BASIC BRAIN CROSS SECTIONAL AND

SURFACE ANATOMY AND FUNCTION

LOCALIZATION

Moderator: Prof R.V. Phadke

Presented by: Dr Deb K. Boruah
 Adult human Brain weight -1,300 - 1,400 gms while
Newborn 350 - 400 gms
 Brain comprising 2% of total body weight

 Intracranial contents by volume (1,700 ml):

 brain = 1,400 ml (80%);

 blood = 150 ml (10%)

 cerebrospinal fluid = 150 ml (10%)

 Average number of neurons in the brain = 100 billion

(from Rengachary, S.S. and Ellenbogen, R.G., editors,
Principles of Neurosurgery, Edinburgh: Elsevier Mosby, 2005)
 EACH CEREBRAL HEMISPHERE
 THREE SURFACES
 Superiorlateral
 Medial surface
 Inferior surface- It is divided into an anterior part –Orbital
Surface and a posterior part –Tentorial Surface.
 FOUR BORDERS
 Superior medial
 Inferior lateral border –separate SLS from inferior surface.
 Medial Orbital Border- -separate medial border from the
orbital surface.
 Medial Occipital Border- separate medial surface from the
tentorial surface.
SURFACE NEUROANATOMY
 Interhemispheric Fissure
- Divides brain into 2 hemispheres
 Defining the lobes

central (rolandic)
frontal lobe sulcus

parietal lobe

occipital
lobe

temporal lobe sylvyan (lateral) sulcus

 A. SUPERIOLATERAL SURFACE
 Major Sulci –
 Central sulcus
 Lateral sulcus
 Parieto-occipital sulcus – Divides the superiorlateral
surface into lobes.
 Frontal lobe-
 Pre-central sulcus
 Superior frontal sulcus
 Inferior frontal sulcusl
 Anterior part of the lateral sulcus subdivides the inferior
frontal gyrus into pars orbitalis, trainagularis and
operacularis.
SUPERIORLATERAL SURFACE
 Parietal Lobe:
 Post central sulcus
 Intra-parietal sulcus-devides the area behind the post central
gyrus into superior and inferior parietal lobule.
 Temporal Lobe:
 Superior temporal sulcus
 Inferior temporal sulcus –devides the Temporal lobe into
superior , middle and inferior temporal gyri
 Occipital Lobe:
 Lateral occipital sulcus – devides the lobe into superior and
inferior occipital gyri.
 Lunate sulci –separate the occipital lobe from the occipital
pole.
Superiorlateral surface
 Sylvian Fissure (or lateral sulcus)
-Deep, mostly horizontal
-insula (purple) is buried within it
-separates temporal lobe from parietal and
frontal lobes

Sylvian Fissure
 Central Sulcus
 usually free standing (no intersections)-just anterior to ascending cingulate
 Postcentral Sulcus
 often in two parts (superior and inferior)
 often intersects with intraparietal sulcus
 marks posterior end of postcentral gyrus (somatosensory strip)
 Precentral Sulcus
 often in two parts (superior and inferior)
 intersects with superior frontal sulcus (T-junction)
 marks anterior end of precentral gyrus

ascending band
of the cingulate
 Central and adjacent sulci identification:

 Superior frontal sulcus – pre CS sign

 The posterior end of the superior frontal sulcus
joins the precentral sulcus in 85%

Superior frontal gyrus

Superior frontal sulcus

Precentral sulcus Superior frontal

sulcus
Precentral gyrus
Precentral sulcus

Central sulcus
 Sigmoid “Hook”
 Hook like
configuration of the
posterior surface of
the precentral gyrus
 The “hook”
corresponds to the Precentral sulcus

motor hand area

 The “hook” is well
seen on CT (89%) and Central sulcus

MRI (98%)
 Pars bracket sign
 The paired pars
marginalis form a
“bracket” to each
side of the Superior frontal
sulcus
interhemispheric
fissure at or behind Precentral sulcus

the central sulcus

(96%) Central sulcus

Paracentral lobule

Pars bracket
 The Central Sulcus (CS)
 Bifid post – CS sign
 The post – CS is bifid (85%)
 The bifid post – CS encloses the lateral end of the
pars marginalis (88%)

Central sulcus

Postcentral sulcus

Pars bracket
 Thin post – CG sign
 The postcentral gyrus is
thinner than the precentral
gyrus (98%)

Precentral gyrus

Postcentral gyrus
  Intraparietal Sulcus (IPS) and the post – CS
 In axial MRI, the IPS intersects the post – CS (99%)

Postcentral sulcus
IPS IPS

Pars bracket Pars bracket

 Superior and Inferior Temporal Sulci
• Superior Temporal Sulcus -divides superior temporal gyrus
from middle temporal gyrus
• Inferior Temporal Sulcus -not usually very continuous
-divides middle temporal gyrus from inferior temporal gyrus
Medial Surface
 MFG

