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Hello, everyone. Hi, my name is William. I'm just gonna give people a minute or two to pile in and then we'll start. Ok, I've just put a link to the charity that I'm a part of called brain book and it just basically links on to our Instagram. You can check us out while you wait if you like. We're basically a charity that promotes quote unquote demystifying neurosurgery, which is a, as far as being a medical student is concerned, it's a great way of boosting a CV to show engagement in anything neurological or neurosurgical or neuroradiological. So that's a great way of boosting A CV. And we recruit regularly. So we look for ambassadors and from that, you can become part of a team and then a lead. And if you become a lead in what you'd call a national charity, which is what we are that can score you points for specialty selection. So it's something to get started on in medical school. We recruit regularly several times a year sometimes. So that's something to keep on the radar for you guys. Ok. So I'll just wait another minute more just to have people who are maybe a bit light and I'll just talk about what I'm gonna go through today and we add on for it. I just bring up my slides. Mm mm. Should I scream? There we go. Let me just check if that's working. Does that work? Yeah, that's working. Oops, fiddlesticks. You did not see them? Ok. I'm gonna have it like this because sometimes I have notes and I figure it'll be more useful cos there's gonna be a video afterwards which I'll put up and it's more useful. If you have the Fuller powerpoint, I find it's also nice to have some context as to where the slides are going. So when it hits 1803, that's when I'll start. Ok? All right. So let's begin. So these slides are made by myself and someone else and these are brain book slides. So there are a part of the charity, we often give them to ambassadors, but we're also giving them to 6 p.m. series to branch out and make more people aware of the charity. Today. We're going to be covering neuroanatomy or the Gross General neuroanatomy. There are gonna be two of the powerpoints, they're gonna cover things like the spine. This is more of an overview of the brain. We're going to look at different areas. There are probably two main categories. There's the part of this which is going to be like pointing out parts on a map which I think goes sometimes a bit beyond what was required for medical school and is maybe a bit more of a point of interest for people who are interested in neurosurgery. And there's some points which will go over what you've heard of in years, two and three. And there's also some parts where it goes over some stuff which maybe goes a bit beyond that, but it sort of circles back in and it's useful to help you remember how things work? OK. So let's be in the first part is more like geography if I dare say so. So it's a bit of an overview. Here are some of the lobes of the brain. So you've got the frontal, this is more your higher cognitive function. It's what separates us from the animals. It's more uh higher function. It's the calculus, it's the in, well, actually, perhaps not as much calculus, but more the higher moral reasoning if you like. Of course, there's Phineas gauge who I believe he was working on a railroad and he got a rod that went through his eye into his brain and that basically damaged his ability to control himself. He'd make inappropriate jokes and he improved with time, which is testament to the plasticity of the brain. But it's a sign of this higher function of who we are is very much there. I believe his wife said after he had the rod in the front of his brain, this is not the man I married. So remarkably, he was still able to function, which is quite impressive. And this is also the part of the brain which spends the most time developing, which you could say is a weakness. But actually when people reach 25 it's actually had more time to be shaped by culture, by the world around it. So in many ways, this long time to develop is actually more time gathering data to be shaped and more plasticity and flexibility. So it's as much a disadvantage as it is an advantage. If you're willing to play the long game and human beings do, it has great advantages because it's the most programmable part of the brain. Some could argue. So that's in some ways, a subjective point. I'm not gonna talk as much about the other loves. I'm just going to talk about them generally and I'll talk about some pathologies in some of them. So prior to that's more sensory and you can see this area here with these two intersect, which we'll come back to in a second occipital, that's generally speaking, seen as the vision part. And of course, there's the cerebellum here. An easy mistake is to think we're talking about the cerebellum here when in a lot of models, the cerebellum is taken off. So that's something to be aware of. We've got the temporal lobe which of course is next to the ear and something to be aware of there is it has a lot more to do with hearing, which that's not so surprising considering it's so near to the ear. It also has a lot to do with long term memory. I will say that when it comes to lobes and this is something I'll touch on briefly, maybe I'll go a bit more into it later. The brain doesn't work quite as simply as this area does this and nothing else does that. It's very much a case of it interconnects all over the place. And if you get rid of one area, it quite often has backups all over the place. It's something called the