大腦解剖及功能區(qū).doc

應(yīng)該是“1234溝后前，5678再后前，九十一二C最前，十七八九枕向前，三七三八顳后前； 二十一二下中上，三九四十溝后上，四一二三顳中上；四五六七額中下?！边@樣背。Locational Descriptions of Human Brodmann areas1 - intermediate postcentral (area postcentralis intermedia). Located in the postcentral gyrus. Bounded cytoarchitecturally by the rostral postcentral area 3 and the caudal postcentral area 2 and, at its ventral tip, by the subcentral area 43.2 - caudal postcentral (area postcentralis caudalis). Located primarily in the caudal portion of the postcentral gyrus and the rostral lip of the postcentral sulcus with a caudal extension along the intraparietal sulcus. Cytoarchitecturally bounded rostrally by the intermediate postcentral area 1 and caudally by the preparietal area 5, the superior parietal area 7 and the supramarginal area 40.3 - rostral postcentral (area postcentralis oralis). Located primarily in the rostral portion of the postcentral gyrus including the caudal bank of the central sulcus. At either end of the sulcus it can extend beyond the depth of the sulcus into the precentral gyrus. Cytoarchitecturally bounded rostrally by the gigantopyramidal area 4 and caudally by the intermediate postcentral area 1.4 - gigantopyramidal (area gigantopyramidalis). Located in the precentral gyrus. Cytoarchitecturally the caudal boundary with the rostral postcentral area 3 does not coincide precisely with the floor of the central sulcus but lies variably in the banks of the postcentral gyrus and the precentral gyrus. The area also does not extend in all cases to the cingulate sulcus medially or to the end of the central sulcus ventro-laterally. Bounded rostrally by the frontal agranular area 6.5 - preparietal (area praeparietalis). Occupies the superior parietal lobule and a portion of the postcentral gyrus, particularly on the medial aspect of the hemisphere. Bounded approximately by the cingulate sulcus on the medial aspect of the hemisphere and by the superior postcentral sulcus on the lateral aspect. Cytoarchitecturally bounded by the caudal postcentral area 2, the superior parietal area 7 and on the medial bank of the hemisphere by the gigantopyramidal area 4 and the dorsal posterior cingulate area 31.6 - agranular frontal (area frontalis agranularis). Located primarily in the caudal portions of the superior frontal gyrus and the middle frontal gyrus and the rostral portions of the precentral gyrus not occupied by the gigantopyramidal area 4. It extends from the cingulate sulcus on the medial aspect of the hemisphere to the lateral sulcus on the lateral aspect. Cytoarchitecturally bounded rostrally by the frontal region and caudally by the gigantopyramidal area 4.7 - superior parietal (area parietalis superior). Occupies much of the superior parietal lobule and some of the precuneus. Bounded approximately by the superior postcentral sulcus rostrally, the intraparietal sulcus laterally, the parieto-occipital sulcus caudally and, on the medial bank of the hemisphere, the subparietal sulcus. Cytoarchitecturally bounded rostrally by the preparietal area 5 and the caudal postcentral area 2; caudally by the peristriate area 19; and medially by the dorsal