Cing. sulcus

P.O.sulcus
Post Po

Calcarine sul.
Ant
paraolfac
tory

Parahippocampal Collateral sulcus

Gyrus
 Cingulate Sulcus
-divides cingulate gyrus from precuneus (purple) and
paracentral lobule (gold)
 Medial Frontal Gyrus

• superior frontal gyrus continues on medial side

 Parieto-occipital Fissure and Calcarine Sulcus
• Parieto-occipital fissure (red)
• very deep
• often Y-shaped from sagittal view, X-
shaped in horizontal and coronal
views
• Cuneus (pink)
• Triangular area between the PO
and calcarine sulci.visual areas on
medial side above calcarine (lower
visual field)
• Lingual gyrus
• visual areas on medial side below
calcarine and above collateral sulcus
(upper visual field)
INFERIOR SURFACE
Orbital Surface

Tentorial Surface
Gyrus Rectus
Olfactory bulb

Medial orbital gyrus

Anterior orbital Gyrus

Lateral orbital gyrus
Posterior orbital gyrus
Uncus

Parahippocampal gyrus
Medial occipitotemporal gyrus
Collateral sulcus

Occipitotemp.
Lateral occipitotemporal gyrus

Inferior Surface
 Collateral Sulcus
-divides lingual (white)and parahippocampal (green) gyri from Occipito-temporal gyrus
(pink)
SECTIONAL CORTICAL
NEUROANATOMY
Superior Temporal gyrus

Middle Temporal gyrus

Inferior Temporal gyrus

Superior Temporal gyrus

Middle Temporal gyrus

Hippocampus

Inferior Temporal gyrus

Parahippo.gyrus

Temporo-occipital fissure

Lingual gyrus
 Medial orbital gyrus

Gyrus rectus

Uncus
Superior Temporal gyrus

Middle Temporal gyrus

Inferior Temporal gyrus

Temporo-occipital fissure

Middle occipital gyrus

Lingual gyrus
 Medial orbital gyrus

Gyrus rectus Anterior orbital gyrus

Olfactory sulcus
Posterior orbital gyrus

Superior Temporal gyrus

Parahippocampal gyrus

Temporo-occipital fissure Lingual gyrus

Calcarine sulcus
Middle occipitotemp.gyrus
Intra-occipital sulcus

Cuneus
 Frontomarginal gyrus Superior frontal gyrus

Anterior orbital gyrus

Posterior orbital gyrus

Cingulate gyrus

Intra-occipital sulcus Superior occipital gyrus

 Superior frontal gyrus Middle frontal gyrus

Inferior frontal gyrus,

pars orbitalis
Lateral fissure

Inferior frontal gyrus,

pars opercularis

Inferior parietal gyrus Insula

Lateral fissure

Superior temporal gyrus

Cingulate gyrus
Superior temporal sulcus
Parieto-occipital fissure

Middle temporal gyrus Calcarine sulcus

Middle occipital gyrus Cuneus

Superior occipital gyrus
Intra-occipital sulcus
 Superior frontal gyrus
Middle frontal gyrus

Inferior frontal gyrus

Central sulcus Postcentral gyrus

Lateral fissure Inferior parietal gyrus

Superior temporal gyrus

Superior temporal sulcus

Intra-occipital sulcus Parieto-occipital sulcus

Superior occipital gyrus
 Precentral sulcus

Precentral gyrus

Central sulcus Central sulcus

Middle occipital gyrus Cuneus

Intra-occipital sulcus
Superior occipital gyrus
 Superior frontal gyrus

Middle frontal gyrus

Superior frontal sulcus

Inferior frontal gyrus

Centrum semiovale

Central sulcus

Postcentral sulcus
Postcentral sulcus

Supramarginal gyrus
Intraparietal sulcus

Angular gyrus

Parietooccipital sulcus Superior parietal gyrus

Precuneus
 Superior frontal gyrus

Middle frontal gyrus

Superior frontal sulcus

Central sulcus Central sulcus

Supramarginal gyrus
Postcentral sulcus

Intraparietal sulcus
Angular gyrus

Intraparietal sulcus Pars marginalis

Superior parietal gyrus

 Superior frontal gyrus

Middle frontal gyrus

Superior frontal sulcus

Precentral gyrus
Precentral sulcus

Central sulcus
Postcentral gyrus

Postcentral sulcus

Supramarginal gyrus Intraparietal sulcus

Angular gyrus
Pars marginalis

Superior parietal gyrus

 Superior frontal gyrus

Superior frontal sulcus

Middle frontal gyrus

Precentral sulcus

Central sulcus
Precuneus
Postcentral sulcus

Paracentral lobule

Superior parietal gyrus

Intraparietal sulcus
Pars marginalis
Superior frontal gyrus Cingulate sulcus
Marginal ramus of
Cingulate sulcus
Cingulate gyrus
Paracentral lobule