theory of 1000 brains, which is something maybe I'll touch on a bit later. So we're gonna talk about these lobes and the gyra and the sulci and just a bit of a recap. The gyri is just where it goes up. The sulci is where it goes down. It sort of sips into a hole and, or in a sort of crack, if you like the fissures, the subcortical areas which we'll be touching on mostly will touch a bit on the basal gangle though we will touch on each of these generally. And we won't bring in some research. Well, some general points of research though I won't get too political. Ok. So nice and simple. We've got this fissure down here and this is, of course, the longitudinal fissure and the connection between the two is the corpus callosum which connects between the brains. I think I remember once being told by one of my lecturers in biomedical science that apparently girls have more fibers in the corpus closer than boys do. I don't know what that signifies, but apparently that's normal anatomical variation. So, so far this is fairly basic stuff. OK. Now, this is one of the important features. The Sylvian fissure separates the frontal and the temporal lobe. And what you can see here is this looks like I said, like an ei think it like one of those Russian hats with flaps that goes down and it's been turned on its side a little. But if you get some instruments and pull between, you can actually see there's 1/7 lope right here called the insulin. This is an easy one to forget and I think it's quite a cool one. It's also one of the older ones because a lot of things it does are quite primitive. I wanna go into more detail about what each of the lobes do you'll probably find. Well, that sounds quite vague and it sounds a lot like this other one. That's the general point that evolution of course builds on itself and you find there's a lot of redundancy and more complex ideas of built on other ideas. So I will go into the inlet briefly but you'll find that it won't be as nice and simple and different from the other as one like that might like it to be. Ok. So as I said, this is the seventh hidden lobe. You can see it here. You can see someone's got a nice ice cream scoop and scooped out the temper on the frontal. To be able to see that we can see it splits. You can see lots of various Gyt and sca I'm not gonna make a habit of pointing out specific ones because it's mostly de scripted in terms of anterior superior, et cetera, et cetera. Generally speaking, it plays a role in a lot of the basic things that we share with a lot of other animals. So this is very much part of our lower function. I say the insulate in many cases, it's not quite brainless, but it is very much something that any other mammal you would expect to have a good amount of b. So this is more the temporal area. But you can see that the he school's gyrus goes in here and this is just a different angle. I wouldn't be too focused on learning these various gyrus because the truth is you can pass medical school perfectly easy without learning all these though. It's more there for people who are interested in seeing what they look on the map. So to speak, of course, you've got the precentral salt warn people use most often as long as it's descriptively accurate, you'll probably get away with it. And here you can see quite logically that you've got the superior, middle and inferior frontal gyri. So it's fairly straightforward. So it's simultaneously not that useful to you at medical school. And it's so simple by the point when you get to surgery, you're probably not gonna get any points for getting that right. So it's one of those things where it's nice to see, but it doesn't necessarily serve you to remember every single little detail. I have to give you a bit of detail about the frontal lobe. Just cos I feel like I'm copping out a bit there by not giving enough information. There's a great book called Sapiens by a guy called Rob Sapolsky who basically spent 10 years living with some, I believe it was baboons learning about them and how they think. And of course, we have a lot in common with them. Basically, he basically talked about how we have the dorsolateral prefrontal cortex, which is what you might call the slightly more logical Mr Spox part of the brain, which is about the higher function, the sort of thinker, the great rationalize and in terms of emotional regulation integration, you've got, the more I believe it was the ventromedial prefrontal cortex. So those are two different areas if you want to know a name, which is closely related with these two things, the more rational versus emotional side in terms of the frontal cortex, you have them. But as I said, there are so many other parts of the brains which handle it as well. The way it was explained to me is the brain is like a production line for thought and like any chain, it's only as strong as its weakest link. So in terms of pathology, we tend to look at it in terms of which part goes wrong. Most often, it's, it's like Parkinson's, we often think of substantia Nigra. There's a part of the area where the dopamine neurons are going missing or they're dying. That doesn't mean that's the only part that's important for movement. But it does mean it's the weakest link in the chain. So that's a very different perspective of looking at it in terms of how it goes wrong versus how it normally works when it's working well. OK. So here we go. So in white, we have the Sulci and pay close attention to this one. You can probably guess which one this is. So we have these cingulate gyrus here, we'll come