posterior cingulate area 31.8 - intermediate frontal (area frontalis intermedia). Located primarily in the superior frontal gyrus extending from the cingulate sulcus on the medial surface over the margin of the hemisphere to the middle frontal gyrus. Cytoarchitecturally bounded caudally by the agranular frontal area 6 and ventrally by the granular frontal area 9.9 - granular frontal (area frontalis granularis). Occupies portions of the superior frontal gyrus and the middle frontal gyrus. Its approximate boundary on the medial aspect of the hemisphere is the cingulate sulcus and, on the lateral aspect, the inferior frontal sulcus. Cytoarchitecturally bounded dorsocaudally by the intermediate frontal area 8, caudally by the agranular frontal area 6, and ventrally by the frontopolar area 10, the middle frontal area 46 and the opercular area 44.10 - frontopolar (area frontopolaris). Occupies the most rostral portions of the superior frontal gyrus and the middle frontal gyrus. On the medial aspect of the hemisphere it is bounded ventrally by the superior rostral sulcus. It does not extend as far as the cingulate sulcus. Cytoarchitecturally bounded dorsally by the granular frontal area 9, caudally by the middle frontal area 46, and ventrally by the orbital area 47 and by the frontopolar area 12.11 - prefrontal (area praefrontalis). Constitutes most of the orbital gyri, gyrus rectus and the most rostral portion of the superior frontal gyrus. Bounded medially by the inferior rostral sulcus and laterally approximately by the frontomarginal sulcus. Cytoarchitecturally bounded on the rostral and lateral aspects of the hemisphere by the frontopolar area 10, the orbital area 47, and the triangular area 45; on the medial surface it is bounded dorsally by the area 12 and caudally by the subgenual area 25.12 - prefrontal (area praefrontalis). Occupies the area between the superior rostral sulcus and the inferior rostral sulcus. Cytoarchitecturally bounded dorsally by the frontopolar area 10 and the dorsal anterior cingulate area 32; caudally, ventrally and rostrally it is bounded by the prefrontal area 11. (Originally described as part of prefrontal area 11 but not shown in the map, subsequently it was labeled as an independent area 12.)17 - striate (area striata). Part of the occipital lobe of the cerebral cortex that is defined on the basis of cyto- and myeloarchitecture, primarily by the band/stripe of Gennari.18 - parastriate (area parastriata). Located in parts of the cuneus, the lingual gyrus and the lateral occipital gyrus of the occipital lobe. Cytoarchitecturally bounded on one side by the striate area 17, from which it is distinguished by absence of a band/stripe of Gennari, and on the other by the peristriate area 19.19 - peristriate (area peristriata). Located in parts of the lingual gyrus, the cuneus, the lateral occipital gyrus and the superior occipital gyrus of the occipital lobe where it is bounded approximately by the parieto-occipital sulcus. Cytoarchitecturally bounded on one side by the parastriate area 18 which it surrounds. Rostrally it is bounded by the angular area 39 and the occipitotemporal