Superior parietal lobule

Parietooccipital sulcus

Cuneus

Calcarine sulcus

Lingual gyrus

Gyrus rectus Subcallosal gyrus

 Superior frontal gyrus Cingulate sulcus Precentral gyrus
Marginal ramus of
Cingulate gyrus Central sulcus Cingulate sulcus

Superior parietal lobule

Precuneus

Parietooccipital sulcus

Cuneus

Calcarine sulcus

Frontomarginal gyrus Caudothallamic groove

Gyrus rectus Lingual gyrus
 Precentral
sulcus Central sulcus
Superior frontal gyrus
Marginal ramus of
Corona radiata Cingulate sulcus

Superior parietal lobule

Precuneus

Parietooccipital sulcus

Calcarine sulcus

Inferior occipital gyrus

Lingual gyrus
 Central sulcus

Superior parietal lobule

Parietooccipital sulcus

Frontopolar gyrus

Frontomarginal gyrus Superior occipital gyrus

Middle occipital gyrus

Medial orbital gyrus

Posterior orbital gyrusInferior temporal gyrusTemporal horn, Lingual gyrus Inferior occipital gyrus
lateral ventricle
 Central sulcus

Superior Temporal gyrus

Middle Temporal gyrus

Inferior Temporal gyrus

 Central sulcus Superior parietal
gyrus
Inferior frontal gyrus

Frontomarginal gyrus

Anterior orbital gyrus

Superior occipital
gyrus

Posterior orbital gyrus Middle occipital

gyrus

Superior Temporal
gyrus
Inferior occipital
gyrus
Middle Temporal gyrus
Inferior Temporal gyrus Lingual gyrus
NP/MG
H
 Precentral sulci

Superior frontal sulci

Central sulcus
Postcentral sulcus
Lateral fissure,
Inferior frontal gyrus, posterior segment
pars triangularis

Inferior frontal gyrus, Angular gyrus

pars orbitalis

Superior Temporal gyrus

Superior Temporal sulcus Middle occipital gyrus
Middle Temporal gyrus
Inferior Temporal gyrus Anterior occipital sulcus

Inferior occipital gyrus

NP/MG
H
Interhemispheric Fissure
Superior Frontal gyrus
Inferior Frontal gyrus

Middle Frontal gyrus

Inferior Frontal gyrus

Gyrus rectus
Medial Orbital gyrus

Olfactory bulb
 Superior Frontal gyrus
Forceps Superior Frontal sulcus
minor

Middle Frontal gyrus

Inferior Frontal gyrus

Lateral orbital sulcus

Medial Orbital gyrus Gyrus rectus

Anterior Orbital gyrus
Lateral orbital gyrus Olfactory Sulcus
 Circular insular sulcus Cingulate gyrus Superior Frontal
gyrus Middle Frontal gyrus

short insular gyrus Inferior Frontal sulcus

Inferior Frontal gyrus

pars opercularis

Sylvian Fissure

Posterior Orbital gyrus

Middle Temporal gyrus Olfactory Sulcus

Superior Temporal gyrus Medial Orbital gyrus
Inferior Temporal gyrus Gyrus rectus
 Superior Frontal
Superior Frontal sulcus gyrus Cingulate sulcus

Middle Frontal gyrus

Precentral sulcus

Precentral gyrus

Sylvian Fissure

Superior Temporal gyrus

Superior Temporal Sulcus

Middle Temporal gyrus

Amygdala Inferior Temporal gyrus

Anterior commissure
 Superior Frontal Superior Frontal
sulcus gyrus
Cingulate gyrus
Middle Frontal gyrus
Precentral sulcus

Precentral gyrus

Sylvian Fissure

Superior Temporal gyrus

Superior Temporal Sulcus

Heschl’s gyrus Middle Temporal

gyrus

Inferior Temporal sulcus

Ambient gyrus

Entorhinal area Amygdala Inferior Temporal gyrus

 Superior Frontal
gyrus
Middle Frontal gyrus

Central Sulcus

Superior Temporal gyrus

Hippocaampus

Middle Temporal
gyrus

Inferior Temporal gyrus

Parahippocampal gyrus CA1, cornu ammonis Fusiform gyrus

 Postcentral gyrus Paracentral lobule Intraparietal sulcus
Intraparietal sulcus Central Sulcus Cingulate gyrus

Supramarginal gyrus

Superior Temporal gyrus

Middle Temporal
gyrus

Inferior Temporal gyrus

Fusiform gyrus
Collateral sulcus
Parahippocampal gyrus
 Paracentral lobule
Central sulcus

