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Today we will start with the brain.

As you know that the brain is the superior part of the central nervous system that lies within the skull and continues with spinal cord through foramen magnum , so the nervous tissue anatomically not physiologically is divided into central and peripheral , central everything us protected within the bone , the brain and the spinal cord but peripheral is the nerves outside those would be the cranial and spinal nerve so twelve cranial nerve and spinal nerve are those the peripheral . Functionally or physiologically the nervous system is divided to another 2 parts somatic and autonomic " . " the somatic subdivides into sensory and motor , motor like when touch something hot you move your hand away so the motor you control it , but autonomic which you dont control it , is another 2 parts are sympathetic and parasympathetic , sympathetic mainly by sympathetic trunk carried out but the parasympathetic is carried out by vague nerve . Major Parts of the Brain: when we study the brain in anatomy we divide it into 4 parts , the most top areas which is made mainly by the cerebrum ,so the forebrain its the most superior part its other name is pros encephalon because its formation , its mainly composed of the cerebrum and what we refer it is covered by cerebrum is diencephalon , di means two structures , encephalon covered within the cephalon the head , because you cannot see those two structures ; they are covered by the cerebrum . The diencephalon is two structure the thalamus and hypothalamus. The midbrain which we refer to it as mesencephalon, the mesencephalon is a very small part around 2.5 3 cm , just bellow the diencephalon The tale brain or the hindbrain which is the lowest part, and we call it the romp encephalon, romp means tale. This made of three structures; the Pons, Medulla oblongata, and behind them the Cerebellum . Pons means the bridge ; its bridging horizontally the two halves of the cerebrullum , vertically the upper part of the brain with the medulla oblongata and spinal cord bellow it, so that why the refer it as the Pons . Medulla oblongata which means longitudinal oblongata as rectangular in shape, its the lowest part of the brain. Behind the Pons and the medulla there is the cerebellum. Another terminology you going to hear it in the brain is called the brain stem ,stem refer to the trunk of the tree for example, so its the part where you can hold the brain from. So this stem or trunk of the brain is made of midbrain Pons and medulla oblongata, pay attention that the cerebellum is not part of the brain stem, its part of the hindbrain.

The largest part of the brain is the cerebrum and its made of two hemispheres; Right & left, which they are totally separated by a very deep fissure its called longitudinal fissure; because it goes longitudinal from anterior to posterior. So within this longitudinal fissure you can find a dural reflection, this reflection we call it flax cerebli; which is part of the dural matter that enters this fissure separating the right from the left hemisphere. Internally if you cut the cerebrum transverse cut in the cerebrum and you look inside , you can see that the cerebrum is made of two layers ; an outer layer which is gray or brown in color the dark area , this is called the cerebral cortex and it represents the gray matter of the cerebrum . While the inner part its called the white matter. The difference between the white and the gray matter in the cerebrum: If you look to the neurons you know that it has dendrites, nerve cells and axons, when the axon becomes covered with myelin sheath this myelin has a glistening white appearance ,so when you look to the brain you can see in white, this representing myelinated axons of nerve cells. While the gray matter the cortex is representing the nerve cell bodies, dendrites and unmyelinated axons. So the main area is the gray matter which is more important, because the nerve cell bodies are there, and the communicate through dendrites. The white matter here is the myelinated axons, so that is the difference. Something else, when you look inside here you can see a chamber this is the thalamus, you cannot see the thalamus unless you cut the brain, thats why they call it Diencephalon within the cephalon, because its covers totally by the cerebrum .. Diencephalon 2 structures: the thalamus and below it is the hypothalamus.

