Neurophysiology

Understanding
how the nervous system works

Zainal Muttaqin, M.D., Ph.D.

dnS
Department of Neurosurgery, Diponegoro University
Central Nervous System (CNS)
• CNS – composed of the brain and spinal cord
• Cephalization
• Elaboration of the anterior portion of the CNS
• Increase in number of neurons in the head
• Highest level is reached in the human brain

Basic Pattern of the Central Nervous System

• Spinal Cord
• Central cavity surrounded by a gray matter core
• External to which is white matter composed of myelinated fiber tracts
• Brain
• Similar to spinal cord but with additional areas of gray matter
• Cerebellum has gray matter in nuclei
• Cerebrum has nuclei and additional gray matter in the cortex
Basic Pattern of the Central Nervous System

The Brain
• Composed of wrinkled,
pinkish gray tissue
• Surface anatomy
includes cerebral
hemispheres,
cerebellum, and brain
stem
Embryology :
Neuroectodermal origin,
forming the neural tube,
consist of the walls and
their respective, fluid-
filled space called vesicles
Prosencephalon Mesencephalon Rhombencephalon
P. vesicles M. vesicle R. vesicle
Telencephalon Diencephalon Mesencephalon Metenceph. Myelenceph.

Cerebral Cortex Diencephalon Mesencephalon Pons-Cereb. MO-MS

Lateral ventr. 3rd.ventricle Sylvian aquaeduct 4th.ventricle - central canal

dnS
Department of Neurosurgery, Diponegoro University
Space Restriction and Brain Development

Figure 12.3
 Adult
Brain
Structures

• Fates of the secondary brain vesicles:

• Telencephalon – cerebrum: cortex, white matter, and basal nuclei
• Diencephalon – thalamus, hypothalamus, and epithalamus
• Mesencephalon – brain stem: midbrain
• Metencephalon – brain stem: pons
• Myelencephalon – brain stem: medulla oblongata
Adult Neural Canal Regions
• Adult structures derived from the
neural canal
• Telencephalon – lateral ventricles
• Diencephalon – third ventricle
• Mesencephalon – cerebral aqueduct
• Metencephalon and myelencephalon
– fourth ventricle

Figure 12.2c, e
CNS Imaging
and
Anatomy

dnS
Department of Neurosurgery, Diponegoro University
Cerebral Hemispheres
• Form the superior part of the brain and make up 83% of its mass
• Contain ridges (gyri) and shallow grooves (sulci)
• Contain deep grooves called fissures
• Are separated by the longitudinal fissure
• Have three basic regions: cortex, white matter, and basal nuclei

Major Lobes, Gyri, and Sulci of the Cerebral Hemisphere

• Deep sulci divide the hemispheres into five lobes:
• Frontal, parietal, temporal, occipital, and insula
• Central sulcus – separates the frontal and parietal lobes
• Parieto-occipital sulcus – separates the parietal and occipital lobes
• Lateral sulcus – separates the parietal and temporal lobes
• The precentral and postcentral gyri border the central sulcus
Cerebral Cortex
• The cortex – superficial gray matter; accounts for 40% of the mass of the brain
• It enables sensation, communication, memory, understanding, and voluntary
movements
• Each hemisphere acts contralaterally (controls the opposite side of the body)
• Hemispheres are not equal in function
• No functional area acts alone; conscious behavior involves the entire cortex

Functional Areas of the Cerebral Cortex

• The three types of functional areas are:
• Motor areas – control voluntary movement
• Sensory areas – conscious awareness of sensation
• Association areas – integrate diverse information
Functional Areas of the Cerebral Cortex
Functional Areas of the Cerebral Cortex
Cerebral Cortex
- total area about 0.25m2, consist of about 10 billion neurons
- cell variation : granular , agranular, fusiform, pyramidal, etc.
- cell layers, motor cortex c.o. 6 layers; I-IV sensory function,
and pyramidal neurons in layer V and VI
- Brodmann‘s numbering, according to histological studies ;
area 4 : primary motor cortex; 1,2,3 : primary sensory cortex
- presence of afferen and efferen pathways between thalamus
and cortex, cortex is an outgrowth of thalamus

dnS
Department of Neurosurgery, Diponegoro University
Cerebral Cortex
Somatotopic Arrangement :

- receptor for each sensory modality represented separately by

different neurons in the somatosensory area of the cortex.
- somatotopically arranged as each hemisphere controls contra-
lateral side of the body; the lower part of the body controlled
by neurons located in the upper part of the respective cortex.
- number of neurons (so as its cortical area) controlling/ repre-
senting a certain body part is proportional to function of the
respective body part, not anatomical size of the body part (s).

dnS
Department of Neurosurgery, Diponegoro University
 Sensory Functions
I. 1. Primary visual area
P
F 2 2. Primary somatosensory area
2a
4 3. Primari auditory area
3a O1
1a
3

T just for simple analysis, such as localization

II. Secondary area : association area, for more difficult analysis

located just outside or surrounding the specific primary areas : 1a, 2a, 3a.