area 37.20 - inferior temporal (area temporalis inferior). Corresponds approximately to the inferior temporal gyrus. Cytoarchitecturally bounded medially by the ectorhinal area 36, laterally by the middle temporal area 21, rostrally by the temporopolar area 38 and caudally by the occipitotemporal area 37.21 - middle temporal (area temporalis media). Corresponds approximately to the middle temporal gyrus. Bounded rostrally by the temporopolar area 38, ventrally by the inferior temporal area 20, caudally by the occipitotemporal area 37, and dorsally by the superior temporal area 22.22 - superior temporal (area temporalis superior). Corresponds approximately to the lateral and caudal two thirds of the superior temporal gyrus. Bounded rostrally by the temporopolar area 38, medially by the posterior transverse temporal area 42, ventrocaudally by the middle temporal area 21 and dorsocaudally by the supramarginal area 39.23 - ventral posterior cingulate (area cingularis posterior ventralis). Occupies most of the posterior cingulate gyrus adjacent to the corpus callosum. At the caudal extreme it is bounded approximately by the parieto-occipital sulcus. Cytoarchitecturally bounded dorsally by the dorsal posterior cingulate area 31, rostrally by the ventral anterior cingulate area 24, and ventrorostrally in its caudal half by the retrosplenial region.24 - ventral anterior cingulate (area cingularis anterior ventralis). Occupies most of the anterior cingulate gyrus in an arc around the genu of corpus callosum. Its outer border corresponds approximately to the cingulate sulcus. Cytoarchitecturally bounded internally by the pregenual area 33, externally by the dorsal anterior cingulate area 32, and caudally by the ventral posterior cingulate area 23 and the dorsal posterior cingulate area 31.25 - subgenual (area subgenualis). A narrow band located in the caudal portion of the subcallosal area adjacent to the paraterminal gyrus from which it is separated by the posterior parolfactory sulcus. It is bounded by the prefrontal area 11rostrally and by the paraterminal gyrus caudally.26 - ectosplenial (area ectosplenialis). A narrow band located in the isthmus of cingulate gyrus adjacent to the fasciolar gyrus internally. It is bounded externally by the granular retrolimbic area 29.28 - entorhinal (area entorhinalis). Located in the entorhinal area on the medial aspect of the temporal lobe. It and the dorsal entorhinal area 34 together constitute approximately the entorhinal area.29 - granular retrolimbic (area retrolimbica granularis). A narrow band located in the isthmus of cingulate gyrus. Cytoarchitecturally bounded internally by the ectosplenial area 26 and externally by the agranular retrolimbic area 30.30 - agranular retrolimbic (area retrolimbica agranularis). Located in the isthmus of cingulate gyrus. Cytoarchitecturally bounded internally by the granular retrolimbic area 29, dorsally by the ventral posterior cingulate area 23 and ventrolaterally by the ectorhinal area 36.31 - dorsal posterior cingulate (area cingularis posterior dorsalis). Occupies portions of the posterior cingulate gyrus and medial