Aphasia p 95% result from left hemisphere lesions ‘cause 95% of right handed individual and 70% of left handed are left hemisphere dominant for language p Crossed aphasia: aphasia after lesion of right hemisphere in a right handed individual .

Primary Language Area (perisylvian area) Girus Girus postsentralis presentralis Fasikulus Arcuatus Area Broca Area Wernicke Girus temporalis superior Sulkus lateralis .

Language model of Wernicke-Geswind kiri kanan .

Perisylvian area p Aphasia most often caused by damage of perisylvian language. that comprises of: n Broca’s area: motor programming of speech à Broca aphasia n Wernicke’s area: critical for auditory comprehension of spoken words à Wernicke aphasia n Arcuate fasciculus: links Broca’s and Wernicke’s areas. important for repetition à Conduction aphasia .

Extra perisylvian aphasias p Aphasia may also caused by lesions that do not directly damage the perisylvian language area. but isolate them from brain regions involved in semantic processing and production of volitional speech à Transcortical aphasias .

Clinical evaluation p Fluency p Naming p Repetition p Auditory comprehesion .

variation of pitch. loudness. well articulated.e.Fluency p Fluent aphasias n plentiful verbal output. easy produced utterances of relatively normal length and prosody (i. effortful utterances of short phrase length and disrupted prosody n Lesion: pre-Rolandic cortex . rhythm). n Lesions: post Rolandic cortex p Non Fluent aphasia: n sparse..

or anomia.Naming p All aphasic patients exhibit naming impairment. usually in combination with other language deficits p Isolated anomia à anomic aphasia .

Wernicke’s area) result in significant impairment of auditory processing .Auditory comprehension p Most aphasic patients show auditory processing defective p Anterior lesions result in relatively mild auditory comprehension impairment. whereas posterior lesions (esp.

Repetition p Requires intact perisylvian language area p Perisylvian aphasias: repetition distrubed p Extra-perisylvian aphasia: preserved of repetition .

Classification of Aphasia .

poor .Broca’s Area Executive or motor for production of language Broca’s dysphasia Þ Motor dysphasia p Nonfluent / hesitant speech p Telegraphic speech p Comprehension – relative preserved p Repetition – poor p Handwriting.

Wernick’s Area–Receptive Area Wernicke’s dysphasia p Comprehension – Impaired p Speech fluent but nonsensical p Neologism p Paraphasia – half right words p Patient unaware of language problems p Repetition: relative preserved p Hand writing poor .

poor .Conduction Aphasia n Speech nonsensical but fluent n Comprehension - normal n Repetition .

Global Aphasia p Non-fluent speech p Comprehension impaired p Repetition .poor .

. - Conduction aphasia Fluent . + - Anomia aphasia Fluent . + + +: relatively preserved -: relatively disturbed . . + - Mixed transcortical aphasia Non-fluent . . + Wernicke aphasia Fluent . + Gobal aphasia Non-fluent .Boston Aphasia Classification Aphasia syndromes Fluency Naming Repetition Auditory Comprehen sion Broca aphasia Non-fluent . + + Transcortical sensory aphasia Fluent . . - Transcortical motor aphasia Non-fluent .

Memory .

Registration 3. Recognition 2.Memory p Involves : 1. Recall – Retrieval p Anatomical basis of memory ß Hippocampus .

The Anatomical Basis of Memory .

Recent memory 3. Remote memory . Test of Memory 1. Immediate memory 2.

Disorder of Memory (Amnesia Syndrome) 1. Anterograde amnesia Ø Inability to learn new verbal or non-verbal information from onset of illness or injury . Retrograde amnesia Ø Impairment of memory for events that antedate illness or injury 2.

mild cognitive impairment amnestic type. a pre-dementia stage .Disorders of Memory Retrieval p Senescence – AAMI (Age Associated Memory Impairment) –retrieval of stored memory slow but accurate p Depression – disorder in motivation and concentration p Dementia – especially recent memories p MCI.

