Anatomy and Physiology

Anatomy of the Brain

The Cerebrum:

The cerebrum is the largest part of the brain and controls voluntary
actions, speech, senses, thought, and memory.
The surface of the cerebral cortex has grooves or infoldings (called
sulci), the largest of which are termed fissures. Some fissures separate
lobes.
The convolutions of the cortex give it a wormy appearance. Each
convolution is delimited by two sulci and is also called a gyrus (gyri in
plural). The cerebrum is divided into two halves, known as the right and left
hemispheres. A mass of fibers called the corpus callosum links the
hemispheres. The right hemisphere controls voluntary limb movements on
the left side of the body, and the left hemisphere controls voluntary limb
movements on the right side of the body. Almost every person has one
dominant hemisphere. Each hemisphere is divided into four lobes, or
areas, which are interconnected.
• The frontal lobes are located in the front of the brain and are
responsible for voluntary movement and, via their connections with
other lobes, participate in the execution of sequential tasks; speech
output; organizational skills; and certain aspects of behavior, mood,
and memory.

• The parietal lobes are located behind the frontal lobes and in front of
the occipital lobes. They process sensory information such as
temperature, pain, taste, and touch. In addition, the processing
includes information about numbers, attentiveness to the position of
 one’s body parts, the space around one’s body, and one's
relationship to this space.

• The temporal lobes are located on each side of the brain. They
process memory and auditory (hearing) information and speech and
language functions.

• The occipital lobes are located at the back of the brain. They receive
and process visual information.

The cortex, also called gray matter, is the most external layer of the
brain and predominantly contains neuronal bodies (the part of the neurons
where the DNA-containing cell nucleus is located). The gray matter
participates actively in the storage and processing of information. An
isolated clump of nerve cell bodies in the gray matter is termed a nucleus
(to be differentiated from a cell nucleus). The cells in the gray matter
extend their projections, called axons, to other areas of the brain.
Fibers that leave the cortex to conduct impulses toward other areas are
termed efferent fibers, and fibers that approach the cortex from other areas
of the nervous system are termed afferent (nerves or pathways). Fibers that
go from the motor cortex to the brainstem (for example, the pons) or the
spinal cord receive a name that generally reflects the connections (that is,
corticopontine tract for the former and corticospinal tract for the latter).
Cortical areas receive their names according to their general function or
lobe name. If in charge of motor function, the area is called the motor
cortex. If in charge of sensory function, the area is called a sensory or
somesthetic cortex. The calcarine or visual cortex is located in the occipital
lobe (also termed occipital cortex) and receives visual input. The auditory
cortex, localized in the temporal lobe, processes sounds or verbal input.
Knowledge of the anatomical projection of fibers of the different tracts and
the relative representation of body regions in the cortex often enables
doctors to correctly locate an injury and its relative size, sometimes with
great precision.

Central Structures of the Brain:

The central structures of the brain include the thalamus, hypothalamus,

and pituitary gland. The hippocampus is located in the temporal lobe but
participates in the processing of memory and emotions and is
interconnected with central structures. Other structures are the basal
ganglia, which are made up of gray matter and include the amygdala
(localized in the temporal lobe), the caudate nucleus, and the lenticular
nucleus (putamen and globus pallidus). Because the caudate and putamen
are structurally similar, neuropathologists have coined for them the
collective term striatum.
 • The thalamus integrates and relays sensory information to the cortex
of the parietal, temporal, and occipital lobes. The thalamus is located
in the lower central part of the brain (that is, upper part of the
brainstem) and is located medially to the basal ganglia. The brain
hemispheres lie on the thalamus. Other roles of the thalamus include
motor and memory control.

• The hypothalamus, located below the thalamus, regulates automatic

functions such as appetite, thirst, and body temperature. It also
secretes hormones that stimulate or suppress the release of
hormones (for example, growth hormones) in the pituitary gland.

• The pituitary gland is located at the base of the brain. The pituitary
gland produces hormones that control many functions of other
endocrine glands. It regulates the production of many hormones that
have a role in growth, metabolism, sexual response, fluid and
mineral balance, and the stress response.

• The ventricles are cerebrospinal fluid-filled cavities in the interior of

the cerebral hemispheres.

The Base of the Brain:

The base of the brain contains the cerebellum and the brainstem. These
structures serve complex functions. Below is a simplified version of these
roles:
• Traditionally, the cerebellum has been known to control equilibrium
and coordination and contributes to the generation of muscle tone. It
has more recently become evident, however, that the cerebellum
plays more diverse roles such as participating in some types of
memory and exerting a complex influence on musical and
mathematical skills.

• The brainstem connects the brain with the spinal cord. It includes the
midbrain, the pons, and the medulla oblongata. It is a compact
structure in which multiple pathways traverse from the brain to the
spinal cord and vice versa. For instance, nerves that arise from
cranial nerve nuclei are involved with eye movements and exit the
brainstem at several levels. Damage to the brainstem can therefore
affect a number of bodily functions. For instance, if the corticospinal
tract is injured, a loss of motor function (paralysis) occurs, and it
may be accompanied by other neurologic deficits, such as eye
 movement abnormalities, which are reflective of injury to cranial
nerves or their pathways in the brainstem.

o The midbrain is located below the hypothalamus. Some cranial

nerves that are also responsible for eye muscle control exit
the midbrain.

o The pons serves as a bridge between the midbrain and the

medulla oblongata. The pons also contains the nuclei and
fibers of nerves that serve eye muscle control, facial muscle
strength, and other functions.

o The medulla oblongata is the lowest part of the brainstem and

is interconnected with the cervical spinal cord. The medulla
oblongata also helps control involuntary actions, including
vital processes, such as heart rate, blood pressure, and
respiration, and it carries the corticospinal (that is, motor
function) tract toward the spinal cord.

Meninges:

Three connective tissue membranes, the meninges, surround and

protect the brain and spinal cord. The most superficial and thickest of the
meninges is the dura mater. The dura mater around the brain is tightly
attached to the periosteum of the skull to form a single functional layer.
The second meningeal layer is the very thin and wispy arachnoid mater.
The space between the dura mater and arachnoid mater is the subdural
space, which is normally only a potential space containing a very small
amount of serous fluid.
Pathophysiology

Definition:

Craniectomy is the surgical removal of a portion of skull (cranium), leaving

an opening in the skull that may be left open or covered with synthetic
material.

Predisposing:

• age older than 60 years

• alcohol abuse
• use of anticoagulant drugs
• bleeding disorders
• male gender

Precipatating:

• Head Injury
Risk factors: Causes (injuries):
• age older than 60
years • Head Injury
• alcohol abuse
• use of
anticoagulant drugs
• bleeding disorders

TRAUMA

Bleeding
Inflammation and Edema
Hematoma
Possible Infection

With Medical Treatment No Medical Treatment

Incision of the skin in the head Increased Intracranial Pressure

Drill to make a small burr hole Compress brain Compress blood

stem vessel
Retractor in the brain

Loss of Vital Ischemia and

Correct the problem Functions Necrosis
Respiratory and
Suture the skin of the head cardiovascular
controls

Recovery