back to that in a second. I believe this is the thalamus here. And here we have lingular and quite important soccers here. So effectively, you've got, you know, there's a better diagram in a second which I'll come round to. OK. So we have the precentral versus postcentral gyro. And each of these have a homunculus, which is one of these weird looking men with big arms, maybe a big tongue. And this is basically the body stretched out along the cortex showing how much of the neurons in this area off for each side of the body. So as you can see, they're quite distributed quite a bit for the hands, not so much for the feet. So you can see in terms of sensation, a higher proportion of that is for things like the hands. Cos we need that to have good sensation, prefrontal precentral. This is more part of the frontal area, which is more for movement. And if we think higher function, I'm going to pick this thing up, I'm going to throw this at someone or premeditated murder. Let's say picking up a murder weapon. That's definitely more precentral, something more about sensation about maybe what we might say, taste. That's definitely post central. That's probably a bit of revision for most of you in terms of your education. So I won't tarry too much on this. Ok. So this is a bit more of the geography side of things. So, as we can see here, the parietal area is cut up into different parts. We can see the various different Sulci is this relevant to something you need to know in terms of years, one or two to pass anatomy. I wouldn't say so. I'd say it goes well beyond that, but it's just a point to say that in anatomy, you never get to the end of it. There's always something more you can learn. But generally speaking, I'd say when it's no longer functionally relevant to the basics, it's probably not as important. And again, you can see how they're labeling different gyro. Ok. Now, this is labeled much more nicely. You've got the fusiform gyrus which causes pathology for faces, which will cover it in a bit. And we can see here this is one of the areas which I think is nice because on a brain you're supposed to be able to see a nice h here in the sub Brietal focus looks a bit like a, it's not perfect. You have to imagine it on its side. So that's a, a bit of geography though. And of course, you have the cingulate cortex. I believe this is the foulness here. And of course, this is the frontal, again, fairly simple, superior, middle, inferior. OK. Now, this is the part where things get a bit more interesting. For the first part, I'd say I've been touching more on geography in terms of just pointing out different parts. Now, we're going to get a bit more into function. This is where things start to pick up a little bit. So as we can see here at the bottom of the brain, we have the parahippocampal gyrus, which is right next to the hippocampus. And of course, for giving my pronunciation, enterorenal cortex, which is at the end of that, which is important for memory, navigation and perception of time. And of course, a lot of other things are important for memory and navigation. And that's one of the points I make where there's a lot of redundancy and overlapping functions within the brain. So it's a sense of when this gets damaged, what things tend to be affected. That's the best way of thinking about it. And that's of course, in the more anterior side of it. Ok. Here we go. So in terms of the occipital, you can see there's no cerebellum here, a mistake I made. Even now when I looked at this, I was thinking, oh, I was like, that's a strange cerebellum. Then I had to remind myself. Oh, no, it's been taken away. So what you can see quite nicely is there is the calc sulcus and this isn't dividing the cerebellum. This is dividing the occipital. So above here is called a cus. And above that, in the parietal area is called the precuneus, which is fairly logical and low down here below the fissure, we have the lingual area, which of course is the Latin for tongue. You have one of these projections in the lung as well. And I'd say here, it actually looks a bit more like a tong. So you can see that quite nicely bit deeper to that around the thalamus. You've got the Singulair here, which is more allowed to do things with processing emotion, automatic motor function, cognitive function, attention, memory, and perception, emotional responses. And as I said before, some of these things overlap. Whenever I hear that, I think to myself, well, that sounds an awful lot like the prefrontal. These are more in a basic sense. So these are the more essential things which you don't think about as much. Again, that's one of the problems that comes up where so many of the descriptions sound very, very similar. So in terms of the parahippocampal gyrus, that's related to the hippocampus, which is about memory and it's very much about memory and transferring and referring. So it's a bit like the liaison between the brain and the learning center of the brain. That's a very simplified way of putting it. But we do tend to have simplified things in trying to understand the brain cos it's so complicated and of course, the connection, the isthmus that's Latin for narrowing. You of course have that in the femur reproductive tract. You see the connection between here between the cingulate gyrus and the parahippocampal gyrus. These subcortical structures I found when I was learning these in biomedical science that these are actually some of the harder things to learn because a lot of the parts of the brain are quite large and you can tell them