Brandeis Human Neuropsychology (Exam 1 - Class Notes)

Front 1

Phineas T. Gage

Back 1

Odd effects of brain injury, explosion led to pipe going through his brain. After the accident, his personality changed (frontal lobe damage). Thought personality must be in the frontal lobe. Phineas had a problem with inhibition.

Front 2

Frontal lobe damage

Back 2

leads to disinhibition and difficulty controlling impulses

Front 3

Prefrontal Lobotomy

Back 3

Incision to disconnect prefrontal lobe

Front 4

Prefrontal Lobectomy

Back 4

Removal of the prefrontal lobe

Front 5

Reason for Prefrontal Lobotomies and Lobectomies

Back 5

psychotic, depressed, insane, schizophrenia.... Doctos would do this to people in hopes of "fixing" their personalities, procedure was used almost indiscriminately in the 1940s

Front 6

Result of Prefrontal Lobotomies and Lobectomies

Back 6

person was calm, but had other cognitive issues

Front 7

Broca

Back 7

French physician, credited with discovering Broca's area and function. Realized that damage to the 3rd left frontal convulsion resulted in the loss of ability to formulate speech.

Front 8

Broca was not quite right...

Back 8

Damage to the white matter (under cortex), fibers covered with myelin sheath, was also necessary.

Front 9

Broca's area

Back 9

It is a language production area

Front 10

Broca's Aphasic

Back 10

Can communicate with yes, no, and some nouns. Some Broca's aphasics can still sing.

Front 11

Broca and Cerebral Dominance

Back 11

He was credited with the notion of cerebral dominance, "we speak with the left hemisphere."

Front 12

How Broca became famous

Back 12

Broca was a member of the Anthropology Society of Paris, where he gave a speech about Broca's area to a very influential audience. He brought an actual brain in a jar. Broca let the world know of his discoveries.

Front 13

Angular gyrus

Back 13

refers to "bump" on brain, if damaged, people can no longer read and write (dyslexia)

Front 14

Alexia

Back 14

refers to more extreme version of dyslexia although the terms are often used interchangeable (amusica, amathematica...)

Front 15

Wernicke

Back 15

Noticed patients with damage to Wernicke's area would use the wrong words and in extreme cases, could not comprehend/understand anything.

Front 16

Broca and double-dissociation

Back 16

Broca never discovered double-dissociation, which is one of the weaknesses of his argument.

Front 17

double-dissociation

Back 17

Double Dissociation is when two related mental processes are shown to function independently of each other.

A classic example of Double Dissociation is speech and language comprehension. Although both processes pertain to use of language, the brain structures that control them work independently. When a part of the brain called the Broca's area is damaged, patients may still understand language but be unable to speak fluently. They know what they want to say, but are unable to express themselves. On the other hand, when a part of the brain called Wernicke's area is damaged, patients may still speak fluently, but be unable to comprehend language. This results in properly constructed but nonsensical sentences.

Front 18

Cerebral Dominance

Back 18

Right handed people are most likely to have language in the left hemisphere (~95%).
Left handed people are ALSO most likely to have language in the left hemisphere (~70%), however some have language in the right hemisphere or in both the left and right hemisphere.

Front 19

Broca's area location

Back 19

right next to the area of the motor cortex that is used for moving the mouth and lips

Front 20

Wernicke's area location

Back 20

right next to the auditory cortex

Front 21

Wernicke and Arcuate fasciculus

Back 21

Wernicke could never find a connection between Broca and Wernicke's area, but he knew that one must exists, and of course, he was right. These connecting fibers were named the "arcuate fasciculus".

Front 22

Arcuate fasciculus

Back 22

It is subcortical, and connects Broca's area and Wernicke's area. If broken, people would not be able to repeat words, but Broca's area and Wernicke's area would still work. This damage would be called "conduction aphasia".

