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Major Regions of the Brain
Slide 7.27 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
CerebralhemispheresDiencephalon
Brain stem Cerebellum
http://www.alc
oholpolicysolutions.net/hot _issues_brain _2.htm
Figure 7.12
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Cerebrum
Slide7.28b
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
Thesurface ismade of ridges(gyri) andgrooves(sulci)
Purpose:triplesurface
areaFigure 7.13a
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Lobes of Brain
Surface lobes of the cerebrumFrontal lobeParietal lobeOccipital lobeTemporal lobe
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Chapter 14The Central Nervous System
The brain is a centerfor:
1. registeringsensations
2. correlating with
stored information 3. making decisions
4. taking action.
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The NeocortexThe cerebral cortex is a thin layer of cells about 1.5 to4 mm thick.
The cortex provides the connections and pathways
for the highest cognitive functions, such as language
and abstract thinking.
The cerebral cortex contains about 25 billion neurons,more than 62,000 miles of axons, and
300,000,000,000,000 synapses.
Neocortex layer
The thin layer of the
neocortex is dense
with neurons.
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Figure 29-5
Blood Supply
Inferior view of brain showing vertebral, basilar,and internal carotid arteries and branches
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Cranial Meninges
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Interior Skull SurfaceThe base of the skull is rough,with many bony protuberances.
These ridges can result in injury
to the temporal lobe of the brain
during rapid acceleration.
Bony ridges
Injury from contact
with skull
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Blood Vessels of the SkullThe brain requires a rich bloodsupply, and the space between
the skull and cerebrum contains
many blood vessels.
These blood vessels can be
ruptured during trauma,resulting in bleeding.
Groove for middlemeningeal artery
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Brain Ventricles Ventricles are Internal chambers within the
CNS
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Flow of Cerebrospinal Fluid CSF is formed by
the choroidplexuses and
circulatesthrough the:
ventricles, down central
canal of spinalcord to
subarachnoidspace of cordand brain,
up to beabsorbed by the
i ki
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History taking IThere is no single, correct way to take a history; you will develop your own
style; one effective and commonly used sequence as follows:
Full patient personal and contact details to include Gp1. PC: Presenting complaint2. HPI/HPC: History of current illness/complaint3. PMH: Past medical history: Surgical/Gynae/Psych
4. Medications and allergies: Rx, OTC, Herbal, Rxn’s?5. FHx: Family history: Medical/Genetic?6. SHx: Social history: Occupation, Smoking, Alcohol,
Recreational drugs? Elderly: Carer support?Independence? Mobility: frame/sticks?
7. ROS: Review of Systems8. O/E: Examination findings: By System OR Injury
specific9. Patient’s ideas, concerns and expectations 10. Impression11. Plan
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Pain assessment
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Sensory and Motor Areas of theCerebral Cortex
Slide 7.31 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
Figure 7.14
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Anatomy
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Homunculus Man
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MUSCLE POWER
Muscle power is graded on an MRC (MedicalResearch
Council) scale of 0 –5
0 = no visible contraction
1 = visible contraction without active movement
2 = movement possible, but not against gravity
3 = movement possible against gravity 4 = movement possible against gravity and resistance,
but weaker than normal
5 = normal power
Figure 8 116
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Figure 8.116Schematic diagram of lateral and anteriorcorticospinal tracts (red) ventral andmotor neurons and axons (black). Lettersand numbers indicate the various
levels of the spinal cord. For details of these tracts see p. 998. (From CarpenterM B 1991. Core text of neuroanatomy,Williams & Wilkins, with permission of author and publisher.)To
Figure 8 111
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Figure 8.111Schematic diagram of the anteriorspinothalamic tract (red), and thespinotectaltract (black). The anterior spinothalamic
tract, composed of mainly crossed fibresarises from cells in laminae I, IV to VIII(for details of segmental location andfunctional significance of these cells see p.983, 8.99). The spinotectal tractarises from neurons of laminae I, IV to VIII
and is composed of crossed fibreswhich intermingle and ascend with thoseof the spinothalamic system.Spinotectal fibres project to the superiorcolliculus, and functionally conveynociceptive information. Letters and
numbers represent the segmental levels of the spinal cord. (From Carpenter M B1991. Core text of neuroanatomy, Williams& Wilkins, with permission of author andpublisher.)
