Sir eso nonay. uat) FIGURE 16-9 Iain and them stimulating various parts of the body tltermine i the cortical area being recorded c= ons to the simuls. For example, when the sur wish touches the paiene’s ager. only a small spe ‘fe ave of the corse, located in a consistent poston the cortex among vatious people, responds ‘Osher experiments involee mild elececal simul jon of the cortex. In dhese experiments the stimula: tion may elicit movements of a part of the body oF tase the patent ro reel a particular situation, iinaging techniques can ako be’ used to investigate Iyain function without inive procedures. For xa ses the brain activigy when 4 peson i having a eon- ‘ration can be recorded and analyze. Localized Functions of the Cerebral Cortex" Different arcs ofthe cerebral cortex ate specialized perform a variery of fanetons. Based on heir fine five categorie of cortex have been identifi + The primary sensory cortex discriminates among lif ferent iments and uals of sensory information. + The sensory assoiation cortex peronms more com plex anus of sensation, ason Motor laning| Emotions, nerery proces ov CHAPTER 6 391 + The soror planning areas organize movements The primary motor cortex provides descending tool of motor ouput + The asociation cortex coatols behavior, interprets sensation, and proceses emotions and memors Each ope of cortex may play a roe in response 10a scimalus. For example, when one secs a Bell the pe mary visual corte discriminates ts shape and. its Frighiness fom the background. The viual association Coen analyzer the bells color The association cortex may recall dhe name ofthe objec, what sound che bell Inakes and specific memories asocated with bel. The {sociation cortex ako participates in che decision of What 10 do withthe bel. I the decision isto lift che Fell premoror areas plan the movement, and then the primary motor cortex sends commands 10 neurons in the spinal cord. The How of cortical activity from the Primary semory cortex eo cortical motor outpat i ils trated in Figure 16-9. Figure 16-9 is 2 simplified ‘chematic that only apples to. mosemene generated in response to an external stimulus, An equally plausible akemative would begin with a decsion in the aswcit tion cortex leading ro movement Primary Sensory Areas of the Cerebral Cortex Primary sensory areas receive sensory information di realy fom the vernal tet of thalamic clei. Fach primary sensory ar discriminates among iret in since and quaiies of ne type of input. Tus there392 CHAPTER 16 Corum Somatseensory (312) Viual 17) Somatosensory (1-2) essay artrior 40) vial (17) ‘satory (41) Primary somatorersory _Owciminates shape, tenure, oF Sze of objects Primary sustery ‘Conscious dacrminaton of Tous and pon of roids Primary wsvat Ditnguines ions of locaton of tects Dierminates among head Datlons and hess ae" | FGURE 16-10 ary serory area othe cercbra ener: Corespnding Brean ac are dated in penises ae separate primary sensory aeas for somatosensory, “faditory, vital and vestibular information. Most pri ary sensory areas are located sithin and adjacent 9 Tandeark cortical fissures (Fig. 16-10). The primary somatosensory eorex is located within the central suk fur and on the adjacent postcencal gyrus. The pt mary audiory cortex is located in the lateral sure nd on the adjacent superior temporal gyrus. The pr tary visual cortex i within dhe calcarine slcus and tn che adjcene gyri, Only the primary vestibular cor tex isnot close toa landmark fissure; instead, the pri mary vestibular corer is posterior to che primary s0- smatorensory cortex. PRIMARY SOMATOSENSORY CORTEX The primary somatotensory cortex receives information From ractile and proprioceptive receptors via a chee neuron. pathway: peripheral affeent/dorsl columa neuron, medial lemniseus neuron, and thalamo- Corsica neuron, Although crude awareness of soma: ‘icasation occurs in the vental posterolateral and the ventral posteromedial nuclel of the thalamus, hnewons in the primary somatosensory cortex iden- {ify the location of stimuli and discriminate