Anatomy clinical correlates: Cerebral hemispheres

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Anatomy clinical correlates: Cerebral hemispheres



Anatomy of the cerebral cortex

Anatomy of the cerebellum

Anatomy of the cranial meninges and dural venous sinuses

Anatomy of the brainstem

Anatomy of the basal ganglia

Anatomy of the white matter tracts

Anatomy of the limbic system

Anatomy of the blood supply to the brain

Anatomy of the diencephalon

Anatomy of the ventricular system

Anatomy clinical correlates

Anatomy clinical correlates: Anterior blood supply to the brain

Anatomy clinical correlates: Cerebellum and brainstem

Anatomy clinical correlates: Cerebral hemispheres


Anatomy clinical correlates: Cerebral hemispheres

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 77-year-old woman is brought to the emergency department for evaluation of left-sided numbness and unsteady gait. The patient was having dinner with family one hour ago when she suddenly developed numbness in the left side of her body and could no longer sense the temperature of her food. Past medical history includes diabetes mellitus type II, hypertension, and hyperlipidemia. The patient takes metformin, glipizide, amlodipine, losartan, and atorvastatin. Temperature is 37.0°C (98.6°F), pulse is 102/min, respirations are 15/min, and blood pressure is 190/100 mmHg. Neurological examination demonstrates deficits in touch, two-point discrimination, pain, and temperature on the left side of the body and face. Motor strength and speech are normal. Romberg sign is positive. An ischemic stroke involving which of the following areas of the brain is the most likely cause of her clinical findings?  

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Jake Ryan

Cassidy Dermott

Elizabeth Nixon-Shapiro, MSMI, CMI

The cerebral hemispheres are two symmetrical halves of the brain that contain billions of neurons and their connections, forming an amazing network of cells which help govern our everyday actions. These cerebral hemispheres consist of the cerebral cortex, subcortical white matter, and gray matter masses called the basal ganglia found throughout the subcortical white matter. Due to the complexity of our brains, the clinical conditions affecting our cerebral hemispheres lead to a variety of abnormal and strange symptoms, so understanding the anatomy of the cerebral hemisphere is crucial in understanding these conditions.

Let’s start with lesions of the cerebral cortex, which is the superficial gray matter of our brains containing billions of neurons responsible for processing information. Depending on which part of the cortex these lesions occur in, it can cause different clinical manifestations.

First, there are lesions of the prefrontal cortex, which is an area responsible for the makeup of a person’s personality and governs social behaviour. So, prefrontal cortex lesions cause frontal lobe syndrome which generally result in personality changes, and can specifically cause problems with planning, initiative, judgment, and social behaviour. Individuals have difficulty making decisions, and may become impulsive and aggressive. Individuals can also exhibit socially unacceptable behavior, where they no longer restrain from saying or doing inappropriate things, and may also no longer care about their clothing and appearance.

Injury to the prefrontal cortex may also contribute to the reemergence of primitive reflexes, such as the grasp reflex, suckling reflex, and groping reflex. Bilateral damage of the prefrontal cortex may lead to incontinence, gait apraxia, and can even lead to akinetic mutism, where awake individuals lack the will or motivation to move or speak, but will follow you with their eyes in response to noise.

Next up, there are injuries to the frontal eye fields which can be found on the middle frontal gyrus - specifically, in Brodmann's area 8. Possible causes of lesions to the frontal eye fields include stroke involving the middle cerebral artery, brain tumors, or injury during neurosurgery.


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