brodmann areas

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Basic Anatomy of Brain and History of Brodmann

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Brodmann's areas : 

Brodmann's areas Dr. Korbinian Brodmann Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Outline : 

Outline Brief Biography of Dr. Korbinian Brodmann The Cortical Anatomy that helps define Brodmann’s Areas A Review of some of Brodmann’s Areas Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 3: 

Born November 17th, 1868 in Liggersdorf, Hohenzollern Father was a farmer. Studied medicine in Munich, Würzburg, Berlin and Freiburg. 'Approbation' in 1895. Clinical Neurologist Influenced by meetings with Ludwig Binswanger Biswanger’s Disease: rare form of multi-infarct dementia caused by damage to white brain matter. It is characterized by loss of memory and intellectual function and by changes in mood. Alois Alzheimer Alzheimer’s Disease: Dementia associated with amyloid plaques and neurofibrillary tangles Doctorate in Leipzig in 1898. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 4: 

Neurobiological Laboratory in Berlin 1901-1910. Published Major Works describing the cytoacritechture of the human cortex as well as other primates Major results were published between 1903 and 1908 as a series of communications in the Journal für Psychologie und Neurologie Journal of Brain Research (Impact Factor 2.2) Works first summarized in 1909: “Vergleichende Lokalisationslehre der Grosshirnrinde in ihren Prinzipien dargestellt auf Grund des Zellenbaues“ 3rd Edition Available (328 pgs) Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Career Setbacks : 

Career Setbacks Diphtheria 1896 Rejection by the Medical Faculty of Neurobiological Laboratory for his 'Habilitation' thesis on the prosimian cortex Moved to the Psychiatric and Neurological Clinic in Tübingen August 17th, 1918, he developed what seemed to be a simple influenza, but after a few days died of septicemia. Only 49 yrs old Died one year after his first marrage. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 6: 

'Just at the moment when he had begun to live a very happy family life and when, after years of interruption because of war work, he was able to take up his research activities again in independent and distinguished circumstances, just at the moment when his friends were looking forward to a new era of successful research from him, a devastating infection snatched him away after a short illness, on 22 August 1918' - Oskar Vogt Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Significance of Work : 

Significance of Work The basis of Brodmann's cortical localization is its subdivision into 'areas' with similar cellular and laminar structure. This area of study is called “cytoarchitectonics” In man, he distinguished 46 areas, each carrying an individual number, and some being further subdivided. Brodmann believed that these architectural differences reflected functional organization, which has been confirmed with the development of functional imaging studies. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Brodmann’s Cortical Map : 

Brodmann’s Cortical Map Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 9: 

Robert Ayer, MD, Dept of Neurosurgery, LLUMC Brodmann’s Cortical Map

Terminology for Classifying Cerebral Cortex : 

Terminology for Classifying Cerebral Cortex Neocortex/Isocortex 6 layers Mesocortex 3-6 layers Allocortex 3 layers Paleocortex Archicortex Corticoid Areas no distinct layers Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 11: 

Most Cerebral Cortex is Neocortex, also known as Isocortex Origins of “Neo” refer to its more recent appearance in vertebrate evolution. Isocortex (same) refers the fact that at some point in development this area of cortex consisted of 6 distinct layers. These distinct layers can be altered in later development. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 12: 

Mesocortex Transitional cortex between Isocortex and Allocortex Consists of 3 to 6 layers Cingulate gyrus Parahippocampal Gyrus Temporal Pole Insula Caudal Orbitofronal Cortex Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 13: 

Allocortex “other” Consists of three layers, never goes through a six layer stage of development Paleocortex Piriform cortex Archicortex Hippocampal formation Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 14: 

Corticoid Areas Poorly differentiated cortex Septal Region Substantia innominata Parts of the amygdaloid complex Robert Ayer, MD, Dept of Neurosurgery, LLUMC

The NeoCortex Has Six Layers : 

The NeoCortex Has Six Layers Robert Ayer, MD, Dept of Neurosurgery, LLUMC I. Few Neurons. Dendrites and axons from the lower layers. II. Stellate and small Pyramidal Neurons. Cortical to Cortical connections. IV. Stellate and Small Pyramidal Neurons. Inputs from Sensory Relay Nuclei of Thalamus. V. Large Pyramidal Neurons. Outputs to non-thalamic structures: Brainstem Cord Basal Ganglia VI. Neurons of variable shape size. Outputs to the thalamus. III. Small Pyramidal Neurons. Cortical to Cortical Connections