aspect of the parietal lobe. Approximate boundaries are the cingulate sulcus dorsally and the parieto-occipital sulcus caudally. It partially surrounds the subparietal sulcus. Cytoarchitecturally bounded rostrally by the ventral anterior cingulate area 24, ventrally by the ventral posterior cingulate area 23, dorsally by the gigantopyramidal area 4 and preparietal area 5 and caudally by the superior parietal area 7.32 - dorsal anterior cingulate (area cingularis anterior dorsalis). Forms an outer arc around the anterior cingulate gyrus. The cingulate sulcus defines approximately its inner boundary and the superior rostral sulcus its ventral boundary; rostrally it extends almost to the margin of the frontal lobe. Cytoarchitecturally bounded internally by the ventral anterior cingulate area 24, externally by medial margins of the agranular frontal area 6, intermediate frontal area 8, granular frontal area 9, frontopolar area 10, and prefrontal area 11.33 - pregenual (area praegenualis). A narrow band located in the anterior cingulate gyrus adjacent to the supracallosal gyrus in the depth of the callosal sulcus. Cytoarchitecturally bounded by the ventral anterior cingulate area 24 and the supracallosal gyrus.34 - dorsal entorhinal (area entorhinalis dorsalis). Located in the entorhinal area on the medial aspect of the temporal lobe. It and the entorhinal area 28 together constitute approximately the entorhinal area.35 - perirhinal (area perirhinalis). Located along the rhinal sulcus. Cytoarchitectually bounded medially by the entorhinal area 28 and laterally by the ectorhinal area 36.36 - ectorhinal (area ectorhinalis). Located primarily in the fusiform gyrus, with its medial boundary corresponding approximately to the rhinal sulcus. Cytoarchitecturally bounded laterally and caudally by the inferior temporal area 20, medially by the perirhinal area 35 and rostrally by the temporopolar area 38.（四）大腦大腦半球為中樞神經(jīng)中最大的結(jié)構(gòu)，左右各一。上面觀略呈卵圓形。在大腦半球表面，呈現(xiàn)許多深淺不同的裂或溝，溝、裂之間有隆起的腦回。胎兒5個月發(fā)生溝、回，在出生后逐漸完成。溝、裂的產(chǎn)生是因為大腦皮質(zhì)各部在發(fā)生上快慢不勻所致，發(fā)育快的露在表面而將生長的部分擠住深部。1大腦半球的外形每個半球分為背外側(cè)面、內(nèi)側(cè)面和底面。大腦半球借三條大的溝裂分為五葉，即額葉、頂葉、枕葉、顳葉和島葉（圖1035，1036）。外側(cè)溝（sulcus lateralis）為背外側(cè)面最明顯的深裂。自前向后上方斜行，將大腦半球額葉、顳葉（lobus temporalis）分隔。外側(cè)溝的深部隱藏著島葉（insula）。中央溝（sulcus centralis）在背外側(cè)面近中間的稍后方。此溝自頂部向前向下，下端接近外側(cè)溝，但未與其通連。中央溝頂端多半越背內(nèi)側(cè)緣至內(nèi)側(cè)面，向后下延伸1cm即終止。此溝前部為額葉（lobus frontalis），后部為頂葉（lobus parietalis）。頂枕溝（sulcus parietooccipitalis）位于半球內(nèi)側(cè)面的后部，略轉(zhuǎn)至背外側(cè)面，在頂葉和枕葉（lobus occipitalis）之間。枕葉、頂葉、顳葉之間的分界是假設(shè)的。在大腦下緣，自枕葉后端向前約4cm處有一枕前切跡，自頂枕裂至枕前切跡的連線為枕葉的前界，由此線的中點連至外側(cè)構(gòu)的后端是頂、顳二葉的分界。1）半球背外側(cè)面的溝和回（1）額葉 在中央溝的前方有與中央溝平行的中央前溝，中央溝與中央前溝之間為中央前回。自中央前溝向前走出上、下兩條與半球上緣平行的溝，分別稱額上、下溝。額上溝的上方為額上回，額上、下溝之間為額中回，額下溝的下方為額下回。（2）頂葉 在中央溝的后方有與中央溝平行的中央后溝。中央溝與中央后溝之間為中央后回，自中央后溝向后走出一條與半球上緣平行的頂內(nèi)溝。頂內(nèi)溝的上方為頂上葉、下方為頂下葉。頂下葉前部稱緣上回，后部稱角回。（3）顳葉 在大腦外側(cè)溝下方有與之平行的顳上溝和顳下溝，顳上溝的上方為顳上回，下方為顳中回。顳下溝的下方為顳下回。此外，在大腦外側(cè)溝內(nèi)，顳上回的上面有幾條短的橫回，稱顳橫回。2）半球內(nèi)側(cè)面的溝和回 自中央前、后回背外側(cè)面延續(xù)到內(nèi)側(cè)面部分稱中央旁小葉。在枕葉有一深溝稱距狀溝。頂枕溝與距狀溝之間為楔葉。距狀溝的下方為舌回。舌回向前與顳葉的海馬旁回相連。海馬旁回的前端彎成鉤形，稱海馬旁回鉤。環(huán)抱胼胝體上方的為扣帶回（圖1036）。