apart. The temporal lobe is very easy to tell and you don't need to get the exact division of the frontal and parietal. But if you get the general pattern, you'll be fine. I found getting these right lot trigger. So I'll try and give you some tips to be able to tell. So this is quite nice cos it shows you something that looks more realistic and something that simplifies it into more cartoonish. So one of the things I always got wrong initially was the Putin here and the Globus Pallidus, I remember thinking to myself, OK. So this is the Globus Pallidus. This is the outside and this is the inside that that isn't true. This here is the Globus Pallidus. This is the Putin and, and that's the main thing I'd try and take away from this page, this slide. Sorry. So what you effectively have, you have internist or internal externus Internus. These two parts here of the Globus Pus and Putin. This is the cald, but this is also the caudate and you can see that here. And the reason for that is you'll see it in some other pictures. It basically wraps round like a tail. So you have the thalmus here and in a different plane you'll see it almost come up, come around the thalmus and come around here and where it's a lot thinner. That is one of the tricky things. And of course, you have the internal capsule here which feeds through which basically connects the brain. We'll touch a bit more on the thalmus in a second together, the putamen and the globus ps are called the lent to form nucleus. It's fun because sometimes in exam questions, you can find that they'll switch back and forth between terminology. In one second, they're talking about the Globus Pallidus, and then in the exam question, it'll be something like the length of form Eucallus will be one of the answers and they're trying to trick you up cos they'll expect you, well, they'll quote unquote, expect you to know all the various terminologies. So that's one of the things I'd remember done. I'd say that is probably one of the high yield pieces of information. Okey doke. So here's a look through so we can see it here. So we can see Putterman globus pus here, external, internal, it looks like the thalmus here. I believe that's the corpus callosum. And I'm gonna mispronounce this the claustrum here. So you can see a nice pa here, Claustrum. Putin globus pelvis, external, internal. And I believe you have the subthalamic nucleus and the substantia Nigra would be here, which is, of course, the thing you would lose in Parkinson's. So the thing you should know about the basal ganglia is there is a really old set of circuitry of how it all connects and how it all inhibits and promotes itself. And I remember learning in biomed, they told me it's really important, you know, this. Then in the third lecture about it, they told us this isn't actually how it works. And we don't actually fully understand how it works, but you've got to learn the old model because we're still trying to figure out what the accurate model is and it's not fully accepted. So as far as medicine goes, you don't need to know all of how it works. You just need to know these are all parts of it. I come to here. What is it about? The cald? You can see how there's a nice big body here and you can see how it swoops round over the foulness and comes around to here. I believe that's the Putin and deep to, that is a globus pallidus. It, it's hard to visualize, but it is one of those things that you have to see a few times from a few different images. And then once you've got it, it sort of clicks nicely together. Essentially, the basal gangle is the reward center. I'm simplifying it a bit. The term they used was selective disinhibition. So if you put someone on dopamine medications, levodopa for instance. So sorry, bromocriptine, perhaps a better example is a dopamine agonist. Yes, the substantia nigra is missing dopamine neurons. So the idea is you replace that. But the problem is it doesn't necessarily just go there. It goes all manner of places in the brain. So people can of course get problems where they may be gambling more, more promiscuous, drinking, more all the inhibitions they normally have go away. And when it comes to addiction, so much of that, I've been trying to give up sugar and I'm already struggling with that because of the compulsion. I suppose there's a bit of how much of that is frontal versus basal ganglia. But the difference is people are in different places and some people may have, I don't go too much into that. So we can see here. So this is different angle. You can see this is where the, it's turned into the tail and this is where it's turned to the nucleus, sub nucleus here. And of course, below that is the substantia nigra colostri I said before. So you can see these different images. There is some redundancy here. But the idea of seeing a few different ways helps get into that be thalamus was best described to me like a sensory bus stop, you're going somewhere and you can't go there all in one go. So you have to go to a intermediary bus stop. So you basically get the sensory neurons to go into the brain. They get off at that bus stop, so to speak, and they get another one to a specific location within the brain. It's a bit like, I don't know, you, you're getting a train down to London and you get a at a train station there and then you get on the tube that, that's how I describe it. It's sort of the intersection point. You could learn all the nuclei if you want, but you're never going to be asked about all of them. The main thing to know is that you've got the internal