Clinical Neuroscience

HIGHER CORTICAL FUNCTIONS

Higher cortical functions are mainly those that are found in the
cortex of the cerebral hemispheres. If you have a lesion in the cortex
of the cerebral hemispheres you will have symptoms which you will not
have if you have a lesion in the brainstem or in the other parts of the
neural axis.

In contrast, for example, if you will have a lesion on the motor

strip you can have weakness but you can also have weakness if you
have a lesion or damage on the brainstem, spinal cord or peripheral
nerves. But if you have lesions in several parts of the cerebral
hemispheres, it is only there that you will develop these symptoms,
and you will not develop them in your spinal cord or peripheral nerves
or the brainstem.

The brain is one of the reasons of mans means of a more

complicated communication. This is because the cerebral cortex is
well-developed in higher forms of animals, like the primates. And
among the primates, humans have the best form of communication
because we have a larger cerebral hemisphere-larger area and we
have a more prominent prefrontal lobe, prefrontal cortex.

The cerebral cortex acquire more functions by having more

cells, and to make more room for the cells the cortex would have more
folds, gyri and sulci in our cerebral hemispheres.
Higher Cortical Functions:

Level of Consciousness

Cognitive Functions
Memory
Fond of Knowledge
Calculation
Abstract Thinking
Judgment

Cortical Sensory Function

Brocas Area (44,45): think of motor; think of expression or expressive

language
located in the frontal lobe
frontal lobe; precentral: motor functions
If you have a problem in the Brocas Area, then your
problem would be on the motor or your expressive type of
speech.
Wernickes Area (22): think of comprehension
can be found in the superior temporal gyrus
temporal lobe: related to audition
If you have a problem in the Wernickes Area, then
your problem would be on audition or hearing.
Arcuate Fasciculus band of fibers that connects the two areas.
- It travels below the cortex by subcortical and connects one with the
other.
* Area 22, 44 and 45 are Broadmans terminologies.
Angular Gyrus at the tip of the superior temporal sulci
Area 40 supramarginal gyrus (at the tip of the Sylvian Fissure)
It is located in the intersection of various cerebral
cortices (occipital cortex, temporal cortex and parietal
cortex) and these cortices all converge on this area
It is also where the arcuate fasciculus will travel or
pass through.
Classification of Aphasia as to the many dimensions of speech and
language:
1.

Word and sentence production

a.

Word Finding Impairment- word retrieval is delayed or difficult

b.

Paraphasia
incorrect word is produced instead of the real word
it may not be similar or there might not be any
similarities at all
sometimes the words may sound the same.

Tactile Discrimination you will only see it in the cortex and not in the
other pathways.
Example: If you will be stimulated at the same time by two
sharp needles or sharp objects, you can and you will be able to
distinguish that there are two. But there will come a time when
you bring them closer and closer you will not be able to
distinguish the two anymore.

Tests to measure cerebral functioning:

1. Neuropsychological Testing the one mainly used to test for
language and other cognitive functions
2. PET
3. SPECT
4. Dynamic MRI
5. Electroencephalogram

2 main types of aphasia: Wernicke and Broca

verbal or semantic substitute an entire word

Example: instead of spoon you say fork

2.

phonemic change or substitute a phoneme within the

word; part of the word would be changed
Example: instead of water you say wafter or wapak

Example: If somebody where to write a number on your palm

or even at your back you will be able to tell what that person
wrote.
If you have an intact parietal lobe or intact cortical
sensory functions you will be able to distinguish it. Its not
just a matter of being able to feel, it is being able to feel
and then connect what you felt with your knowledge. Its
about understanding and putting meaning in what is being
felt.
Cortical Motor Function
Language

APHASIA

main disorder of language

refers to an acquired disturbance in comprehension

and formulation of verbal messages
It is not there when you were born, but you develop
it. At first you can communicate but something happened and you
acquired a failure to comprehend and communicate.

usually caused by a dysfunction in the cortical and

subcortical structures in the left hemispheres
It usually occurs in the left hemisphere because of
cerebral dominance. Majority of the population is right handed,
and the very few that are left handed would still, like the right
handed individuals, have their cerebral dominance on the left
hemisphere. Few of the left handed would have it on the right.
It is very important in neurology that when you
examine the patient you always have to ask for the handedness
of the individual.
Dont presume. Most left handed individuals are
ambidextrous.
Dexterity and handedness also has a familial basis
too.

1.

3.

neologism produce new words in which the person you

are talking to cannot understand the word but you can
understand the word.
not really a neurological condition but more on the
psychiatric conditions.
but this can be seen in the lesions of the cortex

4.

perceveration if you ask different questions they give

you the same answer over and over again.