3）半球底面 額葉底面有一條縱行的纖維束，稱嗅束。嗅束的前端膨大，稱嗅球，嗅球與嗅神經(jīng)相連。嗅束向后擴大為嗅三角，連于海馬旁回前部和海馬旁回鉤等嗅覺高級中樞（圖1037）。2大腦半球的內(nèi)部結(jié)構(gòu)大腦半球表層被覆一層灰質(zhì)，為皮質(zhì)，皮質(zhì)的深部為髓質(zhì)。髓質(zhì)內(nèi)含有神經(jīng)纖維束與核團。1）基底核（huclei basles）共有四對，因位置靠近腦底故名。（1）尾狀核（nucleus caudatus）呈“C”字形（圖1038），狀如松鼠之尾。前端膨大稱頭，在側(cè)腦室前角底部，內(nèi)囊內(nèi)側(cè)，后部變?yōu)榧氶L作弓形彎曲稱體與尾，它沿著側(cè)腦室壁自前向后行進，至側(cè)腦室中央部分即位于下角的頂部，并隨下角在顳葉向內(nèi)向前行進而與杏仁體相連接。（2）豆?fàn)詈耍╪ucleus lentiformis）在島葉的深部（圖1038），介于內(nèi)囊與外囊之間，其前下端與尾狀核頭相連接。豆?fàn)詈嗽谒角忻嫔铣嗜切危藘?nèi)有兩個白質(zhì)薄板層將它分為三部，外側(cè)部最大稱殼（putamen），其余二部稱蒼白球（globus pallidus）。尾狀核與豆?fàn)詈撕戏Q紋狀體（corpus striatum）。爬行類、鳥類已具有尾狀核和殼，它們在種系發(fā)生上出現(xiàn)較晚，稱新紋狀體；蒼白球出現(xiàn)較早，在魚類已經(jīng)存在，故稱舊紋狀體。紋狀體主要與肌肉運動活動有關(guān)，在進化階梯上比控制肌肉進行隨意運動的錐體系要古老得多。在哺乳類以下，它是調(diào)節(jié)軀體、內(nèi)臟活動對環(huán)境作本能性適應(yīng)的高級中樞，在高等哺乳類，它則退居次要地位，成為大腦皮質(zhì)控制下的錐體外系中樞。用熒光組織化學(xué)方法發(fā)現(xiàn)，紋狀體內(nèi)含有大量多巴胺能神經(jīng)末梢，而其胞體主要位于中腦黑質(zhì)。正常的紋狀體活動，要求其內(nèi)部的神經(jīng)遞質(zhì)多巴胺和乙酰膽堿的含量保持平衡。已知多巴胺是抑制性遞質(zhì)，乙酰膽堿是興奮性遞質(zhì)。生理學(xué)的研究還表明，尾狀核可以對各種感覺刺激（包括視、聽、軀體、內(nèi)臟）發(fā)生非特異性反應(yīng)，刺激尾狀核能影響感覺傳入活動。在針刺鎮(zhèn)痛原理研究中，我國學(xué)者證明了尾狀核參與了針刺鎮(zhèn)痛的過程，并在形態(tài)學(xué)上證明了尾狀核與有關(guān)鎮(zhèn)痛的核團具有廣泛的聯(lián)系。臨床上用埋藏電極刺激尾狀核，成功地解除了晚期癌癥病員的頑痛。（3）屏狀核（claustrum）為島葉和豆?fàn)詈酥g的一薄層灰質(zhì)。（4）杏仁體（corpus amygdaloi deum）與尾狀核的末端相連，是邊緣系統(tǒng)的皮質(zhì)下中樞。2）半球內(nèi)的白質(zhì) 可分為三系：（1）連合纖維（commissural fibers）是連合左、右兩大腦半球的纖維（圖1039）。胼胝體（corpus callosum）是大腦半球中最大的連合纖維。它在兩半球中間形成一個弧形板，其纖維向四面投射到大腦皮質(zhì)。胼胝體在種系發(fā)生上出現(xiàn)較晚，它的發(fā)育和大腦皮質(zhì)的發(fā)育是相平行的。腦重量大的動物，其胼胝體也大。人類的胼胝體最發(fā)達。前連合（commissura anterior）為前后兩個弓形的纖維束組成，呈“H”形，中間彼此連接。主要連合兩側(cè)顳葉，小部分連合兩側(cè)嗅球（參見圖1036）。穹窿（fornix）是嗅腦的連合纖維，也是嗅腦的投射纖維。它起自海馬，纖維先向后再弓形向上貼附在胼胝體的下面，然后再彎向前下，而終于下丘腦的乳頭體（圖1039）。（2）聯(lián)合纖維（association fibers）是同側(cè)半球皮質(zhì)之間的聯(lián)合纖維，纖維長短不一。（3）投射纖維（Projection fibers）是進出大腦半球的神經(jīng)纖維束。纖維有長短之分，短纖維如大腦與間腦之間的升降纖維。但以長纖維為主，長纖維主要為內(nèi)囊（capsula interna），在水平切面上內(nèi)囊呈“”形板，主要成分為投射纖維（其中也含有紋狀體的橫行交錯纖維），內(nèi)囊分三部。內(nèi)囊前腳：位于尾狀核與豆?fàn)詈酥g，含有額橋束。內(nèi)囊膝：位于豆?fàn)詈恕⑽矤詈伺c丘腦之間，含有皮質(zhì)腦干束。內(nèi)囊后腳：位于豆?fàn)詈伺c丘腦之間，由前向后排列為：皮質(zhì)脊髓束、丘腦皮質(zhì)束、枕顳橋束、聽輻射與視輻射。內(nèi)囊是大腦半球內(nèi)極重要的“關(guān)口”，在此有大量的上、下行纖維束緊密排列。若一側(cè)內(nèi)囊受損（如腦溢血），根據(jù)病變位置和被損傳導(dǎo)束的性質(zhì)及局部位置，可出現(xiàn)多種癥狀，如對側(cè)半身感覺喪失，對側(cè)肢體偏癱等等。（4）側(cè)腦室（ventriculus lateralis）是左右大腦半球內(nèi)的腔隙，內(nèi)含透明的腦脊液，通過室間孔與第三腦室相通。側(cè)腦室有三個角：前角伸入室間孔以前的額葉，后角伸入枕葉，下角伸入顳葉（圖1040）。3大腦皮質(zhì)及其組織結(jié)構(gòu)從種系發(fā)生來說，大腦皮質(zhì)可以分為：古皮質(zhì)（archicortex）又稱原始皮質(zhì)，由海馬和齒狀回組成；舊皮質(zhì)（paleocortex），由梨狀區(qū)的嗅皮質(zhì)及部分海馬旁回組成；古皮質(zhì)與舊皮質(zhì)稱異型皮質(zhì)（allocortex），只顯示三層構(gòu)造。新皮質(zhì)（neocortex），又稱同型皮質(zhì)（isocortex），一般均可分六層，大腦皮質(zhì)的絕大部分屬新皮質(zhì)。大腦皮質(zhì)含有許多錐體形的神經(jīng)細胞、其它各型神經(jīng)細胞及神經(jīng)纖維。顯微鏡觀察，按細胞與纖維排列情況可以分為多層。一般以顳葉皮質(zhì)為典型，大致分為六層（圖1041）。）分子層 在皮質(zhì)的最淺層，內(nèi)含少量水平細胞和星形細胞，有許多與表面平行的神經(jīng)纖維。）外粒層 內(nèi)含小型錐體細胞和少量星形細胞。）外錐體層內(nèi)含中、小型錐體細胞，以中型錐體細胞為主。）內(nèi)粒層 細胞密集，多數(shù)是星形細胞。）內(nèi)錐體層內(nèi)含大型錐體細胞，其軸突向髓質(zhì)行進。在中央前回和中央旁小葉，此層的錐體細胞特大，稱貝茨（Betz）細胞，高120m，寬80m。）多形層 內(nèi)含梭形與三角形的神經(jīng)細胞。此外，還可根據(jù)皮質(zhì)有髓纖維分布的特點分為六層，但名稱不同（圖1041）。來自丘腦外側(cè)核的腹后核和內(nèi)、外側(cè)膝狀體的特異性上行纖維主要進入第四層與星形細胞形成突觸，而星形細胞又與其它細胞進行廣泛的聯(lián)系。第三層的錐體細胞發(fā)出纖維對皮質(zhì)各層之間、各部位之間和左右半球之間進行聯(lián)絡(luò)及