Now studying the topography of the outer side of the brain or the cerebrum, we divide the cerebrum into parts Lobes, the names of the lobes will be taken the name of the covering bones. So the cerebrum from the outside is divided into 4 main lobes: 1 - Frontal lobe is covered by frontal bone and so on . 2 - Parietal lobe 3 - Occipital lobe 4 - Temporal lobe

And as I told you in previous lecture that the brain is folded into gyri elevations & sulci depressions ; to increase the surface area, this increasing of the surface area increase the number of the neurons , in human brain we have around 80 100 billions neurons . So this is how we could include all of these neurons in the brain by producing these folding gyri & sulci. For the cerebral lobes what are the borders, they decide that the border from frontal and parietal or parietal and occipital for example should be the sulci not gyri. So we always look to the sulci that separate those lobes. The first one called The Central Sulcus because its in the central passing all the way from up to down, so its separating the frontal from the parietal lobe. Another one behind, you can see part of it here but its more present and prominent medially, if we have a medial view of the brain you can see it.. This is called The Parieto Occipital Sulcus ; because its the border between parietal and occipital lobe . And the one that separates between the temporal lobe from frontal and parietal lobe, its called The Lateral Sulcus , the Lateral fissure or Sylvain fissure referring to the one who discovered it . So those are the main sulci . The main cerebral sulcus as I told you is the central sulcus which separates the frontal from the parietal lobe , and its located between two important gyri . once you have a sulcus , anterior and posterior you have a gyri , so those two gyri the one before the central sulcus which we call it precentral gyrus , and the one behind the central sulcus which we call it postcentral gyrus , those are very very important gyri because the

precentral one in the frontal lobe is considered the primary motor area in the brain , so your motor movements as when I raise my hand up and down or walking , all these movement are controlled from the primary motor area in the precentral gyrus. The postcentral gyrus which is located in the parietal lobe this one is considered the primary sensory area in the brain .. Remember this : * pRe central gyrus ------- motoR .. with R in the frontal lobe * poSt central gyrus ------- Sensory .. with S .. in the parietal lobe What is happening here , there is a communication between those two gyri through interneuron. How !? for example if this cup of coffee is very hot and Im going to to touch it and its very hot ,so the signals will come from my fingers tip all the way to the brain to the postcentral gyrus the analysis in postcentral gyrus will say its very hot and it will send a signal through the interneuron t the precentral gyrus , now the neurons in the precentral gyrus will order the motor nerves to my hand to move my hand far away . Touch something hot postcentral precentral move your hand away All this happen in milliseconds . Motor neurons are large neurons so : The sensory neurons are smaller than the motor neurons in the brain. The motor neurons control the voluntary motor , voluntary means the skeletal muscles , its control the voluntary movements in the opposite side of the body , so the right precentral gyrus controlling the left side of your body while the left precentral gyrus controlling the right side of your body ; Because the nerve fibers which I mean the myelineted axons (the tracts ) of this motor neurons usually the descend down along the brain and at the lower part of the brain which is medulla oblongata , where the medulla oblongata becomes spinal cord , there , close to the foramen magnum those motor neurons will cross over within medulla oblongata , so the right one will go to the left part of the spinal cord , and the left one will go the right side , this is what its called (decussation ) = cross over within medulla oblongata , so thats why the right side of the brain is controlling the left , and the left of the brain is controlling the right . Again: the motor neurons cross over to the other side within medulla oblongata are called decassation

Also, in addition, the motor of control in the precentral gyrus is represented in an inverted way ( >> )WHAT DOSE THIS MEAN? This means that the motor neurons in the top most point of the precentral gyrus will control the muscles of the foot, while the lowest motor neurons of the precentral gyrus will control the muscles of the face. And the same in the postcentral gyrus, (both , the sensory and the motor ) , are represented in an inverted way, and in a cross over way (horizontally crossed and vertically inverted) SO the foot is controlled here , the leg , the thigh , the trunk , the hands , the neck and the head (inverted way ( Postcentral is the same , the primary sensory areas containing sensory nerve cells it receives input for general sensation ( not special , the special sensations is related with cranial nerve , and they have special areas in the brain ) but for general sensation which includes : pain , thermal, hot and cold , pressure , touching .. all of them is controlled in the postcentral gyrus in the sensory general sensory area and it receives usually the sensation from the opposite side of the body in an inverted way . - So , where you feel he sensation in the right ? in the left side of the brain - and left ? in the right side of the brain Those sensory neurons they usually cross over at 2 sides : spinal cord , down , if they are general like : thermal, pressure , touching , pain all if them they cross over at the opposite side once they enter the spinal cord and then ascend , however , the fine sensations like fine touch or vibration , those usually cross over at a higher level at medulla oblongata , thats why the sensory neurons they cross over at 2 sides : spinal cord and medulla oblongata , BUT the motor >> 90% of them cross over within medulla oblongata . SO AGAIN Sensory >> 2 sides of crossing over : 1) spinal cord. 2) medulla oblongata Motor >> 90% of crossing over at > medulla oblongata

Main cerebral sulci that we spoke already about them : Central sulcus : separate frontal from parietal lobes .