Cells of the Neocortex : 

Cells of the Neocortex Stellate Neuron (Layers II; IV) Interneurons with short axons that remain within the cortex Most are inhibitory (GABA) Small Pyramidal Neuron (Layer III) Intracortical communication Excitatory signaling (Glutamate) Association fiber Commissural fiber Large Pyramidal Neuron (Layer V) Axons sending excitatory (glutamate) signals to other cortical areas or subcortical structures Betz Cells Granule Cell (Layers II and IV) Generic term for small cells that can be either stellate or pyramidal. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Cells of the Neocortex : 

Robert Ayer, MD, Dept of Neurosurgery, LLUMC Cells of the Neocortex Golgi Stain

Slide 18: 

Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Terminology for Functional Regions of Cortex : 

Terminology for Functional Regions of Cortex Primary Sensory or Motor Areas: Directly receive sensory information from thalamic projections Sends axons through the corticospinal tract to direclty influence motor function. Association Cortex Unimodal Sensory: Receives input from 1○ sensory cortex to perform higher order functioning. Unimodal Motor: projects to 1○ motor areas Heteromodal Areas: has bi-directional connections with multiple functional areas, including the limbic system, to perform the highest order function. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Cytoarchitecture Reflects Function : 

Cytoarchitecture Reflects Function Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Specific Brodmann’s Areas : 

Specific Brodmann’s Areas Eloquent cortex: areas of cortex that—if removed—will result in loss of sensory processing or linguistic ability, or paralysis. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Motor Cortex : 

Primary Motor Cortex Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Motor Cortex : 

Primary Motor Cortex Brodmann Area 4 (MI): Influences the motor system via direct projections to the corticospinal and corticobulbar tracts Indirect motor influences via the red nucleus and reticular formation. This area has a somatotopic arrangement referred to as the homunculus. Additionally cortex is arranged into functional columns: Each column innervates a groups of muscles round one particular joint to elicit a particular movement. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Motor Cortex : 

Primary Motor Cortex MI Lesions: Result in immediate paresis of contralateral musculature with hyptonia and diminished stretch reflexes. In time the development of spasticity and its associated increased stretch reflexes sets in. increased resistance to passive stretch, velocity dependent and asymmetric about joints (i.e., greater in the flexor muscles at the elbow and the extensor muscles at the knee). Exaggerated deep tendon reflexes and clonus are additional manifestations Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Motor Association Areas : 

Motor Association Areas Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Motor Association Areas : 

Motor Association Areas Brodmann Areas 6, 8, 44 Includes Supplemental Motor Area (MII): 6 Premotor Area: 6 Frontal Eye Fields: 8 Broca’s Area: 44 Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Motor Association Areas : 

Movements can be illicited by stimulating unimodal motor association areas, but more current is needed. Supplementary MII: Involved in pre-motor planning Functional imaging demonstrates that this are is active when thinks about a movement in the absence of motor activation. Stimulation of this area results in bilateral movement and vocalizations. Premotor Area: Also involved in motor planning of limbs and eyes Stimulation causes complex motor movement, such are rotation of the torso, or whole arm movements. Robert Ayer, MD, Dept of Neurosurgery, LLUMC Motor Association Areas

Motor Association Areas : 

Frontal Eye Fields Stimulation of this area leads to deviation of the eyes toward the opposite side Also involved in all volitional and reflexive saccades-fast conjugate eye movements that place an object on the fovea. Robert Ayer, MD, Dept of Neurosurgery, LLUMC Motor Association Areas

Right way and Wrong Way Eyes : 

Right way and Wrong Way Eyes Frontal Eye Fields: Stimulation-contrlateral gaze Inhibition-loss of contralateral gaze Pre-Pontine Reticular Formation Stimulation-ipsilateral gaze Inhibitioin-contralateral gaze Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Broca’s Area : 

Broca’s Area Brodmann 44 It plans the motor functions to produce either speech or other means of communication by projecting to 1○ motor areas. Lesions here result in Broca’s Aphasia: Decreased fluency, intonation of speech, naming difficulties and impaired repetition. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Somatosensory Cortex : 

Primary Somatosensory Cortex Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Somatosensory Cortex : 

Primary Somatosensory Cortex Primary Somatosensory Cortex: Primary recipient of somatosensory information from the thalamus. Brodmann’s 3,1,2 3a: Muscle Spindle Fibers 3b,1: Cutaneous Fibers 2: Joint Receptors Somatotopic organization mirrors MI Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Somatosensory Cortex : 