III. Tertiary area : for complex analysis, center of interpretation

located between main association areas, only in the dominant hemisphere/cortex : 4

dnS
Department of Neurosurgery, Diponegoro University
Motor Functions
1. Primary motor cortex
2 1 the beginning of pyramidal tract
3
2. Broca area and Hand (Exner) areas
2
coordinating activity of all muscles
related to speech & hand movements
(located at pre-motor cortex)

3. Prefrontal cortex : additional area for cerebration or thinking

- planning the future, planning sequence of movements
- postponing planned works related to incoming new information
- solving difficult problems, mathematic, datas - diagnosis, etc.
- correlating behavior with values, polite or unpolite, good or bad

dnS
Department of Neurosurgery, Diponegoro University
Sensory Perception :
Primary area ;
- auditory : not deaf, but don･t understand what is heard
- visual : not blind, but don･t understand what is seen
- somatosensory : not anesthesia, but don･t understand what is felt

Secondary/ association area ;

- understood what is heard / seen, but not in a coherent manner; such
as reading without understanding the meaning of sentences

Tertiary/ interpretation area ;

- a higher brain function / cerebration, mainly developed in the left /
dominant side; from birth to 6 year-old right and left side still same
- the word “dominant” is for intellectual /verbal /language function

dnS
Department of Neurosurgery, Diponegoro University
Cerebral Cortex: Motor Areas
• Primary (somatic) motor cortex
• Premotor cortex
• Broca’s area
• Frontal eye field
Primary Motor
Cortex
• Located in the precentral gyrus
• Composed of pyramidal cells
whose axons make up the
corticospinal tracts
• Allows conscious control of
precise, skilled, voluntary
movements
• Motor homunculus –
caricature of relative amounts
of cortical tissue devoted to
each motor function
Premotor Cortex
• Located anterior to the precentral gyrus
• Controls learned, repetitious, or patterned motor skills
• Coordinates simultaneous or sequential actions
• Involved in the planning of movements

Broca’s Area
• Located anterior to the inferior region of the premotor area
• Present in one hemisphere (usually the left)
• A motor speech area that directs muscles of the tongue
• Is active as one prepares to speak

Frontal Eye Field

• Located anterior to the premotor cortex and superior to Broca’s area
• Controls voluntary eye movement
Sensory Areas
• Primary somatosensory cortex
• Somatosensory association cortex
• Visual and auditory areas
• Olfactory, gustatory, and vestibular cortices
Primary
Somatosensory
Cortex
• Located in the postcentral gyrus, this
area:
• Receives information from the skin and
skeletal muscles
• Exhibits spatial discrimination
• Somatosensory homunculus –
caricature of relative amounts of
cortical tissue devoted to each
sensory function
Somatosensory Association Cortex
• Located posterior to the primary somatosensory cortex
• Integrates sensory information
• Forms comprehensive understanding of the stimulus
• Determines size, texture, and relationship of parts

Visual Areas
• Primary visual (striate) cortex
• Seen on the extreme posterior tip of the occipital lobe
• Most of it is buried in the calcarine sulcus
• Receives visual information from the retinas
• Visual association area
• Surrounds the primary visual cortex
• Interprets visual stimuli (e.g., color, form, and movement)
Association Areas
• Prefrontal cortex
• Language areas
• General (common) interpretation area
• Visceral association area
Prefrontal Cortex
• Located in the anterior portion of the frontal lobe
• Involved with intellect, cognition, recall, and personality
• Necessary for judgment, reasoning, persistence, and conscience
• Closely linked to the limbic system (emotional part of the brain)

Language Areas
• Located in a large area surrounding the left (or language-dominant) lateral sulcus
• Major parts and functions:
• Wernicke’s area – involved in sounding out unfamiliar words
• Broca’s area – speech preparation and production
• Lateral prefrontal cortex – language comprehension and word analysis
• Lateral and ventral temporal lobe – coordinate auditory and visual aspects of language
General (Common) Interpretation Area
• Defined region including parts of the temporal, parietal, and occipital lobes
• Found in one hemisphere, usually the left
• Integrates incoming signals into a single thought
• Involved in processing spatial relationships

Visceral Association Area

• Located in the cortex of the insula
• Involved in conscious perception of visceral sensations
 Lateralization of Cortical Function
• Lateralization – each hemisphere has abilities not shared with its partner
• Cerebral dominance – designates the hemisphere dominant for language
• Left hemisphere – controls language, math, and logic
• Right hemisphere – controls visual-spatial skills, emotion, and artistic skills
Cerebral White Matter
• Consists of deep myelinated fibers and their tracts
• It is responsible for communication between:
• The cerebral cortex and lower CNS center, and areas of the cerebrum

• Types include:
• Commissures – connect corresponding gray areas of the two hemispheres
• Association fibers – connect different parts of the same hemisphere
• Projection fibers – enter the hemispheres from lower brain or cord centers
Fiber Tracts in White Matter
Fiber Tracts in White Matter

Figure 12.10b
Cortical networks dysfunction :
Agnosia ;
- auditory agnosia : not deaf but fails to recognize specific sounds/ speech/ music
- visual agnosia : not blind, but fails to recognize object visually, prosopagnosia
means failure to recognize familiar faces
- tactile agnosia : inability to recognize objects by touch
Apraxia ;
- ideomotor apraxia: inability to perform complex acts on command, but the same
acts can be performed automatically
- ideational apraxia: failure to perform sequences of acts, but not individual act
- kinetic/ motor apraxia/ gait apraxia: paient has his feet ‘glued to the floor’
Aphasia ;
- Broca’s aphasia : comprehend spoken/ written language, but difficult with speech
- Wernicke’s aphasia: poor speech comprehension, incorrect word to express thought,
use words without precise meaning, or may substitute words

dnS
Department of Neurosurgery, Diponegoro University
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dnS
Department of Neurosurgery, Diponegoro University