Superior Temporal gyrus

Middle Temporal gyrus

Inferior temporal gyrus

Fusiform gyrus
 Paracentral lobule

Postcentral gyrus Central sulcus

Intraparietal sulcus

Supramarginal gyrus

Middle temporal gyrus

Inferior temporal gyrus

Fusiform gyrus Calcarine sulcus Cingulate gyrus

Lingual gyrus
 Superior parietal lobule
precuneus

Cingulate gyrus Inferior parietal lobule

Lingual gyrus
Middle occipital gyrus
Calcarine sulcus

Collateral sulcus

Fusiform gyrus Inferior occipital

gyrus

Lingual gyrus Tentorium cerebelli

 LIMBIC SYSTEM
 Hippocampal formation
 Cingulate gyrus
 Fimbria & fornix
 Amygdala
 Mamillary bodies
 Part of thalamus
 Habenula
 Regions we can segment within the temporal lobe (EC = entorhinal
cortex; PHG = parahippocampal gyrus; MITG = middle and inferior
temporal gyri; STG = superior temporal gyrus
CA- cornua ammonis.
LIMBIC SYSTEM
Amygdala
 Hippocampal Formation
 The hippocampal formation is a primitive cortical structure
that has been "folded in" and "rolled up" so that it is submerged
deep into the parahippocampal gyrus. It consists of the dentate
gyrus, the hippocampus, and neighboring subiculum.
 The dentate gyrus is a thin, scalloped strip of cortex that lies
on the upper surface of the parahippocampal gyrus. The dentate
gyrus serves as an input station for the hippocampal formation.
It receives inputs from many cortical regions that are relayed to
it via the entorhinal cortex.
 The hippocampus has been divided into several sectors partly
on the basis of fiber connections and partly because pathologic
processes, such as ischemia, produce neuronal injury that is
most severe in a portion of the hippocampus (H1 [also termed
CA1 and CA2].
T1 coronal image at the amygdala (A), and T2
images at the hippocampal. Atrophy (arrows) is
distributed from the amygdala to the hippocampal tail
on the left side. Signal hyperintensity is marked at the
hippocampal head/body junction. Ipsilateral temporal
lobe atrophy also is present
Bilateral diffuse type of hippocampal
Sclerosis
Cross sectional localization
SUPRA MARGINAL GYRUS
ANGULAR GYRUS
LINGUAL GYRUS
MARGINAL SULCUS
CORONA RADIATA
INTERNAL CAPSULE
CAUDATE NUCLEUS
BODY OF CAUDATE NUCLEUS
PUTAMEN
GLOBUS PALLIDUS
ANTERIOR COMMISSURE
POSTERIOR COMMISSURE
MAMILLARY BODY
HYPOTHALAMUS
CEREBELLAR TONSIL
CEREBELLAR VERMIS
SUPRASELLAR CISTERN
AMBIEN CISTERN
PRE PONTINE CISTERN
SUPERIOR COLLICULUS
INFERIOR COLLICULUS
CEREBRAL PEDUNCLE
AQUEDUCT OF SYLVIUS
PERI AQUEDUCTAL GRAY MATTER
CEREBELLUM
 FUNCTIONAL
NEUROANATOMY
 Frontal Lobe
 Area 4 is the primary motor area
 In the precentral gyrus. Large pyramidal neurons (Betz's cells)
and smaller neurons in this area give rise to many axons that
descend as the corticospinal tract. The motor cortex is organized
somatotopically.
 The lips, tongue, face, and hands are represented in order within
a map-like homunculus on the lower part of the convexity of the
hemisphere. These body parts have a magnified size as projected
onto the cortex, reflecting the large amount of cortex devoted to
fine finger control and buccolingual movements.
 The arm, trunk, and hip are then represented in order higher on
the convexity.
 The foot, lower leg, and genitals are draped into the
interhemispheric fissure
MOTOR SYSTEM
 Area 6 (the premotor area) contains a second motor map. Several other
motor zones, including the supplementary motor area (located on the
medial aspect of the hemisphere).
 Area 8 (the frontal eye field) is concerned with eye movements.
 Pefrontal cortex
 has extensive reciprocal connections with the dorsomedial and ventral
anterior thalamus and with the limbic system. This association area
receives inputs from multiple sensory modalities and integrates them.
The prefrontal cortex serves a set of "executive" functions, planning
and initiating adaptive actions .
 When prefrontal areas are injured (eg, as a result of tumors or head trauma), patients
become either apathetic (in some cases motionless and mute) or uninhibited and
distractible, with loss of social graces and impaired judgment.
 Broca's area
 Within the inferior frontal gyrus, areas 44 and 45 are located anterior
to the motor cortex controlling the lips and tongue.
 Broca's area is an important area for speech .
 Broca's aphasia (Area 44- in inferior frontal gyrus)
 is usually caused by a lesion in the inferior frontal gyrus in the
dominant hemisphere . The patient has difficulty naming even
simple objects. Repetition is impaired, but comprehension of
spoken language is normal. The patient is usually aware of the
deficit and appropriately concerned about it.
 Most lesions that involve Broca's area also involve the
neighboring motor cortex. Patients are often hemiplegic, with
the arm more affected than the leg. Broca's aphasia often
occurs as a result of strokes, most commonly affecting the
MCA territory.
 Wernicke's Aphasia (Area 22- in posterior part of the STG)
 caused by a lesion in or near the superior temporal gyrus, in
Wernicke's area. Because this part of the cortex is not located
adjacent to the motor cortex, there is usually no hemiplegia
 Patients with Wernicke's aphasia have fluent speech, but repetition and