among. Nrarious shapes, sizes, and textures of objec. The Cortical termination of nociceptive and tempera: ure pathways is more widespread chan the disrim- inate tactile and. proprioceptive information and thus is not limited to. the primary somatosensory PRIMARY AUDITORY AND PRIMARY VESTIBU- LAR CORTICES The primary auditory core. re ‘ives information from the cochlea of both ears via a puchway that synapses in the inferior colliculus and Iredial geniculate Body before reaching the cortex (see Chapter 13). The primary auditory cortex provides Conscious awarenest of the intensity of sounds. The primary vesbular cortex receives information regard Fig head movement and head position relative co fevity by a vebulothalamocortcal pathway (see ‘Chapter 15). PRIMARY VISUAL CORTEX Visual information raves eo the corcex via pathway from the retina t0 the latend geniculate body of the thalamus, thea to the primary visual core. Individual neurons in che primary visual cortex ae specialized to distinguish be- een Tight and dark, vasious shapes, location of ob- Jecs, and movement of objectssory Associaton Areas ind the pri Somatosensory (6.7) Visa! (18-21) | somatosensory ‘ot ol vaual taion Casseaon of sounss | ‘Sereognetis and memoyot | Auatryassocaton iguRe 16-1 CHAPTER 16 393, ‘ers that the ubjce is small, smth, ad slic ist ava por, although a diferent area nf the cttes fy 0 nuanpulating am object. Newton ithe 0 Imatosernoty anwciaton area provide streoginis be tomshow comparing somtesensation fiom the ct fn het with memories of ether objet. The vival awocation cortex analyzer eos and rion. and iy ouput co the tectum divets wna fsscion, the mainsnage ul am object sm central i sion, The auditory asciaion cortex compares sounds with meinorics oF ontcr suns and then categorizes the sounds 4s language, music, oF nose. Sensory ass ‘lation areas ate ustaed in Figore 16-11 Primary Motor Cortex and Motor Planning ‘Areas of the Cerebral Cortex The primary motor core is locate. in the presenta tus anterior ro the cent ula. The primary motor Sovtex it dhe source of many cortical upper motor net rons and contle contralateral voluntary: moves, purcolary the fine movements af the hand and fice Because the primary moor cortex is unique ia provid ing precise conirol of hand and lower fice movements, 4a mich greater proportion of the tral area of primary Imorur cortex is devoted t9 neurone that control these pares of the body than is devned eo che teunke and proximal lib, there more grose motor activin is te- fired, The hand, fos, and lower face representations in che motor cortex are ently contalateral. In con- trast, many muscles that tend to be active bilterally rltancously muscles of the back, for example are onealled by the primary motor cortex on both sides The cortical motor planning areas include the fol lowing Supplementary movor ares Premoror area Bocas aren The area corresponding 0 Bocas area in the oppo" sit hemisphere MOTOR PLANNING AREAS The cortex anterior to the primary motor cortex consist of theee eas: Supplementary motor area, premotor ares, nd [Beocal area (or, on the cinttlateral side, the 63 0394 ‘CHAPTER 16 Cnbran Sepplamentary mejor Primary mater () ‘Supplomentary rotor fupere medal) Promotor ‘ater, f roca ara, art ols} Motor Aves mary moto eorox ureion ‘Yaurariyconted rovers Cento unk and gi rmecls,ascipatoy pest acjusments Supplementary motor tation of manera area creraten planing, binanus and sequental reverts etor programing ot seen (usualy init hamisprere ony) Panning nenverta com: rmuricato frstoal ges: es, tne of wer oul Inthe Hight hempher), Premotr are riguRe 16 Moor ats a the cerebral coe. Carmsponding Ban sneered in parents responding co Bris ar, The suplementay motor {ote led a ote we dy pon of he primary wwar cars imporaon fr ion ot Ihnen, nation of he js and hay an pl ing Bana equal ovement The pon to in lcd ater the nper body man of the primary moter concn cnt tink an ge imu ithe medal achaton 9am roca; infn nthe pemorr ea and an sxe de fo and dom fon of he pana tmovor