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Figure 8.110Schematic diagram of the anterior (red) andposterior (blue) spinocerebellartracts, and also the cuneocerebellar tract (blue). Fibres forming the posterior
spinocerebellar tract arise from neurons of thethoracic nucleus, and are mainlyuncrossed; this tract carries information from musclespindles and Golgi tendonorgans. The anterior spinocerebellar tract, composedof crossed fibres, arises
mainly from cells in laminae V to VII of thelumbosacral cord; it conveys impulsesfrom Golgi tendon organs. The cuneocerebellar tract,composed of uncrossedfibres, originates from cells of the accessory cuneatenucleus, and is regarded asthe upper limb equivalent of the posterior
spinocerebellar tract. Letters andnumbers denote the segmental levels of the spinalcord. (For details of thesetracts see p. 990.) (From Carpenter M B, 1991. Coretext of neuroanatomy,Williams & Wilkins, with permission of author andpublisher.)
Figure 8.112
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Figure 8.112Schematic diagram of the lateralspinothalamic tract. This tract, arising fromcellsin laminae I, IV to VIII is composed mainly
of crossed fibres. Letters and numbersindicate the segmental levels of the spinalcord. For details of segmental locationof the cells and their functional significancesee p. 983, 8.99. (From Carpenter MB 1991. Core text of neuroanatomy,
Williams & Wilkins, with permission of authorand publisher.)
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Figure 8.108
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gu e 8 08Schematic diagram of the dorsal column –mediallemniscus pathway. The dorsalwhite column contains ascending and descendingfibres of dorsal root ganglioncells. Ascending fibres in the fasciculi gracilis and
cuneatus synapse on neuronsof the nuclei gracilis and cuneatus respectively. Axons from neurons of thesenuclei cross in the lower medulla oblongata to formthe medial lemniscus whichascends to end in the ventroposterolateral nucleusof the thalamus. Neurons of
this nucleus then project axons via the internalcapsule to the somaestheticcortex. Impulses mediated by this pathway areconcerned with discriminativetouch and pressure sense, and also withproprioceptive sense. Dorsal root
ganglia and their fibres entering the spinal cord atvarious levels are colourcoded(red = sacral; blue = lumbar; yellow = thoracic;black = cervical). Lettersand numbers show the segmental levels of thespinal cord. (From Carpenter M B1991. Core text of neuroanatomy, Williams &
Wilkins, with permission of authorand ublisher.
Figure 8.117
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Figure 8.117Schematic diagram of the vestibulospinaltracts. The lateral vestibulospinal tract(blue) projects ipsilaterally in the spinalcord. The medial vestibulospinal tract
(red) descends in the medial longitudinalfasciculus at brainstem levels and thenprojects bilaterally in the spinal cord.Letters and numbers indicate thesegmentallevels of the spinal cord. (From Carpenter
M B 1991. Core text of neuroanatomy,Williams & Wilkins, with permission of author and publisher.)
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Where is it ? Localization in
neurological disease
Disorders of muscle
Disorders of the NeuromuscularJunction
Disorders of Peripheral Nerve Nerve root Involvement
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What is it ? Determining the
cause of a neurological disorder
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Figure 29-4
Neural Pathway Involved in Patellar(―Knee- jerk‖ ) Reflex
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Figure 23-5
Assessment - Abnormal Reflexes
Abnormal reflexes may beaccompanied by:
Positive Babinski's sign Also called the plantar reflex
Dorsiflexion of the great toe withor without fanning of toes
Relaxation of sphincter tone
with evacuation of the bowelsand/or bladder
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I - Olfactory Nerve
Provides sense of smell Damage causes impaired sense of smell
Test with coffee grounds, spice not perfume,Why?
Test for smell NOT reco nition of smell. Ch. 16
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II - Optic Nerve
Provides vision
Damage causes blindness in visual field
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VisionThe visual cortex resides in theoccipital lobe of the brain.
Sensory impulses travel from
the eyes via the optic nerve to
the visual cortex.
Damage to the visual cortexcan result in blindness.