Lateral sulcus : temporal from frontal and parietal lobes ( . ) Parieto-occipital sulcus : separates parietal from occipital lobes . Calcarine Sulcus : it is medial sulcus within the occipital lobe . it is medially only and it goes all the way interiorly to meet the parieto-occipital sulcus ,calcarine means spur , which they use it in north America cowboy they use it over the hourses to hit the hourse to run . It is important because it is the region of the visual interpretation ( vision area is a special sense which is located in the occipital lobe ) but its mostly concentrated in the calcarine sulcus . So Again what you have to know about calcarine sulcus are : At medial side of occipital lobe ( not lateral ) . It communicates interiorly with parieto-occipital sulcus . It considered as visual interpretation area .

Now functional region of the cerebrum that you have to know : Primary Motor area : located in precentral gyrus , it is controlling the opposite side in an inverted way Sensory area : postcentral gyrus

Auditory area : interpretation of sound ( not language ) , located at the middle of the superior temporal gyrus The foldings in the brain , when we name the brain , we just name the lobe where they locate ( gyrus or sulcus ) , and then we name the order ( superior , middle , inferior ) . For example : If we take the temporal lobe : all of these structure here should be temporal > the most superior gyrus is called ( superior temporal gyrus ) , the one in the middle ( middle temporal gyrus ) , the most inferior one ( inferior temporal gyrus ) . For the sulci > we have 3 gyri and between them we have 2 sulci,the superior one which is called the ( superior temporal sulcus ), and the inferior one is called the (inferior temporal sulcus). The same for the frontal lobe .

SO this is the way in naming the topography of the cerebrum . except for certain areas , as I told you those will be just the precentral gyrus , postcentral , central sulcus . etc ( all of what we have spoken about ) , other than that you have to follow the name as in this order .

SO if you look to the interpretation area of the sound ( the auditory area ) it will be at the middle part of the superior temporal gyrus in the temporal lobe , because this area is the closest area to the inner ear . The visual area in the occipital lobe ( in the posterior pole of the cerebellum ) but mostly concentrated in the calcarine sulcus . * Two important areas now are related to the speech : 1) The motor speech area 2) the languages interpretation area ( which is called Wernickes area ) so we have brocas and Wernickes areas that are related to the languages Wernickes area is located to the lower or posterior to the lateral sulcus , mainly in the posterior part of superior temporal gyrus , the neurons in the Wernickes area are specialized to interpret the meaning of speech ( not the voice or the sound remember the sound in the auditory area ) (( for example : What is your name ? )) So whats happening their ? when I ask him whats his name , he take this language or this sentence and the signal pass to the Wernickes area , he analyzed it and then understand it . (( then he said : My name is mohammad , and you ? )) Now neurons will move from Wernickes area to the Brocas area : it is the area of the speak comprehension , which is located in the middle of the inferior frontal gyrus , now he build up what he want to say ( My name is mohammad ) , so those are 2 areas that are very important in the interpretation of speech . The speech depends on the languages which is spoken of course you know that in Wernickes area it can develop as much as how many languages you know ( Arabic , English whatever ) but if you dont know whats the meaning of the speech so you will stop there , there will be no more signals to brocas area SO AGAIN : Wernickes area : it is the area where you interpret the meaning of the speech and recognizing what are the words which is spoken , it is located in the posterior part of the superior temporal gyrus

Brocas area ( motor speech area ) : it is the area for planning and production of the speech in a comprehensive way ( ) in order to build the word in a good ordered sentence with proper grammar , it is located in the inferior frontal gyrus . Now if damage happen to the brocas area what you think will be there ? there will be no comprehension of the speech ( he still can speak , he can speak the words , he can understand what you are talking about , but he cant build a sentence in a proper way . so wernickes area is still functioning ) . for example when I ask a patient with damaged brocas area ( whats your name ? ) he understand my question , and he know that he should answer ( my name is mohammed ) but he cant say it ( he know what he has to say but he cant express it ( it is called expressive Aphasia = A:without , phasia :speech ) or it is called Brocas aphasia SO again : expressive aphasia is the Difficulty in speech , due to damage to brocas area .