Constructional ability p Capacity to draw or construct two or three dimensional figures or shapes p Task n Copying line drawing n Drawing to command n Reconstructing block design p Parietal lobe dysfunction n Right hemisphere produces higher inciden and severity than the left. .

Constructional Abilities Copying Figures Stimulus Results .

Constructional Abilities Copying Figures .

Higher Cortical Function p Attention Basic buiding blocks for p Language development of higher p Memory cortical function Consists of : p Manipulation of well learned material p Abstract thinking p Arithmatic computation etc .

Proverb interpretation . General information/ knowledge 3. The fund of acquired information or the store of knowlegde • Assessed by : 1.1. Simple verbal test of vocabulary 2. Evaluation 1.

Similarities and Differences 3. Calculation 2. Social comprehension .2. Conceptual Series completion 4. Manipulation of old knowledge p Ability to apply information to new or unfamiliar situations p Assessed by : 1.

Related cortical functions
p Apraxia
p Right-Left disorientation
p Acalculia Gerstmann’s
p Agraphia Syndrome

p Finger Agnosia
p Visual agnosia
p Geographic disorientation

APRAXIA

Loss of ability to carry out skilled
movement despite adequate
understanding of task and normal
motor power

Ideomotor apraxia
p Separation of idea of movement from execution
• Dominant hemisphere lesion
• Unable to carry out commands:
• Buccofacial apraxia: “Show me how to blow out a
match” ; “drink through a straw” –
• Limb apraxia: “flipping a coin”, “saluting”, “kicking a
ball”
• Truncal apraxia: “stand like a boxer”
Task: fail in commandà imitating à real object

Apraxia Ideomotor .

sealing it. and placing a stamp on the envelop” . striking candle to match box p Bilateral diffuse cortex lesions especially parietal cortex Task: “ folding a letter.g.Ideational apraxia p Inability to carry out a sequence of movements p Higher order of complex motor planning than ideomotor apraxia p Difficulty in manipulating real object p Sometimes show object agnosia: e. placing it in an envelope.

Gait apraxia (Frontal lobe/anterior corpus callosum disease) 5.Other apraxias 3. Constructional apraxia and dressing apraxia (Non dominant parietal disease) 4. Occulomotor apraxia (Parieto-occipital disease) .

DISCONNECTION PATHWAY 1. INTERHEMISPHERE • Corpus callosum link related parts of the two hemisphere . INTRAHEMISPHERIC • Linking part of the same hemisphere 2.

Broca’s speech area poor repetition Wernicke’s speech area .Intrahemisphere Dysconnection Syndrome CONDUCTION APHASIA p Lesion of the arcuate fasciculus p Fluent dysphasia speech p good comprehension.

self initiated is normal p Patient seems deaf but audiometry is normal .Intrahemisphere Dysconnection Syndrome PURE WORD DEAFNESS p Lesion beetween the primary auditory cortex (Heschl’s gyrus) and auditory association cortex) p Impaired comprehension of spoken word.

INTERHEMISPHERE DISCONNECTION SYNDROME AGENESIS OF THE CORPUS CALLOSUM p No connection between the two hemisphere p Failure to name an object presented visually or by touch to the non-dominant hemisphere .

Interhemisphere Dysconnection Syndrome BUCCAL LINGUAL and SYMPATHETIC APRAXIA p Involves the links between left and right association motor cortices Premotor motor cortex Broca’s p Right brachiofacial area weakness and apraxia of tongue. lip and left limb movements .

INTERHEMISPHERE DISCONNECTION SYNDROME LEFT SIDE APRAXIA p Lesion of the anterior corpus callosum p Apraxia of the left sided limb move- ment .

to copy writing and the ability to identify colours n Inability to read letter (literal alexia) n Inability to read word (verbal alexia) .INTERHEMISPHERE DISCONNECTION SYNDROME ALEXIA WITHOUT AGRAPHIA PURE WORD BLINDNESS p Lesion of the posterior corpus callosum and dominat occipital lobe (primary visual area) p Inability to read. to name colours.

Alexia without agraphia Pure alexia Hemi alexia .