comprehension are impaired. Wernicke's aphasia commonly occurs as a result
of embolic strokes.
 Global Aphasia
 Large lesions in the dominant hemisphere, which involve Broca's area in
the frontal lobe, Wernicke's area in the temporal lobe, and the
interconnecting arcuate fasciculus, can produce global aphasia. In this
nonfluent aphasia, both repetition and comprehension are severely
impaired. Global aphasia most commonly occurs as a result of large
infarctions in the dominant hemisphere, often because of occlusion of the
ICA or MCA.
 Conduction Aphasia
 In this unusual aphasia, verbal output is fluent and paraphasic.
Comprehension of spoken language is intact, but repetition is severely
impaired.
 Conduction aphasia is a result of a lesion involving the arcuate fasciculus,
in the white matter underlying the temporal–parietal junction.
 This lesion disconnects Wernicke's area from Broca's area.
 Parietal Lobe
 Primary sensory areas:
 Areas 3, 1, and 2 are somatotypically represented
(again in the form of a homunculus) in the
postcentral gyrus .
 This area receives somatosensory input from the
ventral posterolateral (VPL) and ventral
posteromedial (VPM) nuclei in the thalamus.
 Through the Medial lemniscal and Spino-thalamic
tracts.
 Sensory Pathways
 One major system—the lemniscal (dorsal column) system —
carries touch, joint sensation, two-point discrimination, and
vibratory sense from receptors to the cortex.
 The other important system—the ventrolateral system—
relays impulses concerning nociceptive stimuli (pain, crude
touch) or changes in skin temperature .
 Each system is characterized by somatotopic distribution,
with convergence in the thalamus (ventroposterior complex)
and cerebral cortex (the sensory projection areas where there is
a map-like representation of the body surface.
 The sensory trigeminal fibers contribute to both the lemniscal
and the ventrolateral systems and provide the input from the
face and mucosal membranes
Cranial Nerves:
 Nerves I, II, and VIII are devoted to special sensory input.
 Nerves III, IV, and VI control eye movements and pupillary
constriction.
 Nerves XI and XII are pure motor (XI: sternocleidomastoid
and trapezius; XII: muscles of tongue).
 Nerves V, VII, IX, and X are mixed.
 III, VII, IX, and X carry parasympathetic fibers.
 Olfactory Nerve and System
 The olfactory epithelium is located in the mucosa of the
superior nasal concha, and takes up about 2.5 cm. Inside the
olfactory mucosa, olfactory cells are located. They are the
peripheral receptors that transmit pulses to the olfactory
neurons. Their dendrites group together in several filaments
which constitute the true olfactory nerves; they cross the
cribriform plate of the ethmoid bone and reach the olfactory
bulb. The olfactory bulb is a gray matter mass, an evagination
of the telencephalon, located between the gyrus rectus and the
cribriform plate, containing neurons termed "mitral cells".
Their dendrites continue in the olfactory tract, which
terminates with the olfactory trigone and tuberculum, in
correspondence with the anterior perforated substance.
Olfactory Nerve
Optic Nerve
 Occipital Lobe
 Primary visual cortex-Area 17
 is the striate cortex.
 The geniculocalcarine radiation relays visual input from the
lateral geniculate to the striate cortex.
 Upper parts of the retina (lower parts of the visual field) are
represented in upper parts of area 17
 Lower parts of the retina (upper parts of the visual field) are
represented in lower parts of area 17.
 Areas 18 and 19
 are visual association areas within the occipital lobe. There
are also visual maps within the temporal and parietal lobes.
VISUAL
PATHWAY
 Impaired vision in one eye
 is usually due to a disorder involving the eye, retina, or the optic
nerve .
 If the lesion is in the optic chiasm, optic tracts, or visual cortex,
both eyes will show field defects.
 A chiasmatic lesion
 (often owing to a pituitary tumor or a lesion around the sella
turcica) can injure the decussating axons of retinal ganglion cells
within the optic chiasm. These axons originate in the nasal
halves of the two retinas. Thus, this type of lesion produces
bitemporal hemianopsia, characterized by blindness in the
lateral or temporal half of the visual field for each eye.
 Lesions behind the optic chiasm
 cause a field defect in the temporal field of one eye, together
with a field defect in the nasal (medial) field of the other eye.
The result is a homonymous hemianopsia .
 Meyer's loop carries optic radiation fibers
representing the upper part of the contralateral field,
temporal lobe lesions can produce a visual field
deficit involving the contralateral superior quadrant.
This visual field defect is called a superior
quadrantanopsia
 Argyll-Robertson pupils, usually caused by
neurosyphilis, are small, sometimes unequal or
irregular, pupils. The lesion is thought to be in the
pretectal region, close to the Edinger-Westphal
nucleus.
Oculomotor Nerve (III Cranial Nerve)
 The nucleus of the oculomotor nerve is on
the upper end of the midbrain, ventrally to
the sylvian aqueduct, on the median line, in
a V-shaped zone formed by the diverging
fibers of the medial longitudinal fasciculus.