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III - Oculomotor Nerve
Provides eye movement, opening of eyelid
Damage causes ptosis (drooping eyelid),double vision
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IV - Trochlear Nerve
Moves eye down and out Damage causes double vision & inability to
look down and out
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VI - Abducens Nerve
Moves eye laterally (ABduction) Damage results in inability to move eye ______
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Innervation of Eye Muscles
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V - Trigeminal Nerve
Main sensory nerve to face (touch, pain andtemperature) and muscles of mastication
Damage produces loss of sensation & impaired
chewing or can cause increased pain = trigeminal
VII - Facial Nerve
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VII Facial Nerve
Provides facial expressions, sense of taste onanterior 2/3’s of tongue, salivary glands and tear,nasal & palatine glands
Damage produces sagging facial muscles &
disturbed sense of taste (missing sweet & salty)’
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Figure 29-12
Bell’s Palsy
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TasteThe gustatory complex(green circle) is the part
of the sensory cortex
(purple area) that is
responsible for taste.
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VIII - Vestibulocochlear Nerve
Provides hearing & sense of balance Damage produces deafness, dizziness,
nausea, loss of balance & nystagmus
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IX - Glossopharyngeal Nerve
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IX Glossopharyngeal Nerve
Provides control over swallowing, salivation,gagging, sensations from posterior 1/3 of tongue,control of BP and respiration
Damage results in loss of bitter & sour taste &
impaired swallowing.
X - Vagus Nerve
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X Vagus Nerve
The wonderer
Provides swallowing, speech, regulation of 2/3 of GI
tract
XI - Accessory Nerve
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XI Accessory Nerve
Contracts upper trap muscles (I don’t know)
Damage causes impaired shoulder
movement
XII - Hypoglossal Nerve
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XII Hypoglossal Nerve
Provides tongue movements of speech, food
manipulation & swallowing Damage results in inability to protrude
tongue, TEST – Stick tongue out and it
points right then the XII is broken
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Reticular Formation
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Reticular Formation
Slide
7.42b Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
Figure 7.15b
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Figure 22-17
Posturing
Abnormal extension
(decerebrate
posturing).
Abnormal flexion
(decorticate
posturing).
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Limbic System
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Orientation
Time/Date
Place
Person (body position /situation)
Who am I?
Where am I?
What year is it?
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Concentration & Attention
Vigilance (simple)
Vigilance (complex) Concentration
Are you on task?
Specialized Area of the
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Specialized Area of theCerebrum
Slide
7.32c Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
Figure 7.13c
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Language Centers
PET Scans during a Language
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PET Scans during a LanguageTask
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CognitionThe prefrontal cortex isinvolved with intellect,
complex learning, and
personality.
Injuries to the front lobe
can cause mental and
personality changes.
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EmotionEmotions are an extremelycomplex brain function. The
emotional core of the brain is the
limbic system. This is where
senses and awareness are first
processed in the brain.
Mood and personality are
mediated through the prefrontal
cortex. This part of the brain is
the center of higher cognitive and
emotional functions.
Prefrontal cortex
Limbic system
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SpeechBroca’s area is where weformulate speech and the
area of the brain that sends
motor instructions to the
motor cortex.
Injury to Broca’s area can
cause difficulty in speaking.
The individual may know
what words he or she wishes
to speak, but will be unable
to do so.
Broca’s Area
A dit A i ti A
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LanguageWernicke’s area is aspecialized portion of the
parietal lobe that recognizes
and understands written and
spoken language.
Wernicke’s area surrounds the
auditory association area.
Damage to this part of the
brain can result in someone
hearing speech, but not
understanding it. Wernicke’s Area
Auditory Association Area
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HearingThere are two auditory
areas of the brain:
• The primary auditory
area (brown circle) is what
detects sounds that are
transmitted from the ear. It
is located in the sensory
cortex.
• The auditory association
area (purple circle) is the
part of the brain that is
used to recognize the
sounds as speech, music,or noise.
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Visual Processes
Tracking
Neglect Suppression /Extinction
Visual Quadrants
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Auditory Processes
Hearing and Neglect
Suppression orExtinction
What’d you say?
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Tactile Sensation
Neglect
Suppression
Reach out and
touch someone .
d l
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Motor and Balance
Balance
PurposefulMovements
Come on and move with me!
M d L i
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Short-Term Memory
Learning Curve
Recent Memory
Remote Memory
Retention
Memory and Learning
Now, what
was I supposed
to remember?