capsule which links throughout the brain and that these puts the globus powders, lentiform nucal, all these things work around this area. Ok. So what we can see here, we can see the hippocampus here and the Amygdala. I'll touch on that briefly and of course, we have the olfactory robe, which is of course due to smell and that's very much tied to. Well, that's, that's cranial nerve one. Now you see that just coming under the frontal lobe, you've got the hypothalamus here. And of course, then you have the pituitary stalk, pituitary gland, et cetera. And that ties to all men of important things. So the hippocampus is tied to turning short term memory into long term memory. It has been said that people who work in London uh as taxi drivers have a larger hippocampus because they have to do this test or at least had to do a test where they had to learn all the various turns and maps of London, which is of course, very tricky. There are two arguments you could say that people who pass the test would have to have a larger hippocampus to be able to basically pass a very hard exam when they're probably working full time as well. Or it could be a neuroplasticity argument where it's a bit like a muscle where the more you practice, the bigger the muscle gets so to speak, it may be a mix of the two. But the argument is if you're better at learning, you probably have a better hippocampus cos you can burn things from short term to long term more easily and the input via the, the pardon me. And it sends stuff to the fus via the for Fornix. The Amygdala, which is on the end of the hippocampus is quite important. It's something we all have. It's our sense of fear except for maybe psychopaths an interesting fact and this isn't necessarily a good thing or a bad thing, but people who are more neurotic or more politically oriented to conservatism have a greater fear of change. And the Amygdala is generally speaking larger. That's and that's not a bad thing or a good thing, innately, it's all dependent on context. But the idea is that this fear center about the shape of an arm basic contributes to how people think. And a lot of the time we think, oh I'm me, I choose to it. It makes perfect sense to be this afraid or not be afraid at all. And a lot of the time that's not necessarily as much choice as we like to think. It is at least as a starting point because literally our genes have encoded and of course experienced as well first to have a certain size of Amygdala. So that's just something to be aware of. This is going to be more on the side of revision. Cos I expect a lot of you have learnt this again. This is more of a high yield slide because this is something that can come up in your M CQ. So I would try your best to learn this if you already know it. Fantastic, just think of it as revision. But this is a very important one to know. So you have bronchus area which is in the frontal cortex and you have Vernix, which is in the temporal cortex. If you down this area bronze, you end up with expressive dysphasia. So you understand things fine, but you can't produce words and it makes a logical sense because if the temporal area has more to do with hearing and it's closer to the ear, then your hearing things, OK. You're understanding things fine. If you think of the frontal cortex, the frontal lobe as more sort of conscious, the act of building sentences expressing yourself, that's gonna be a lot harder. So there is a certain logic there. Whereas here you may have something to say, but you don't understand the language well enough to sort of hear it. That's a simplification, but that's how I got it in my head. Of course, connecting the two is the Arcuate fasciculus, which is a fancy way of saying it's an arc and it connects if you get damage there. And this can be a very tricky exam question. You can with problems that are intermediary and it could be that you damage a bit of the arcuate fasciculus and a bit of one of the areas. It could be something where someone says, can you say pencil back to me and they'll say pencil with an F as opposed to ap So that's something to be aware of that. I'd say this is one of the better slides that is relevant to exams as opposed to curiosity and what we might call brain geography. This could come up in, in exams. It also was something I heard in a book called the Man Hugs wife for a hat. The Fasciculus gyrus basically is important for looking at faces. When we think of going to the supermarket and scanning barcodes. That's kind of what your face, sorry, your brain does to other people's faces. Recognizing where the eyes are, how to recognize who someone is. And if you face blindness or prosopagnosia, that's why you effectively can't do that. So you see this here, there are different areas which are set to recognize shapes, faces, places. A again, it's one of those things that's very tricky because whenever we say that that doesn't mean that's the only part of the brain that does that. But it doesn't mean if you damage the area, the functions within the brain that respond, testing, testing. I don't know why it's done that. This is a new headset. I'm just gonna plug it into charge just in case. OK. All right. So I'll just get back to the powerpoint. OK? I'll do it like this just simply because I do not have to go through the whole slide and burn your time. This is another important one which could come up in exams, Gerstman syndrome. So this is the more parietal area. And again, you don't need to know the supra marginal gyrus, et cetera, et cetera. But knowing Gerstmann's