Front 23

The Gall & Spurzheim Diagram (1810)

Back 23

Gall was incorrect, but phrenology followers were cult-like. The primary idea was that physically larger parts of the brain are more developed. Areas included parental love, self esteem.... Argued that certain areas were specialized, but the phrenologists were wrong in the way that they divided up the brain.

Front 24

The Wernicke-Lichtheim Diagram (Classic Diagram)

Back 24

Wernicke did not specify where the concept center was. The diagram is simple and straightforward. Consists of Broca's area and Wernicke's area, motor pathways, and auditory pathways.

Front 25

The Wernicke-Geschwind Model (Modern Diagram)

Back 25

These people looked at the connections on the cortex.

Front 26

The Wernicke-Geschwind Model (PPT)

Back 26

Repeating a spoken word and repeating a written word according to the Model (in PPT).
Spoken: auditory cortex -> Wericke's area -> arcuate fasciculus -> Broca's area -> motor cortex
Written: Primary visual cortex -> angular gyrus -> Wernicke's area -> Broca's area -> Motor cortex

Front 27

Freud's psychoanalytic theory of motivation (1891 - On Aphasia).

Back 27

His findings were very complicated when published, yet mundane today. Frued coined the term "auditory agnosia," when people cannot recognize sound or spoken word, yet can read just fine. Freud disagreed with the G-S Diagram, W-L Diagram, and the W-G Model. Freud knew that whit matter connections went throughout the brain subcortically, and believed that the brain was interconnected and interactive.

Front 28

Jackson

Back 28

Jackson was a better neurologist than Freud. He coined the term "non-propositional speech," which is when the right hemisphere is capable of producing a phrase such as cursing and speaking without semantic context (e.g., you're a son of a b----).

Front 29

Lurea

Back 29

Lurea argued for a fully interactive brain.

Front 30

Zangwill (*book was wrong)

Back 30

Zangwill *did not* overturn the classical doctrine that language must be in the right hemisphere for left-handed people and in the left hemisphere for right-handed people.

Front 31

Goodglass (*book was wrong)

Back 31

Goodglass *did* overturn the classical doctrine. Goodglass looked through countless articles with his colleague (lit. review), and found that language was most commonly in the left hemisphere for both right and left-handed individuals.

Front 32

Modern Imaging & localization

Back 32

Modern imaging may look like it supports localization since one area appears active at a time. However while one area is active, another area may be inhibited.

Front 33

Cuts

Back 33

Originally, anatomists would "cut" brain, but now MRIs and CTs allow us to look at the brain while it is still in a head.

Front 34

Cerebrum

Back 34

Another word for the brain.

Front 35

Cerebellum

Back 35

Cerebellum means "little brain". Is responsible for fine-motor coordination. The cerebellum is also very active in mental activity, and it has many connections with the frontal lobe.

Front 36

Parkinson's damage

Back 36

In the Basil ganglia.

Front 37

Corpus Callosum

Back 37

Comprised on thick fibers that help to hold the two sides of the brain together and transmit info between the two hemispheres.

Front 38

Superior

Back 38

North (upwards/ towards spine/ towards dorsal fin)

Front 39

Posterior

Back 39

East (back/ tail-end)

Front 40

Inferior

Back 40

South (downwards/ towards belly)

Front 41

Anterior

Back 41

West (front/ beak-end)

Front 42

Dorsal

Back 42

North (upwards/ towards spine/ towards dorsal fin)

Front 43

Caudal

Back 43

East (back/ tail-end)

Front 44

Ventral

Back 44

South (downwards/ towards belly)

Front 45

Rostral

Back 45

West (front/ beak-end)

Front 46

CT scan

Back 46

X-ray scan

Front 47

MRI

Back 47

Digital

Front 48

Medial

Back 48

towards the middle

Front 49

lateral

Back 49

towards the side

Front 50

midline

Back 50

the line down the middle

Front 51

Contralateral

Back 51

opposite side

Front 52

ipsalateral

Back 52

same side

Front 53

homologus

Back 53

same area in the other side of the brain

Front 54

Sulcus vs. fissure

Back 54

technically a fissure goes deeper than a sulcus, but so often, they are used interchangeably

Front 55

angular gyrus damage

Back 55

dyslexia

Front 56

central sulcus

Back 56

also known as:
-Rolandic fissure
-fissure of Rolando

Front 57

What runs underneath the supramarginal gyrus?