corte lyin the hemp Bess tea b reponible Br puiming moramees of ceil truth dt spe oe phoned pecs of 4 speech, An area analogous to Brocas area, in the op- posite hemisphere, plans nonverbal communication, Including emociona gestures and adjusting the tone of voice. These area will be considered further in a laer CONNECTIONS OF THE MOTOR AREAS. Premotor, supplementary motor, and Broca areas receive infor: ‘mation from sensory asocaton areas. Boch the pri- ‘mary motor cortex and motor planning areas recive information from the bal ganglia and cerebellum, r= layed by che thalamus. The primary motor cortex re: ceives Somatosensory information relayed by the thal: ‘mus and fiom the primary somatosensory cortex and ‘motor instructions from the motor planning areas Cortical motor ourput, including the corticospinal tracts, coricobulbar tracts, corticopontine tacts, and ‘onic projections to the putamen, originates in the primary motor and primary somatosensory cortex and ‘motor planning areas (Fig, 16-12) Association Areas of the Cerebral Cortex Areas of cortex not ditety involved with sensation for movement are called the asocation corex, Thee teat of cortex are designated the association corte: «Pent, the nei part ofthe frontal abe | Huteennpeed ametaion, atthe fneioe of paral oti and emporl aber + Lin, Inthe amr tempor Tee and ino foal ibe Enormously complex ables are localized in the a sociation areas: personaly, imegacon and intspreta= tion of sensations, procesing of memory, and. gene tion “of emotions. For etample, damage ©. the ctbicoiontal cortex can aler personality characteristic hie damage to other coral areas has litle eect on.Carhrum CHAPTER 16 395 Prteontal (2, 10.12) Lume (19, 23,26, 28,38) Pron r 10.2) Paitctorgera (59,40, parts of 4.99,28,22,57) Lime (19,28, 26, 28,38) (Associaton Conex ___‘Funeton act} won Cortex Funcom Prantl association Graariented behav, so-awareness | Patetotamporal assocaion Sensory negation, prclam solving, understanding | FIGURE 16-13 language and spac reaionshis Acton ae ofthe cereal cote ute assocaton notion, maaton, processing of memory Cron Badan ae ennai, Thus hough the neurophysiology of t= andl temporal lobes and with limbic ars. Pron cor rralty ig not wadermod, pevonaity is suid to be lo- tex functions indude selfawareness and executive func ‘Mieed wo dh onbitofomal cortex Simla, intligence, tons (ako called goal-oriented behavior). Executive Fane SS measured by incligence teste and integration and in” tons include the following texpretation of sensations are laid in the paretotem pond sociation ates. Consions emocions ae loclied + Deciding ona goal In he linbic atociation areas (Fig. 16-13. + Planning how to acsomplish che goal The preffomtal cortex connects extensively wich + Exceuting the plan the sensory asocation areas inthe parital, occipital, + Monitoring the exccution ofthe pln396 CHAPTER 16 Centro Decisions ranging fom she tv «0 the momentous de made inthe ptonal sex what to wear, whether te move, and wheter to have children are decided in Sd eared our by insane fom the prelontl Ite ipa 4 ncn of the pare ctotemporal sociation ae, in the poxerir pt Sal and tempord coviea. Here problem ohing Sa comprehension of communication and of spaal ‘lations occ The thi and Binal, conta awociaton ate sche limbic snocaton area, located Inthe anterior tem- poral lobe and. in the’ orbiofonalcorter located tBove the eer. The limbic sociation area connects rich arene replating mood (abjectve Fling) et {observable demeanor), and grocesing of some types of memory LIMBIC SYSTEM “The term limbic means “border” and refers co the bor- er berwcen the diencephalon and tclencephalon. The texm border could also be applied to the limbic sys tems actviey as a border ton beeween conscious and nonconscios areas ofthe rai. Limbic structures form 4 ring around the thala- mut (Fig. 16-14), Although 2 full consensus on Which struccufes compose the limbie system has not been reached, most authorities inchade the fol. Towing ares: + Hypochalamus * Anterior and medial