5.

echolalia more of a psychiatric disorder; repetition of

the last word of the sentence
Example: What is your name? Name; where do you live?
Live

c.

Agrammatism
a. word order is disrupted, word selection is not
correct for the grammatical speech
b. this is an acquired disturbance because you do
not expect this in a normal individual

d.

Telegraphic Speech - series of single word utterances

2. Fluency: Fluent vs Non-fluent Speech in non-fluent speech, the

individual is having a hard time saying words and having difficulty in
repeating words.
3. Verbatim Repetition - failure to repeat words or sentences is a lesion
in the perisylvian region and external capsule
To repeat words or sentences you should first have an intact
audition, and then you have to have short term memory to
remember what the person is saying and then to be able to
execute and express what is there in your memory.
There are different stations within the brain that this information
would have to travel for it to be repeated. Any problems along the
way would, then there would be difficulty in verbatim repetition.
4.

Articulation may occur independently of aphasia

Be able to distinguish dysphasia from dysarthria.
Dysarthria impairment in the motor aspects of
speech production

there is a problem in the motor part and

the ones that the nerves innervate the perioral-buccal-lingual
area.
If there is a problem there or whether it
is an upper motor lesion type, then it would be dysarthria

But in dysphasia, there is no problem in the motor

muscles of the mouth, but it is in the execution of function that is
affected

Dysarthria is a problem of articulation and dysphasia

is a problem of language.

Articulation also requires the intact functioning of the

vocal cords and lungs. If you have pulmonary problems, then
articulation would be affected.
-

5.

Prosody melodic contour of speech; tonal qualities of speech

emotional
inflections
or
accents;
characterized by a person who speaks very blandly; talks in a
monotonous manner
right hemisphere lesions
-

6.
-

Auditory Comprehension understanding what is heard

should have an intact auditory system;
ears should be intact

7. Reading and Writing may or may not be impaired with aphasias

Etiology

vascular: CI or ICH L MCA

tumors: left hemisphere

head injury

degenerative
condition:
degeneration
Gnosis

frontotemporal

lobar

touch localization (topognosis)

two-point discrimination
weight discrimination (barognosis)

Type of Aphasia

identify objects in the head (astereognosis)

Agnosias

astereognosis (Area 5 & 7)

autopagnasia (Area 7) cannot identify the parts of

the body

Agraphestremia not being able to understand what

is written in the palm of their hand

Finger Agnosia cannot locate their fingers

Visual Agnosia they see things but they cannot

identify it; lesion in the associated visual cortex (area 18 & 19)
wherein they can see things but they cannot identify

Prospagnasia cannot identify oneself

Gerstmanns Syndrome

lesion in the left interior parietal lobe

agraphia cannot write

finger agnosia

R-L disorientation
Cerebral Cortical Examination

consciousness

orientation for time and place

speech (dysphasia, dysarthria)

paresis

sensory (recognition)

memory

intelligence
Higher Cortical Functions:
1.
Store of knowledge or fond of
acquired knowledge
2.
The
manipulation
of
old
knowledge (calculations or problem solving)
3.
Social awareness and judgment
4.
Abstract thinking (e.g.
completion of a conceptual series or proverb interpretation)

Speech
Nonfluent, effortful,
grammatical
Fluent, voluble, well
articulated but lacks
meaning

Comprehension

Repetition

Relatively preserved

Impaired

Greatly impaired

Impaired

Quadrantant
inopsia; no paresis

GLOBAL

Fast, nonfluent

Very impaired

Impaired

Hemiphagia

CONDUCTION

Fast, paraphasic

Relatively preserved

Greatly impaired

Usually none

ANOMIC APHASIA

Isolated
word
finding difficulty

BROCA*
WERNICKE*

Associated Signs
Right arm and face
weakness

Localization
Frontal suprasylvian
Temporal infrasylvian
Perisylvian or frontal or
temporal
Supramarginal gyrus
or insula

Syndromes of Aphasia (Brocas, Wernickes, Conduction, Global, Transcortical Motor, Transcortical Sensory)
Wernickes

Disturbance of comprehension of spoken and written language

- Written language is also impaired because the visual pathway or the cerebral cortex and temporal area is impaired too.
Agraphia
Fluent with a lot of paraphasic disturbances milk for cow, pepper for people, encounter for errors
Logorrhea pressure of speech; do not make sense
Empty speech I came before here and returned there

Brocas: motor; Wernickes: sensory