And you see ! the Brocas area is in the inferior frontal gyrus > which side of inferior frontal gyrus ? those 2 areas are only located in the dominant part ( half ( of the brain . SO if you are a right handed person then they are located on the left part of hemisphere , on the left inferior frontal gyrus and in the left posterior part of the superior temporal gyrus . If you are a left handed > they will be on the right side of the brain . So for most of humans of individuals they are usually in the left side of the brain ( dominant side of the brain ) . So brocas area >> remember this > the person he knows what he want to say but unfortunately he cant speak it in ordered comprehensive way = cant build a proper sentence . And another name of it ( agrammatica aphasia ) . You have to distinguish it with stammering or stuttering ( , ) so that is not related to this area , it is a neurological problem >> a problem in a hypoglossal nerve itself , or it is a muscular problem and he cant control his muscles during movement . SO it is totally different from aphasia . in stammering or stuttering he cant put a sentence but he cant pronounce the word probably . In aphasia he can pronounce the word but he cant build them together in a prober sentence . So to distinguish them , in a case of brocas aphasia : ( now the doctor play a video ) This patient is suffering from Brocas aphasia , and in the last week he suffered from a problem in his legs , he felt weak in his legs and he cant walk so he stay at home and call the doctor for him , what he is trying to say is this (( I have problem in my legs stay at home and

the doctor come to examine me )) but look how he is trying to say this >> ( playing a video and the doctor comment on the video ) >> : whats happening with him he has no problem with pronunciation but the problem in producing the word , he know what he has to say but he cant say it because the brocas area is damaged. ( now playing another video ) > so this is the difference between them >> this is stammering >> so a specific words he cant pronounce it > he can build words probably ( speak in a prober grammar ) ( playing another video >> so you remember she can build the sentence probably but she has problem that she just keep saying the same letter > so this is stuttering > this has nothing to do with Brocas area . If there were a problem in brocas area, the patient wont be able to speak in a proper way; he can say the words normally but he cant put them in a proper sentence. Diencephalon Diencephalon is composed of 2 structures: the Thalamus and the Hypothalamus. Thalamus (means chamber) comes above, and the hypothalamus comes below it and both of them are covered by the cerebrum. Thalamus The thalamus is composed of paired oval masses of gray matter thats coiled, we call it nucleus. Whats the difference between the nucleus we know from biology and the nucleus we are talking about in neuroanatomy? Nucleus in the neuroanatomy is an island of gray matter surrounded by white matter. In the CNS, its a group of neuronal cell bodies that are gathered together within the white matter. In the PNS we dont call it nucleus, we refer to the gathering of the neuronal cell bodies in the PNS as ganglion (plural: ganglia). The same structure in both CNS and PNS but with different names. [Remember]: Nucleus is an area in the gray matter of the neuronal cell bodies that is surrounded totally by mylinated axons or white matter. Thinking of that, we can conclude that the thalamus is somehow close to become a nucleus. The main function of the thalamus is acting as a major relay station for sensory pathways. How? Most of the sensory neurons get in the thalamus, they synapse there and the neurons that get out of the thalamus will continue their way to their respective sensation areas in the brain.