null ofthe thalamus + Limbie cortex (cingulate gyxus, parthippocampal gra neu) + Hippocampus + Amygdala + Basal forebrain: spel are, preopec area, nucleus ae- cumbens, and che nucleus basais of Meysert ‘The hypothalamus and chalamus were described carlier in this chapter. Limbie cortex is a C-shaped region of cortex located on the medial hemisphere, consisting of the cingulate gyrus, parahippocampal fs, and uneus (a medial protrusion ofthe paahip- pocampal gyrus). The hippocampus is named for ite fancied resemblance, in cotonal section, co the shape fa seahorse. The hippocampus is formed by the gray tnd white mater of two gyi rolled together in the redial temporal lobe. The amygdala is a5 almond: haped collection of nuclei deep to she uneus in the temporal lobe, 3t the end of the exudate cil In the basal forebrain, the septal area is 2 region of cortex and muciei anterior to the anterior commissure, tnd the preoptic area is anvsror to the septal aren ‘The nucleus accumbens (also caled ventral swiatum) is the region where the caudate and putamen blend, and the nucleus baslis of Meynere is iferor to the preoptic area, asl nucleus of Maynor Anteoreucius of alam Septal aoa Unicon Mecopeccum, oot torpaoftbelnbc sytem, ite SBE Tele for reece Dereaesa acu of alasCerebram: Cll Applstion tout instead cause behav Common behavioral abnormal’ secondary 10 ‘damage is apathy, with loss of initiative, spontaneous thoughe, and emotional rsponses (Bhatia and Marden, 1994), Conversely acesive activity of the iret connecting the caudate thalamus, and Laer Stbitoftontl conten i correlated with obsessve-com- Pulsive disorders (Saxena et al, 1999). People with Ebrenivecompubive disorder have a tendency to per= foum certain acte repetitively, sin an iresissible urge to wash their ands hundreds of simes per day Disorders of Specific Areas of the Cerebral Cortex Primary Sensory Areas: Loss of Discriminative Sensory Inforation Lesions of the primary sensory areas impair che ability to disciminat intenscy and qualcy of simul, se erly inerfering with the caacty fo use the sense Tons, Lesions of the primary vomatosensory cortex in- ferfere most with the lcaizaton of tactile stim and ‘with propriocepcion. Crude avareness of touch and thermal simul is not affectal in lesions of che pi mary somatosensory cote, since crude awareness 0¢- fue in the thalamus. Alto, lecalzation of pain is not Compromised by lesions confised co the primary so- matesensory corex, Pain information is believed to be procesed inthe sensory asocition corer eather chan the primary somatosensory cortex. eeause auditory information has extensive bilateral projections cathe corte, a lesion in che primary au tory cortex only interferes with the ability co localize founds. (ee Chapter 13). esions in the primary sestbular cortex interfere wih conscious awareness of Foal postion and movemert, Primary visual cortex Icsiont cause contalateral homonymous herianopia (Gee Chapter 15) The consequences of lesions in pe mary sensory areas are lasted in Figure 171 Sensory Association Areas; Agnosia [Agnosia i the general term ‘oe the ably 1 recog fhe objects when using a sfecifc sense, even though Ulcriminative abiiy with that sense is inact. The Forms of agnosia ate 3 follows: + Ascreagnosis Visual agnosia Auditory agnosia CHAPTER 17 an Loss of tact lcatzaton and ‘oresousproprecepton change awareness of Thead postion and Hemenymous homanopis Loss of consceut ‘eal of sours Function! Change Loss of ate foeaizaton land conscious popi~ ‘mary somatosensory Primary austory Prmary vu Peary vestibular ‘ouRE 7-1 Rents f sion in ear sensory ae ASTEREOGNOSIS Aerognss is the insbiliy 1 ‘Kenai objets by couch snd manipulation despite ine toc doctmintive somatoesaion. A peson wih ‘Stercognonis would beable to deeibe an object being fred ur ot resogie the objet by touching ad Trapani Atergnoe rls fiom lens in the “Gmatnersory asocaon are A penon wih asco nos ufecang the information from one hand ay shoud wing te and a reo prepa changes mie fo te ate ba proce normal VISUAL