Back 57

the arcuate fasciculus

Front 58

Transverse fissure

Back 58

separates cerebellum from brain groove

Front 59

Brodmann

Back 59

German neurologist who decided to make a checkerboard of the brain.

Front 60

Brodmann's area 44

Back 60

pars opercularis (frontal operculum)

Front 61

Brodmann's area 45

Back 61

pars triangularis

Front 62

Brodmann's area 44 + 45

Back 62

Broca's area

Front 63

Brodmann's area 22

Back 63

posterior 1/3 is Wernicke's area

Front 64

Brodmann's area 39

Back 64

angular gyrus

Front 65

Brodmann's area 40

Back 65

supramarginal gyrus

Front 66

Brodmann's area 46 + 9

Back 66

dorso-lateral prefrontal cortex

Front 67

Brodmann's area 41

Back 67

Heschl's gyrus (primary auditory area)

Front 68

Brodmann's area 22 + 42

Back 68

secondary auditory areas

Front 69

Brodmann's area 17

Back 69

primary visual area

Front 70

Brodmann's area 18 + 19 + 20 + 37

Back 70

secondary visual areas

Front 71

Brodmann's area 4 (4s, 4a, 4g)

Back 71

motor cortex

Front 72

Brodmann's area 3 + 1 + 2

Back 72

somatosensory cortex

Front 73

Reason for a prefrontal lobotomy

Back 73

serious psychotic depression

Front 74

cingulotomy

Back 74

disconnect and cut off prefrontal area

Front 75

dyslexia

Back 75

terms used to describe children with difficulty learning how to read

Front 76

short-term memory vs. working memory

Back 76

working memory describes holding something in memory and manipulate it at the same time (2 x 4 + 3)

Front 77

Unfortunate side effect of cutting corpus callosum

Back 77

Performed surgery because the woman was having seizures. Woman who underwent the procedure would put together a jigsaw with her right hand and take it apart with her left hand at the same time.

Front 78

4 points on the Corpus Callosum (left to right)

Back 78

1. motor 2. sensorymotor 3. auditory 4. visual (corresponds with brain areas)

Front 79

petit mal seizure

Back 79

May result in temporary loss of consciousness, but may not be able to tell that a person had a seizure. May result in retrograde amnesia or anterograde amnesia.

Front 80

retrograde amnesia

Back 80

no memory of events just prior to amnesia

Front 81

anterograde amnesia

Back 81

no memory of events just after the amnesia

Front 82

grand mal seizure

Back 82

Very noticeable, the person flops around on the floor. It is very dramatic and painful to watch.

Front 83

Are the somatosensory and motor cortex aligned?

Back 83

Closely aligned, but not perfectly aligned.

Front 84

Spinal Cord directions

Back 84

-towards belly (inferior/ ventral)
-towards spine (superior/ dorsal)

Front 85

Human Brain directions

Back 85

-towards back of head (posterior/ caudal)
-towards chin (interior/ ventral)
-towards eyes (anterior/ rostral)
-towards top of head (superior/ dorsal)

Front 86

Cell Hypothesis

Back 86

Mental activity was controlled by the fluid in the ventricles.

Front 87

Right hemisphere damage or lesion

Back 87

Person would have problem with organization but memory would be fine. Person would have difficulty understanding sarcasm. Person is often not as worried as they should be. When parallel parking, crash into cars in front and behind them, but not care. Get lost going to the mailbox (spacial relation problems).

Front 88

Which of the 5 senses go through the Thalamus?

Back 88

All but olfaction.