is important because think of it more the sensory part of the brain in terms of sensory processing and that's more things to do with ac calculate problems, calculating things, agraphia, difficulty writing, think of it more the edy problems of the world. And II know it's a bit of a stretch, thinking a calculator. But think of it more like making sense of the world. I know that's a bit of a stretch, but that's how I sort of got it into my head. I in a sense it's, it's, it, it, it is a bunch of sensory problems. So of course, the division between these things is always very tricky. OK. So we're gonna move on to some questions. Now, this is one of the more geographical questions. If you like, what is the boundary between the temporal and occipital lobe laterally? And remember what I said to you about the cheat you can use to define between neuro and anal barriers. I'll give you a few seconds for that. Cos it's not too tricky, but it may be something that you're not expecting. OK. So the answer is the parietal occipital sulcus. And of course, that's as I said, it's one of those things where it's not necessarily a name you have to remember, but it's a logical thing, II feel like in an anatomy exam or a spotter. If you said the occipitoparietal sulcus, I think there's still a good chance they give you the point for that. Cos it's mostly about being descriptively, right? Sulcus, that's a given because it's gonna be a sulcus parietal occipital. It is very much functional. It, it, it's based on the location. What is it actually in terms of where it is and how it relates to things. So there's no like Latin name you have. Well, there's no Latin person's name, you have to learn for that one. OK. So what is Broca's area? And this is in terms of where it is, this is in terms of the problems it causes you and the name of the aphasia of Sasia. OK. So this is a bit of a revision. So you can see it here. So this is in the frontal area, frontal is more sort of cognitive, more OK. Number three. So wich sulcus splits the superior and inferior parietal lobe. Now this is just me being a bit mean in terms of questions because we threw in a couple of images and I'm just thinking if anyone bothered to read them all, there's nothing wrong with getting this one wrong. OK. You may see this image so it split into the superior and inferior lobule. So it's separated by the post central sulcus or the interparietal sulcus makes a certain level of logic. But it's one of those things where you don't necessarily need to be too focused on learning this. One, of course, you can see the other things here. So the lateral fissure, the superior temporal sulcus, there is a certain logic to this. But again, it's not super important to your exams, I'd say number four. So this is a bit more tricky in terms of the extreme. So the complete outer part of the capsule, the connective wires throughout the brain, the the white matter, I suppose you could say effectively. So the external which is outer and extreme, which is the most outside of the capsule. What things relate to that in terms of the basal ganglia, there is a hint I'll give you that there is one thing I stressed over and over again and certain parts of that relate to other things. Ok. So what we can see here is the internal capsules here, the external capsule is in between the putamen or if you wanna be cheeky, the lentiform nucleus and the claustrum. And outside of that is the extreme capsule. So it's extreme capsule, claustrum, external capsule, Putterman, globus, pallidus, externus internus. And of course, here we have the internal capsule and of course, the bend here is called the genu, which is also the word we use for the knee. So all around the basal gangle, you have the capsule if it's close to the middle, then it's called the internal. If it's more outside, it's called the external. And if it's all the way outside, it's the extreme capsule because it's the most extreme, it's the most external. So that's something to be aware of. Main thing. Again, I'd say is Putamen and Globus Pallidus and the cald, those would be the most important things. The claustrum isn't as important. I would try and make sure, you know, the internal capsule. OK. Now, these are some of the resources we use to gather the information. Of course, you can see a fair amount of Google images as well. These are some great resources. If you're interested in your anatomy, there are going to be two more talks that are going to be given and if any of you want to give any feedback, I would very much appreciate it both in terms of being able to reflect and well focus on improving as an educator. I'm still very much new to educating and it's a skill I want to get better at. And it's also something that's useful for building a CV and getting more experience. So the next one will probably be some time at the end of the month. Any feedback you guys have completely appreciate it. What I'm gonna do is I'm gonna stop sharing now. Oh What I'll do. I, if you mean the link to feedback, what I'll do is on Medal, there's a button where anyone who attends the event basically gets sent one by email. So you should all receive it by default. It's just if anyone was on the phone, they wanted to just do it here. And now don, don't worry, you'll get one by email automatically. I'll make sure of that. Ok. All right. Thank you for your time. I'm sorry about what happened with my headset. It's hopefully just a case of it needing charging. I hope you have a great day and I hope you all have a great week. So thank you for your time.