[Example]: the optic nerve is a sensory nerve that is responsible for the vision. It will come from the eyeball all the way to the thalamus, neurons will synapse in there and then the thalamus will classify the nerve impulse as a vision impulse and direct it out of it to the area of sensation thats responsible for vision which is the occipital lobe to the calcarine sulcus to be exact. Hot and cold (general sensation from the hand) will be directed by the thalamus to go to the midpoint of the postcentral gyrus. Pain sensation that may come from your foot upon stepping on a sharp object will be directed by the thalamus to the top most of the postcentral gyrus thats responsible for sensation of the foot. [Remember]: Neurons get in, synapse, then get out to their respective sensation areas. Hypothalamus Hypothalamus is a total different thing in relation with the thalamus. It contains special nerve cells that secrete hormones. Nerve cells that secret hormones! Because of this we call them neurohormones and thats why the hypothalamus is considered the link between the nervous system and the endocrine system. This is also how the CNS (or the brain) can control the endocrine system in your body; its through the hypothalamus. If you get in a condition where theres a need for a specific hormone to be secreted (like a high blood pressure condition) the nerve cells will stimulate the hypothalamus nerve cells. The hypothalamus now will release the neurohormones, those neurohormones will go to a lower order structure that is the pituitary gland. This gland is considered to control all the endocrine gland of your body. From the pituitary gland the hormones will go to that specific gland in the body to either increase or decrease the release of that gland in your body. Thats why the hypothalamus is really important because it connects the two systems in your body, the nervous and the endocrine systems. It secretes whats called Hypothalamus release hormones. These hormones will control the pituitary gland secretions. [Example]: One example of that is the gonadotropin releasing hormone. This hormone when released from the hypothalamus will go to the pituitary gland. Upon receiving this as a stimulation, the pituitary gland will release other hormones: LH (luteinizing hormone) and FSH (Follicle- stimulating hormone). These two hormones will go all the way from the pituitary

gland to the gonads (testis in males, ovaries in females). In the male, these two hormones will stimulate the secretion of the testerone but in the female they will stimulate the secretion of estrogen and progesterone from the ovaries and once they start to be secreted in the body, the individual will get to the stage thats called puberty. A male will get the masculine character (growth of hair on the face, voice changes..) and in females, they will get the feminine characters and so on. Another hormone that is secreted by the hypothalamus is the Vasopressin/Antidiuretic hormone (it has two names that can easily indicate its function). Whats special in this hormone is that its secreted from the hypothalamus to be stored in the posterior part of the pituitary gland to be released when needed. The vasopressin hormone function when the body undergoes a hypotension condition; it will try to equilibrate that by initiating a hypertension condition by 2 ways. It will go the blood vessels in the skeletal muscle asking them to contract. Once they contract we will get a vasoconstriction state and the blood flow will increase in its rate. Upon this, we will get a hypertension condition that we aimed for to equilibrate the hypotension condition we are undergoing currently. This hormone will go also to the kidneys preventing the loss of water leading to the water retention. Because of this retention, the level of the fluids in the body will increase and the plasma fluid portion in the blood will increase as well therefore initiating a hypertension to equilibrate the hypotension.

So again, functions are emphasized by the two names the hormone have: 1. ADH (antidiuretic hormone): because of the water retention condition that it stimulates in the kidneys. 2. Vasopressin: because it compresses the blood vessels to cause hypertension condition (equilibrate the hypotension). [Remember]: ADH is secreted from the hypothalamus, stored in the posterior Part of the pituitary gland. Midbrain Midbrain is the part that connects the forebrain at the top (diencephalon and cerebrum) with the hindbrain below. Midbrain is divided by a duct that contains a fluid, this duct is called the Cerebral Aqueduct (aqueous: fluid). This cerebral aqueduct takes the CSF thats produced in the brain down to that chamber (seen in the midbrain illustration) and from there it will go to the sub arachnoid space in the