Front 89

Hypothalamus

Back 89

regulates hunger and thirst

Front 90

Result of Thalamus damage?

Back 90

Problems with many areas because so much goes through the Thalamus.

Front 91

Hippocampus

Back 91

Hippocampus means "sea horse," and it is important for memory consolidation.

Front 92

Cerebellum

Back 92

Fine motor control and connected to all parts of the brain, especially the frontal lobe.

Front 93

Where is spinal fluid made?

Back 93

In the lateral ventricles

Front 94

Spinal Fluid

Back 94

-where the brain and spinal cord float
-helps dispose of waste
-fluid protects brain from minor head bangs, not major (car accident)

Front 95

coronal cut

Back 95

cutting away much of the frontal lobe (the face)

Front 96

Why are CT scan slices angled at 15-17 degrees?

Back 96

To avoid the eyes

Front 97

Margaret Naser

Back 97

Margaret Naser discovered all anatomy books showed only horizontal cuts of the brain. She took pictures of different angle slices of various brains. Each slice shows a different shape of the ventricle.

Front 98

CT scan immediately after car accident

Back 98

Bleeding will show up, but lesions/damage will not.

Front 99

What happens when a lesion or stroke leads to dead brain tissue?

Back 99

The brain tissue is absorbed by the spinal fluid and disposed of as waste. Eventually (weeks or months later), the hollow area will fill with spinal fluid.

Front 100

description of structural MRI

Back 100

Very loud, can hear the machine "breathing," then sounds like rattling of machine guns. The machine is full of helium and nitrogen at very cold temperatures, which helps to align electrons in brain with the magnet in the structural MRI machine. The RF coil is moved, and the time it takes for the electrons to return to their original position is measured. Picture looks very similar (if not the same) as a CT scan.

Front 101

T1

Back 101

missing part of brain looks black, good picture of area of damage

Front 102

T2

Back 102

missing part of brain looks black, overestimates damage (more dramatic), preferred by neurologists because it is easier to detect damage

Front 103

What is the standard Tesla of a structural MRI machine?

Back 103

1.5 Tesla

Front 104

5 gauss line

Back 104

Every MRI has one. Anything within the line can be sucked into the MRI machine which could lead to injury or death.

Front 105

fMRI

Back 105

Functional MRI looks at blood flow. It replaces PET, it is quiet, saves money, and does not have a cyclotron. Structural and functional images are automatically superimposed.

Front 106

What is an MRA?

Back 106

MRA is an MRI technology that visualizes blood vessels inside the body. It usually involves a contrast agent to make the vessels show up more clearly.
An MRA can reveal an aneurysm (a bulging section on the wall of a blood vessel. This thins the wall and may burst at any time).
An MRA can also reveal a clot, stenosis caused by plaque, etc.

Front 107

How does an angiogram differ from MRA?

Back 107

Unlike an MRA, that uses MRI technology, angiography uses X-ray technology to visualize blood vessels after introducing a contrast agent into the bloodstream. It is useful for detecting structural abnormalities in structure or arrangement of the blood vessels. It can detect an aneurusm.

Front 108

What is a subdural hematoma?

Back 108

A subdural hematoma is an ordinarily rapidly clotting blood collection below the layer of the dura, but external to the brain and arachnoid membrane.

Front 109

When does a subdural hematoma occur and which population is the most vulnerable?

Back 109

A subdural hematoma is often associated with a blunt head trauma.
It occurs in 1/3 of those with severe head injuries, and is more common in people over 60. This is because older people have less resilient bridging of the veins; But trauma-induced subdural hematomas are not at all limited to older people.

Front 110

What was the treatment of the subdural hematoma?

Back 110

A neurosurgeon was called in. The surgeon drilled holes in the right frontal and parietal areas and placed a right subdural drainage catheter.

Front 111

Case study: Can such an extreme brain herniation (subdural hematoma) actually resolve to this degree?