 The Westphal nucleus and the anterior

median nucleus form the parasympathetic
general visceral efferent (GVE) component
of the nuclear complex. Their fibers
innervate the ciliary muscles and the
sphincter pupillae, and travel together with
the GSE fibers, remaining located at the
periphery of the nerve. For this reason, they
are usually the first to be affected by
extrinsic compressions neurovascular
conflicts, aneurysms, etc.
Trochlear Nerve (IV Cranial Nerve)
 The trochlear nerve nucleus is on the midbrain's lower position,
at the level of the colliculus inferior, ventrolaterally to the
sylvian aqueduct. It is considered an appendix of the
oculomotor nuclear complex, dorsal and caudal to the medial
longitudinal fasciculus. The GSE fibers move posteriorly and
caudally, surround the sylvian aqueduct and penetrate the velum
medullaris anterior, or valve of Vieussens, where they cross and
emerge on the brainstem's dorsal surface, under the inferior
colliculi. They surround the brainstem, penetrate the dural
lateral wall of the cavernous sinus below the oculomotor nerve,
and enter the orbit through the superior orbital fissure. The IV
cranial nerve innervates the superior oblique muscle. It receives
fibers from the medial longitudinal fasciculus, which connects it
to the vestibular nuclei.
Abducent Nerve (VI Cranial Nerve)
 The nucleus of the abducent nerve is located in the
pons, near the tegmen of the fourth ventricle,
surrounded by the genu of the facial nerves' radicular
fibers (colliculus facialis). Its GSE fibers cross the
tegmentum rhombencephali moving ventrolaterally,
and emerge at the end between pons and medulla, at
the level of the pontomedullary sulcus to the foramen
cecum's sides, superiorly to the bulbar pyramids. The
nerve ascends in the prepontine cistern and penetrates
inside the cavernous sinus through the canal of
Dorello. It innervates the lateral rectus muscle.
 Oculomotor Paralysis
 External ophthalmoplegia is characterized by divergent
strabismus, diplopia, and ptosis. The eye deviates
downward and outward.
 Internal ophthalmoplegia is characterized by a dilated pupil
and loss of light and accommodation reflexes.
 Isolated involvement of nerve III occurs as an early sign in
uncal herniation because of expanding hemispheric mass
lesions that compress the nerve against the tentorium.
 Nerve III crosses the internal carotid, where it joins the
posterior communicating artery; aneurysms of the
posterior communicating artery thus can compress the
nerve. Isolated nerve III palsy also occurs in diabetes,
presumably because of ischemic damage.
 Trochlear Paralysis
 This rare condition is characterized by slight convergent
strabismus and diplopia on looking downward. The patient
cannot look downward and inward and hence has difficulty
in descending stairs. The head is tilted as a compensatory
adjustment; this may be the first indication of a trochlear
lesion.
 Abducens Paralysis
 This eye palsy is the most common owing to the long
course of nerve VI. There is weakness of eye abduction.
Features of abducens paralysis include convergent
strabismus and diplopia
 Cranial Nerve V: Trigeminal Nerve
 The trigeminal nerve, contains a large sensory root, which carries
sensation from the skin and mucosa of most of the head, and a smaller
motor root, which innervates most of the chewing muscles (masseter,
temporalis, pterygoids, mylohyoid), and the tensor tympani muscle of
the middle ear.
 The sensory root (the main portion of the nerve) arises from cells in
the semilunar ganglion (also known as the gasserian, or trigeminal,
ganglion) in a pocket of dura (Meckel's cavity) lateral to the
cavernous sinus. It passes posteriorly between the superior petrosal
sinus in the tentorium and the skull base and enters the pons.
 Fibers of the ophthalmic division enter the cranial cavity through the
superior orbital fissure. Fibers of the maxillary division pass through
the foramen rotundum. Sensory fibers of the mandibular division,
joined by the motor fibers involved in mastication, course through the
foramen ovale.
 Clinical Correlations
 Symptoms and signs of nerve V involvement include loss of sensation
of one or more sensory modalities of the nerve; impaired hearing from
paralysis of the tensor tympani muscle; paralysis of the muscles of
mastication, with deviation of the mandible to the affected side; loss of
reflexes (cornea, jaw jerk, sneeze); trismus (lockjaw); and, in some
disorders, tonic spasm of the muscles of mastication.
 Because the spinal tract of V is located near the lateral spinothalamic
tract in the medulla and lower pons, laterally placed lesions at these
levels produce a crossed picture of pain and temperature insensibility
on the ipsilateral face and on the contralateral side of the body below
the face. This occurs, for example, in Wallenberg's syndrome, in
which there is damage to the lateral medulla, usually because of
occlusion of the posterior inferior cerebellar artery.
 .
 Trigeminal neuralgia is characterized by severe pain
in the distribution of one or more branches of the
trigeminal nerve. Although the cause is not always
clear, it is known that excruciating paroxysmal pain
of short duration can be caused by pressure from a
small vessel on the root entry zone of the nerve.
Trigeminal neuralgia is also seen in some patients
with multiple sclerosis. Pain may follow even gentle
stimulation of a trigger zone, a point on the lip, face,
or tongue that is sensitive to cold or pressure.
Involvement is usually unilateral
Facial Nerve:
Facial Nerve:
 The facial nerve consists of the facial nerve proper
and the nervus intermedius . Both parts pass through
the internal auditory meatus, where the geniculate
ganglion for the taste component lies. The nerve exits