Construction/Spatial/Fine
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/ p /Motor
Bender
Clock Drawing
Complex Figure Test (Rey orTaylor)
Fine Motor Sequencing
Nonverbal & Tactile
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Nonverbal & TactileProcessing
Rhythm
Tactile Comprehension
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F t l L b
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Frontal Lobe
Conscientiousness Judgments How we initiate activity in response to our
environment. Controls our emotional response. Controls our expressive language. Assigns meaning to the words we choose (abstract
thought) Attention span Involves word associations (language planning) Memory for habits and motor activities (short term
memory) Motor cortex — Voluntary movement
Impulse control
F t l L b D fi it P bl
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Frontal Lobe Deficit —Problems Loss of simple movement of various body parts
(Paralysis). Inability to plan a sequence of complex movements
needed to complete multi-stepped tasks, such asmaking coffee (Sequencing).
Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Persistence of a single thought (Perseveration). Inability to focus on task ( Attending). Mood changes (Emotionally Labile). Changes in social behavior. Changes in personality. Difficulty with problem solving. Inablility to express language (Broca's Aphasia).
P i t l L b F ti
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Parietal Lobe Function
Location for visual attention. Location for touch perception.
Goal directed voluntary movements.
Manipulation of objects.
Integration of different senses that allowsfor understanding a single concept.
Parietal Lobe —Problems resultingfrom deficit
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from deficit Inability to attend to more than one object at a
time. Inability to name an object ( Anomia).
Inability to locate the words for writing( Agraphia).
Problems with reading ( Alexia).
Difficulty with drawing objects.
Difficulty in distinguishing left from right.
Difficulty with doing mathematics(Dyscalculia).
Lack of awareness of certain body parts and/orsurrounding space (Apraxia) that leads to
difficulties in self-care.
T l L b F ti
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Temporal Lobe Function
Hearing ability
Memory acquisition
Some visual perceptions Categorization of objects.
Temporal Lobe Deficits —Problems
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Difficulty in recognizing faces(Prosopagnosia).
Difficulty in understanding spoken words(Wernicke's Aphasia).
Disturbance with selective attention to whatwe see and hear.
Difficulty with identification of, andverbalization about objects.
Short-term memory loss. Interference with long-term memory Increased or decreased interest in sexual
behavior. Inability to catagorize objects
(Catagorization).
O i it l L b F ti
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Occipital Lobe Function
Vision
O i it l L b D fi it P bl
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Occipital Lobe Deficits--Problems
Defects in vision ( Visual Field Cuts). Difficulty with locating objects in
environment.
Difficulty with identifying colors (Color Agnosia).
Production of hallucinations Visual illusions - inaccurately seeing objects. Word blindness - inability to recognize words. Difficulty in recognizing drawn objects. Inability to recognize movement of an object
(Movement Agnosia)
Functions of Cerebrum Lobes
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Frontal contains voluntarymotor forplanning, mood, smell andsocial judgement
Motor is in FRONT of a car
Parietal integrates
it com-pairs
Occipital is optical
Temporal contains areas for hearing,emotional behavior, learning, memory, smell
Basal Nuclei (Basal Ganglia)
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Basal Nuclei (Basal Ganglia)
Masses of gray matter deep to cerebralcortex
Involved in motor control & inhibition of tremors
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The Limbic System
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The Limbic System
A. Cingulate gyrus
B. Fornix
C. Anterior thalamic
nuclei
D. Hypothalamus
E. Amygdaloid nucleusF. Hippocampus
The limbic system is the
area of the brain thatregulates emotion and
memory. It directly
connects the lower and
higher brain functions.
EEG and Brain Waves
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EEG and Brain Waves
Electroencephalogram (EEG) graphs brain waves May be used to diagnose epilepsy and other seizure
disorders
It may also provide useful information regarding sleepand wakefulness.
Reticular Activating System
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g y(RAS) Throughout pons,
midbrain & medulla
Regulate balance
& posture
Regulates sleep
& conscious attention
injury leads to irreversible coma
Diencephalon
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Diencephalon Thalamus
Pineal Gland
Thalamus, Hypothalamus and Epithalamus (houses pineal glan
The pineal secretes melatonin to influence diurnal cycles
THALAMUS
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THALAMUS
Thalamus is located superior to themidbrain and serves as relay station for
all sensory impulses, except smell , tothe cerebral cortex
1) medial geniculate (hearing),
2) lateral geniculate (vision)
Hypothalamus
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Hypothalamus
Hypothalamus is found inferior to thethalamus
Is a relay station for smell . Major regulators of homeostasis
It controls and integrates the autonomic nervoussystem, which regulates contraction of smooth
muscle, cardiac muscle, and secretions of manyglands.