meninges. So, Cerebral Aqueducts function is: transferring the CSF. As the Aqueduct passes over the midbrain it divides the midbrain into a posterior part and an anterior part. In a cross section, we can see the cerebral aqueduct and also posterior to it, the Tectum (means roof, referring to its position at the top of the aqueduct). The anterior part is called the Cerebral Peduncles. Peduncle is a small pedicle and what is pedicle? It means foot (like the pedicles on the vertebrae). So in the cross section of the midbrain, the midbrain is divided into posterior Tectum and anterior 2 peduncles. Now we have 2 peduncles and each one of them contains 3 structures, anterior, middle and posterior parts. - Anterior Part: which is a white matter (mylinated axons) that is descending down from the precentral gyrus. Theyre the motor tracts that carry out the motor signals from the brain up to the spinal cord down. This is the anterior part and its called the Crus Cerebri. - Posterior Part: is forming the floor to the Aqueduct and is called the Tagmentum (means floor). - Middle Part: whichs a black matter called the Substantia Nigra (nigra means black) and its a very important region in the midbrain. Its the only area in the brain that contains the melanin pigmentation thats why its colored black. It contains neurons and within them there are some dopaminergic neurons, what are these?? Dopaminergic neurons are neurons that release dopamine as a neurotransmitter and within these neurons there is the melanin pigment. The reason behind the importance of the substantia nigra is because any changes in these neurons will cause a disease called Parkinsons disease. How? Why? The function of the substantia nigra is the inhibitory muscle control. [Example]: If I wanted to do a flexion movement with my hand the muscles that should contract are the flexors of course and the work of the extensors should be inhibited. That cant be accomplished without the efforts of the substania nigra that inhibits the work of the hands extensors so we can do the desired movement very easily and flawlessly. If the Substantia nigra has got damaged by any mean there will be continues muscle contraction and that what happens in the Parkinson disease. Hindbrain its composed of the Pons and the Medulla Oblongata. Pons means bridges because its bridging the 2 halves of the cerebellum together, and the medulla oblongata down with the

remaining parts of the brain above. Thats why we call it Pons. Mainly it controls the arousal, waking up from your sleep; the beginning of the stimulation comes up from the Pons. In addition to that, it contains the nuclei for the cranial nerves the V (trigeminal), the VI (Abducens), the VII (Facial) and the vestibular of the VIII (Vestibulocochlear). Medulla Oblongata In the Medulla Oblongata -the lowest part of the brain- theres a median fissure thats made up because of 2 elevations on the sides that we refer to them as the pyramids of the medulla oblongata. They are made up because of the presence of tracts of so many axons descending from there, the motor axons (the motor tracts) actually. At the lower part of the medulla you can see they cross over, the right one goes to the left side and the left one goes to the right side. This is what we call the decussation of the pyramids and thats why in us, the right controls the left and the left controls the right. The medulla connects the spinal cord below with the brain above. As we say, it has a median fissure, 2 pyramids and olives. These olives are important because inside them there are nucleuses called the inferior olivary nucleus. Also something really important in the medulla is that it contains the cardiovascular and the respiratory centers. Thats why damage to the medulla leads to direct death because the damage will reach the 2 centers and destroy them so no respiration neither heart beating. Cerebellum the cerebellum composes 1/10 of the brain yet it has half the number of the neurons of your brain. This indicates how complicated and highly ordered is the function of the cerebellum. The main function is coordination of the muscle tone producing the fine movements; how the muscles will coordinate with each other to produce the fine movements. In the cerebellum theres no crossing over so no decussation on the muscle fine movements function (right side will control the same side muscles and so on). Also one of its functions is the regulation for the posture and balance. If theres damage to the cerebellum a common condition called Ataxia (loss of muscle coordination due to damage in the cerebellum) will occur. A simple test can be done to detect ataxia in a patient. Ask the patient to walk on a straight line, if he has Ataxia youll see him falling and tripping. Another test is to ask your patient to put his finger tip on the tip of his nose and if he has Ataxia, he wont be able to do it because these are very fine movements that require muscle coordination from the cerebellum, and failing to accomplish those movements will indicate that there is a problem in the cerebellum that is called the Ataxia. [Note]: The doctor presented a video of a patient with Ataxia. In the video, 2 tests to detect

the ataxia were done. First of them is the tip of finger on the tip of nose we already talked about. The other was Heel Knee Shin test (shin is the tibia). The patient is asked to put one heel on his opposite knee then pass it over the shin in a straight direction till it reaches his ankle. Being not able to do so, the patient was diagnosed with having ataxia in both sides.

Finally , Sorry for being late , and sorry for any mistakes Done by : Noha Ghazal , Marwa Halalmeh and Eman Nazzal .

Good luck