through the stylomastoid foramen; it innervates the
muscles of facial expression, the platysma muscle, and
the stapedius muscle in the inner ear.
 The visceral afferent component of the nervus
intermedius, with cell bodies in the geniculate
ganglion, carries taste sensation from the anterior two-
thirds of the tongue via the chorda tympani to the
solitary tract and nucleus.
 Clinical Menifestation:
 The facial nucleus receives crossed and uncrossed fibers
by way of the corticobulbar tract .
 The facial muscles below the forehead receive
contralateral cortical innervation (crossed corticobulbar
fibers only). Therefore, a lesion rostral to the facial
nucleus—a central facial lesion—results in paralysis of
the contralateral facial muscles except the frontalis and
orbicularis oculi muscles. Because the frontalis and
orbicularis oculi muscles receive bilateral cortical
innervation, they are not paralyzed by lesions involving
one motor cortex or its corticobulbar pathways.
 The complete destruction of the facial nucleus
itself or its branchial efferent fibers (facial nerve
proper) paralyzes all ipsilateral face muscles; this
is equivalent to a peripheral facial lesion.
 Peripheral facial paralysis (Bell's palsy) can
occur as an idiopathic condition, but it is seen as a
complication of diabetes and can occur as a result
of tumors, sarcoidosis, AIDS, and Lyme disease
 A lesion in or outside the stylomastoid foramen results
in a flaccid paralysis (lower-motor-neuron type) of all the
muscles of facial expression in the affected side; this can
occur from a stab wound or from swelling of the parotid
gland (eg, as seen in mumps).
 A lesion in the facial canal involving the chorda tympani
nerve results in reduced salivation and loss of taste
sensation from the ipsilateral anterior two-thirds of the
tongue.
 A lesion in the middle ear involves all components of
nerve VII, whereas a tumor in the internal auditory canal
(eg, a schwannoma) can cause dysfunction of nerves VII
and VIII.
8th Cranial Nerve and Auditory system
 Cranial Nerve VIII: Vestibulocochlear Nerve
 Cranial nerve VIII is a double nerve that arises from
spiral and vestibular ganglia in the labyrinth of the
inner ear . It passes into the cranial cavity via the
internal acoustic meatus and enters the brain stem
behind the posterior edge of the middle cerebellar
peduncle in the pontocerebellar angle. The cochlear
nerve is concerned with hearing; the vestibular nerve
is part of the system of equilibrium (position sense).
 Temporal Lobe
 Primary Auditory cortex --area 41
 Secondary Auditory Cortex—area 42
 Together, these areas are referred to as Heschl's gyrus.
 They receive input (via the auditory radiations) from the
medial geniculate.
 The surrounding temporal cortex (area 22) is the auditory
association cortex.
 In the posterior part of area 22 (in the posterior third of the
superior temporal gyrus) is Wernicke's area, which plays
an important role in the comprehension of language. The
remaining temporal areas are multimodal association areas.
 Auditory Pathways
 The axons that carry auditory information centrally within the
cochlear nerve originate in the spiral (or cochlear)ganglion,
which innervate the cochlear organ of Corti. Central branches of
these neurons course in the cochlear portion of nerve VIII . These
auditory axons terminate in the ventral and dorsal cochlear nuclei
in the brain stem where they synapse.
 Thus, second-order fibers ascend from the cochlear nuclei on both
sides; the crossing fibers pass through the trapezoid body, and
some of them synapse in the superior olivary nuclei. The
ascending fibers course in the lateral lemnisci within the brain
stem, which travel rostrally toward the inferior colliculus and
then project to the medial geniculate body.
 From the medial geniculate body (the thalamic auditory relay),
third-order fibers project to the primary auditory cortex in the
upper and middle parts of the superior temporal gyri (area 41).
Glossopharyngeal (IX Cranial Nerve), Vagus (X Cranial
Nerve),
Accessory (XI Cranial Nerve),
 The ninth (glossopharyngeal) and tenth (vagus) nerves arise
from the upper part of the medulla, lateral to the olive.
 The eleventh (accessory) emerges behind or lateral to the olive,
with several fibers extended along most of the medulla length.
 The twelfth (haypoglossal) nerve emerges from the
anterolateral (preolivary) sulcus at the lower part of the medulla.
 The IX, X and XI cranial nerves reach the pars nervosa of the
jugular foramen, while the XII cranial nerve exits the skull
through the hypoglossal canal.
 IX, X and XI Nerves
 The glossopharyngeal nerve is rarely involved alone (eg, by
neuralgia); it is generally involved with the vagus and accessory
nerves. The pharyngeal (gag)reflex depends on nerve IX for its
sensory component, whereas nerve X innervates the motor
component. Stroking the affected side of the pharynx does not
produce gagging if the nerve is injured.
 Lesions of the vagus nerve may be intramedullary or peripheral.
Vagus nerve lesions near the skull base often involve the
glossopharyngeal and accessory nerves and sometimes the
hypoglossal nerve as well. Complete bilateral transection of the
vagus nerve is fatal.
 Unilateral lesions of the vagus nerve, within the cranial vault or
close to the base of the skull, produce widespread dysfunction of
the palate, pharynx, and larynx. The soft palate is weak and may be
flaccid so the voice has a nasal twang. Weakness or paralysis of the
vocal cord may result in hoarseness.
 Damage to the recurrent laryngeal nerve, which arises from the
vagus, can occur as a result of invasion or compression by tumor or
as a complication of thyroid surgery.
 Cranial Nerve XI: Accessory Nerve