Seat of rage & aggression, body temperature.hunger and the satiety, thirst,
Maintains the waking state and sleep patterns
Cerebellum Function
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Cerebellum Function
Coordination of voluntary movement
Balance and equilibrium
Some memory for reflex motor acts.
Cerebellum
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Cerebellum
Connected to brainstem Arbor vitae (tree of life) visible in sagittal
section
Sits atop the 4th ventricle
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Cerebellum Deficits—Problems
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Cerebellum Deficits —Problems
Loss of ability to coordinate finemovements.
Loss of ability to walk. Inability to reach out and grab objects.
Tremors.
Dizziness ( Vertigo). Slurred Speech (Scanning Speech).
Inability to make rapid movements.
Brainstem
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Brainstem
Midbrain
Pons
Medulla
Brainstem Function
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Brainstem Function
Breathing
Heart Rate
Swallowing
Reflexes to seeing and hearing (StartleResponse).
Controls sweating, blood pressure, digestion,
temperature ( Autonomic NervousSystem).
Affects level of alertness.
Ability to sleep
Brainstem Deficits—Problems
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Brainstem Deficits —Problems
Decreased vital capacity in breathing,important for speech.
Swallowing food and water (Dysphagia). Difficulty with organization/perception of
the environment.
Problems with balance and movement. Dizziness and nausea ( Vertigo).
Sleeping difficulties (Insomnia, sleep
a nea
Midbrain
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Midbrain
Function:
Body posture
Equilibrium
Autonomic Nervous System
Blood pressure
Temperature
Emotional influence
Reg appetite and hormones
Nuclei of CN III and IV
Midbrain
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CN III and IV
eye movement
Substantia nigra sends inhibitory signals to thalamus(degeneration leads to tremors of Parkinson disease)
Midbrain
Midbrain lesion
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Midbrain lesion
Variable LOC
Abnormal extensor tone
Hyperventilation
CN III and IV deficits
CN IV nerve lesion: head tilted away fromlesion
CN IV nucleus lesion: head tiled towards lesion
CN III: innervates all eyes muscles except
LR6 and SO4 eye deviated laterally and
Pons
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Pons
Function
Respiration
Chewing Taste
Arousal, wakefulness, alertness
Nuclei of CN V, VI, VII, VIII
Pons lesion
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Pons lesion
Semi-coma
Abnormal extensor tone
Apneusis Withdrawal
CN V,VI, VII (facial colliculus syndrome) CN V: ipsi jaw deviation upon opening
VI: diplopia, paralysis of ipsi LR but alsoinablity to turn contra eye medially
VII: can’t close eye or smile
Pons
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Pons Anterior bulge in the brainstem
Pathways between cerebellum
Relays nerve impulses related to voluntaryskeletal movements from the cerebral cortex
to the cerebellum Cranial nerves V- VIII
Medulla
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Medulla
Function:
Life-sustaining control center: controls
hear, respiration, vasomotor Cough, gag, swallow, vomit, digest
Nuclei of CN VIII, IX, X, XI, XII
Medulla Oblongata
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g
Cranialnerves (IX- XII)
Heart rate, respiratory rate
Adjusts blood vessel diameter Reflex centers for coughing, sneezing,
gagging, swallowing, vomiting, and
hiccupping.
Medulla Lesion
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Medulla Lesion
Comatose
Abnormal breathing
Ataxic
Absent gag reflex
Absent cough
CN VIII, IX, X, XI, XII deficits
VIII: ipsi stumbling but contra nystagmus IX, X, XI: absent gag reflex, contra uvula deviation,
dysphonia, dysphagia
XII: ipsi tongue deviation and atrophy
Function of HemispheresRight Hemisphere
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Right Hemisphere judging the position of things in space knowing body position understanding and remembering things we do
and see putting bits of information together to make an
entire picture controls the left side of the body
Left Hemisphere understanding and use of language (listening,
reading speaking and writing)