Primary Somatosensory Cortex Stimulation of these Brodmann’s area’s Produces sensation described as tingling or numbness on the contra lateral side of the body. Sensations usually do not resemble natural stimuli Pain sensation can rarely be elicited Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Somatosensory Cortex : 

Primary Somatosensory Cortex Large lesions of this area cause considerable impairment of finer aspects of somatic sensation. Judging location and intensity. Does not abolish tactile sensation or pain. In a few cases the postcentral gyrus has been removed to try to treat intractable pain Relief typically only temporary, and often the long term result was a state of increased pain. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Auditory and Unimodal Auditory Association Area : 

Primary Auditory and Unimodal Auditory Association Area Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Auditory and Unimodal Auditory Association Area : 

Primary Auditory and Unimodal Auditory Association Area Brodmann 41: 1○ Auditory area Tonotopic Organization Low Frequency: Caudal and Lateral Localization of sounds. Cortical Deafness only results in from bilateral lesions Ascending auditory pathways ascend bilaterally. * Broadmann 22: Auditory Unimodal Association Area Discrimination of auditory frequency, sequence, and pattern Left sided lesion results in Wernicke’s Aphasia Severely limited comprehension Inability to repeat phrases Empty meaningful phrases full of nonsensical paraphasic errors. Written language is similarly affected. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Visual and Unimodal Visual Association Areas : 

Primary Visual and Unimodal Visual Association Areas Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Primary Visual and Unimodal Visual Association Areas : 

Primary Visual and Unimodal Visual Association Areas Brodmann 17 or Striate Cortex 1○ Visual Cortex: Receives visual input from the retina through the lateral geniculate nucleus. Contains a representation of the contra lateral visual field. Destruction of this site (in addition to 18,19) leads to cortical blindness. This can result in Anton’s Syndrome Complete visual loss on confrontation testing Anosognosia: pt unaware of deficits Brodmann 18,19 (parts of 20,21,37) Visual Unimodal Association Areas Deficits in these areas results in loss of depth perception, spatial orientation, and hue discrimination. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Heteromodal Association Areas : 

Heteromodal Association Areas Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Heteromodal Association Areas : 

Heteromodal Association Areas Brodmann 39: Deficits reflecting the complexity of these areas connections. Alexia (can’t read) Anomia (can’t name objects) Constructional apraxia (inability to “construct” or draw simple figures) Agraphia (inability to write) Confusion between left and right Finger Agnosia Gerstmann’s Syndrome: Triad of Agraphia, acalculia, right-left disorientation. Strongly localizing for the angular gyrus of the dominant parietal lobule. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Brodmann’s Areas Variablity : 

Brodmann’s Areas Variablity Each indiviudal has roughly the same area of cerebral cortex Brodmann’s Areas vary in size by 2-3 times between individuals. It is unknown whether or not these variations correlate with functional capacity. Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Brodmann’s Areas Variablity : 

Brodmann’s Areas Variablity Language areas are much more variable in size and location than motor and sensory function Ojemann et al. Found that essential language size varied from 2.5 cm2 to greater than 6cm2. It was also found that greater than 67% of patients had more than on essential language area in the Perisylvian area Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 43: 

Robert Ayer, MD, Dept of Neurosurgery, LLUMC

Slide 44: 

Robert Ayer, MD, Dept of Neurosurgery, LLUMC 250 Glioma Patients with Perisylvian masses. “Positive” language sites were not sought . This "negative mapping" strategy represents a paradigm shift in the language-mapping technique by eliminating the neurosurgeon's dependence on the positive sites as controls, thereby allowing minimal cortical exposure 1.6% of patients had language deficit at 6 months. 52 of the 56 patients (92.9%) with new or increased language deficits had a return to baseline function or better. Rate of gross total resection was 65.5% for WHO grade III tumors and 69.0% for WHO grade IV tumors; the rate was 51.6% for low-grade tumors (WHO grade I and II).

References : 

References Manter and Gatz's Essentials of Clinical Neuroanatomy and Neurophysiology. Philadelphia: F.A. Davis Company, 10thEdition Blumefield. Neuroanatomy Through Clinical Cases. Mass.: Sinauer Associates, 2002. Nolte. The Human Brain. Introduction to Function and Anatomy. New York. Springer 1998. Ojemann G, Ojemann J, Lettich E, Berger M.Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. 1989.J Neurosurg. 2008 Feb;108(2):411-21. Robert Ayer, MD, Dept of Neurosurgery, LLUMC