 The accessory nerve consists of two separate components: the

cranial component and the spinal component .
 In the cranial component, branchial efferent fibers (from the
ambiguus nucleus to the intrinsic muscles of the larynx) join the
accessory nerve inside the skull but are part of the vagus outside
the skull.
 In the spinal component, the branchial efferent fibers from the
lateral part of the anterior horns of the first five or six cervical
cord segments ascend as the spinal root of the accessory nerve
through the foramen magnum and leave the cranial cavity through
the jugular foramen. These fibers supply the sternocleidomastoid
muscle and partly supply the trapezius muscle
 Interruption of the spinal component leads to paralysis of the
sternocleidomastoid muscle, causing the inability to rotate the
head to the contralateral side, and paralysis of the upper portion of
the trapezius muscle, which is characterized by a wing-like
scapula and the inability to shrug the ipsilateral shoulder.
 Cranial nerve XII

Cranial Nerve XII: Hypoglossal Nerve

 Somatic efferent fibers from the hypoglossal nucleus in the ventromedian
portion of the gray matter of the medulla emerge between the pyramid and
the olive to form the hypoglossal nerve . The nerve leaves the skull through
the hypoglossal canal and passes to the muscles of the tongue. The
hypoglossal nerve distributes motor branches to the geniohyoid and
infrahyoid muscles with fibers derived from communicating branches of the
first cervical nerve.
 Clinical Correlations
 Peripheral lesions that affect the hypoglossal nerve usually come from
mechanical causes .
 Nuclear and supranuclear lesions can have many causes (eg, tumors,
bleeding, demyelination).
 Lesions of the medulla produce characteristic symptoms that are related
to the involvement of the nuclei of the last four cranial nerves that lie
within the medulla and the motor and sensory pathways through it.
 Unilateral hypoglossal lesion produces tongue protrusion towards the
lesion.
 Cortical localization with fMRI
 Functional brain mapping is possible by using the blood
oxygenation level-dependent (BOLD) magnetic resonance
imaging (MRI) contrast.
 The BOLD contrast relies on changes in deoxyhemoglobin
(dHb), which acts as an endogenous paramagnetic contrast
agent.. Therefore, changes in the local dHb concentration in
the brain lead to alterations in the signal intensity of magnetic
resonance images.
 Task and/or stimulation induce synaptic and electric activities
at localized regions, which will trigger an increase in CBF,
cerebral blood volume (CBV), CMRO2, CMRglu and
decreased in Deoxyhaemoglobin. These induces magnetic
field changes and produces signals.
 Major clinical uses of fMRI:

 Cortical mapping before any neurosurgical

procedure in Brain Tumour.
 Delineation of Eloquent cortex in cases of
AVM or Brain tumour.
 Localization of Epileptogenic focus and
knowing the risk of post operative
neurological deficit in a patient of Intractable
Seizure.
Functional Cortical Localization with fMRI:
Thank You