Back 111

Yes. Note: A brain herniation refers to the displacement of brain tissue away from its usual position inside the skull.

Front 112

hematoma & location of subdural hematoma

Back 112

A “hematoma” refers to refers to an acumulation of blood in the brain.
A “subdural hematoma” is a collection of blood below the layer of the dura and external to the brain and arachnoid membrane

Front 113

Meninges

Back 113

The meninges refer to the 3 layers (and spaces) that surround the brain and spinal cord.
-think PAD

Front 114

Dura mater

Back 114

(from the Latin, “though/hard mother”: a double-layer dense membrane that adheres to the skull. The outer portion of the dura contains the meningeal veins.

Front 115

Epidural space

Back 115

Space between the two dural layers

Front 116

Subdural space

Back 116

The space between the dura and the arachnoid layers. Cerebral veins crossing the subdural space have little supporting structure; hence vulnerable to injury and bleeding (e.g., a subdural hematoma)

Front 117

Arachnoid membrane

Back 117

(from the Greek, like a “spider-web”): A very thin avascular layer between the dura mater and the pia mater.

Front 118

Subarachnoid space

Back 118

contains the protective CSF (a clear, colorless solution of sodium chloride and other salts) that is continuously made from within the lateral ventricles, circulates around the brain (and spinal cord) and is absorbed by the dural venous sinuses located in the dura mater.

Front 119

Pia mater

Back 119

(from the Latin, “Soft/Tender mother” [your textbook says “Pious mother”]): A thin brain-hugging membrane. Blood vessels spread across the surface of the brain through the pia, with branches of the blood vessels entering the brain.

Front 120

Why didn’t the bleed show up on the initial brain scan that was done in the hospital right after Mr. X’s fall?

Back 120

Because a subdural hematoma is a collection of blood (below the layer of the dura and external to the brain and arachnoid membrane), the blood (unlike tissue loss), would ordinarily show up immediately on a CT scan.
But this need not be so if Mr. X’s bleed was a slow one that took time to build up. (It can take 3 to 7 days after the injury to build up. Sometimes 2 to 3 weeks after the injury.)

Front 121

When Mr. X was initially seen right after his fall were they right to do the CT immediately?

Back 121

Yes, absolutely. It might have shown the presence of blood, even though it didn’t happen to in this case.

Front 122

Internal Carotid Artery

Back 122

There is one on each side of the neck. Carotid: means “to strangle, to choke,” if you cut off this blood flow to brain, person goes unconscious.

Front 123

Which side of the brain does each Carotid artery bring blood?

Back 123

The Left Carotid brings blood to the Left side of the brain, and the Right Carotid brings blood to the Right side of the brain.

Front 124

Circle of Willis

Back 124

Carotid Ateries bring the blood up to the base of the Circle of Willis.
-Anterior Cerebral Artery come up of the Circle of Willis on both sides (going up).
-Middle Cerebral Artery goes up sideways of of the Circle of Willis.
-Posterior Cerebral Artery (brings blood to the back of the head) from different root.

Front 125

Vertibral Artery

Back 125

Brings blood to the Posterior Cerebral Artery.

Front 126

Vampires drink blood from the...

Back 126

Internal jugular vein, not the carotid artery. The jugular vein is the main vein of return.

Front 127

If a person has a stroke...

Back 127

-Something has gone wrong with the Middle Cerebral Artery (if their language is not fine)
-Something has gone wrong with the Posterior Cerebral Artery (having trouble with vision, balance)
-Something has gone wrong with the Anterioal Cerebral Artery (no problem with the language, no problem with gate, might find a paralysis or a weakness in the lower limbs)

Front 128

Cortical Blindness

Back 128

They are blind, but they don’t get a sensation that they are blind. They might say “the lights not very bright in hear, it’s hard for me to see”. The whole visual system is intact, but they cannot see anything b/c the Posterior area in not intact.

Front 129

Geschwind

Back 129

First person to check in the notion that the hemispheres are not the same size and shape.