AGNOSIA Similarly. lesions in che visual sociation rea interfere wth the ability to recognize ‘bjecs in-che contralateral visual field, although the Capacity, for, visual discrimination. remains intact. ual agnosia i che term for inabliy to visually ree- ognize objects despite having inact vision. A person ‘rth visual agnosia can describe the shape and sie of412 CHAPTER 17 bjecs using vision but cannot identify the objects visa “E ghly specific type of visual agnosia is propa nom. People with this rae condion are unable 0 vt ally demi people’ faces, despite being able to cor teaay inerpre emotional cal expressions and being ble wo visually recognize other items in che envio tment, Only visual recognition is defective: people can be identfed by theit voices or by mannerisms Prosopagnosa is usualy asociatel with bilateral dan ge to the inferior visual asocain areas (pact of che ental steam) AUDITORY AGNOSIA Desruzion of che auditory Guacaton corex spares the abilry to perceive sound thar deprives the penon of recogncion of sounds. I the Teton destoys the lle ausizory sociation cores, che person is unable ro understand spech (sce ate section). Baseruction of the right auditory asociaton cortex in terleres with the interpretation of noises. For example, 2 penon cannot distinguish benween che sound of + door Fatrand the sound of fooreeps. The aeas of cortex in ‘olved in agnosis ae iusrated in Figure 17~2, i "Agnosia results from damage to sensory association reas. pie se peer ‘udtory agnosia [Funetonas Change __Corica rea pstereognoss| ‘Somatosensory association Visual agnosia Viva asscation ‘udtory agresia ‘aston association figure 7-2 esl of sions in verry section et aebram: Clinical Aplin! ‘Motor Planning Areas: Apraxia, Motor Perseveration, and Broca's Aphasia [Apraxia isthe inability co perform 4 movement or se Beetee of movements despite intact sensation, auto. fhatic motor_outpu, and understanding of the tak, ‘Thus petsons with apraia may be unable «0 couch their nose on request, but then easily starch hele fhe it itches. Aprasia occurs as a result of damage {othe premotor or supplementary motor areas. A sub (pe of apenas constructional apraxia, interes BM the bily co comprehend the relationship of punts 0 the whole, This deficit impairs the ability to raw and eo arrange objecss correctly in space ‘Motor perseveration i the uncontolable repei- tion of z movement, For example, a person may con- fdaue to lock and unlock the brakes of a shelchai UEapee intending co lock the beakes. Motor persvera: flow is anociated with damage to che supplementary tmoror area (Gelmers, 1983). ‘Beocas aphasia 's dilficulry expressing oneself use ing language or symbols. A peron with Brocas aphae Seis impaired in both speaking and writing, Brocas phosia occurs with damage co Brocis area and will be Aiscusied further ina later section. Primary Motor Cortex: Loss of Movement Fractionation and Dysarthria Damage to the primary moor cortex is characterized by contealaeral paresis and loss of fractionation of ovement (se Chapter 9). The worst effects are dis. tal people with complete destruction of the primary motor cortex cannot voluntarily move their contra tral hand, lower face, andlor foot because these areas fey exchsively on conttalateral primary motor cortex conta ‘Dysarthria is the term wsed co describe speech dis conden resulting fom paris, incoordinaion, oF “patty of the msces used for speaking. To ope SF dysarthria can be dicingushed: spastic and flaccid Damage to upper motor neurons causes spastic dysarthria, charscerzed by harsh, awhward speech In contrast, damage to lower moror neurons (ranial hessee DCX andlor XID) produces Aaeeid dysarthria, fenuleing in breathy, soft. and ienprecise speech, Tn pure dysarthria, nly the production of speech is im- pared? language generation and comprehension are Unafleeed. The ifculty is with che mechanics of producing sounds accurate, not with finding words fr with grammar Lesions in areas of cortex that pro- duce motor disorders are illustrated in Figure 17—3