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Segundo parcial 18 de septiembre de 2026 — Transcript

by Guadalupe Soriano · 3,962 words · 619 segments · language en · Watch on YouTube

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0:01But I wonder if we talked about its
0:04counterpart in the hemisphere, didn't
0:14you see? I just put a bookmark. Oh,
0:18it's the one in charge of giving the
0:19pro, the prose and everything else,
0:21right?
0:22The pros,
0:24uh, the proposal is cool. But just be
0:30very aware, let's take advantage of
0:32this image. Right now, what I'm
0:34touching here is what is conventionally
0:36called Broca's area. Broca's area is in
0:39charge of articulating language, of
0:42giving it a logical meaning. While
0:45Wernick's area, which is the one we're
0:47mentioning here, is the one in charge
0:49of interpreting language. This one
0:52interprets it, this one executes it, so
0:53to speak. Okay? Now, if we go to those
0:57same areas, but in the non-dominant
1:00part, in the non-dominant part, then
1:03these areas would be in charge of
1:06emitting non-verbal aspects in language
1:09and interpreting non-verbal aspects in
1:12language. Okay? So, uh, it's just
1:16important to make the distinction. Uh,
1:19this area, which would be the
1:21parieto-oxipitotemporal area in the
1:22non-dominant hemisphere, is responsible
1:25for non-verbal aspects, but
1:26interpretive aspects. If I didn't put
1:28it here in the section, it's the
1:30interpretation of non-verbal aspects,
1:32while in the same non-dominant
1:34hemisphere, but in the part of Broca's
1:36area, which we would call it that, it
1:39would be responsible for the emission
1:41of non-verbal aspects in language.
1:44We're doing well up to here. Yes, I
1:45mentioned it in the last session. Yes,
1:48yes,
1:49yes. Okay. This, and on the other hand,
1:51in particular, uh this area for
1:56oxipitotemporal in the non-dominant
1:58hemisphere for language, which is
2:00almost always the right, uh is linked
2:03to the location of these visuospatial
2:05aspects. In this sense, I don't know if
2:10I told you about hemineglect. Yes,
2:13this patient who lives in Venice and
2:15who doesn't recognize the buildings in
2:17St. Mark's Square. The ones
2:20on the left.
2:22Exactly. The ones on the left. By the
2:25way, eminence almost always, eminence
2:28almost always manifests itself with
2:30left-sided recognition disorders. Okay?
2:35Because of the unilateral nature of
2:36these aspects of this assessment. This
2:40area would almost always manifest its
2:43characteristics on the left side. Well,
2:47look, let's start talking about the
2:50prefrontal cortex, okay? The prefrontal
2:54cortex. Compared to all the other
2:59functional areas that we have
3:01previously mentioned, this is a very,
3:03very large area; that is, by itself it
3:05is larger than the Wernic area, the
3:07auditory area, the visual area, the
3:09somatosensory area, the primary
3:11associative areas; that is, it is far
3:16larger than all the areas that we have
3:19previously discussed. It is so large
3:23that for its study, for its approach,
3:25it is divided into two portions. The
3:28one marked in orange is known as the
3:30dorsolateral portion of the prefrontal
3:33area. The one marked in green is known
3:37as the ventromedial area of the
3:40prefrontal cortex. The ventromedial
3:44area, as you can see, especially here,
3:46since it rests on the orbit or is in
3:48the orbital gyri, is also called the
3:51orbitofrontal. The orbitofrontal area
3:53comes out. Look, the clinical
4:00manifestations of the other areas, the
4:03manifestations of the affection of the
4:05other areas are more evident, they are
4:07more immediate. That is to say, a
4:11person cannot interpret language
4:12immediately in the ventromedial area. A
4:15person has alterations in the mobility
4:17of a certain area of the body, probably
4:19the primary motor area. A person has
4:22alterations in the coordination of
4:24certain types of movements, in
4:25associative motor movements, etc., etc.
4:27, etc. In other words, this link
4:29between the functional and the clinical
4:31result is immediate. However, the
4:35complexity and the diffusion, by
4:37diffusion, I mean that it is diffusely
4:40distributed in the prefrontal cortex of
4:42the functions associated with this area
4:45mean that from a clinical point of view
4:47it is not advisable to differentiate
4:50within this area. The prefrontal area,
4:54the prefrontal area, I'm going to go to
4:55the definition right now, by the way, I
4:57just remembered that, oh, yes, yes, I
4:59put it, I finally put it. This, in the
5:02prefrontal cortex, in the modern
5:04definition, is not an area that is
5:05located between the sural and the sural
5:08cortex. Nor is it an area that can be
5:11differentiated from a histogenetic
5:12point of view, for example, with the
5:14classic Broman mapping. The prefrontal
5:18association area is defined by its
5:20connectivity with a thalamic nucleus,
5:22specifically with the dorsomedial
5:24nucleus of the thalamus. Right at the
5:28end of the telencephalon, which we
5:29still need a little bit of white matter
5:31and basal nuclei, but at the end of the
5:32telencephalon, we are going to talk
5:34about the diencephalon, which is
5:35everything that has the word thalamus
5:37in its name. And then in the thalamus
5:39we will talk about a nucleus called the
5:41dorsomedial nucleus. That nucleus
5:44connects with an area of the frontal
5:46cortex and that is what defines that
5:48area as being considered prefrontal,
5:49okay? It is not a definition by
5:53Brockman, nor for structural reasons,
5:55nor for any other reason. It is a
5:57connective definition. Now, what I do
6:02believe I did not write down, although
6:03I updated the slides, is the following.
6:07Look, some of the definitions that I
6:08sometimes give you are quite cool and I
6:10love how cool this definition is. The
6:15prefrontal cortex is a machine for
6:17predicting the future. What do you mean
6:21by being a machine for predicting the
6:23future? Look, the cognitive functions,
6:25I'm going to skip that a bit for a
6:27moment. The main executive and
6:30cognitive functions that are carried
6:32out in the prefrontal cortex in order
6:36to be able to do things are based on a
6:38principle that is trying to predict
6:40what is going to happen, the
6:42consequences of what is going to happen
6:44. For example, to plan, well, we have
6:48to formulate that plan, but to
6:50formulate that plan we have to try to
6:53anticipate an outcome for inhibitory
6:55control. Well, you know what? This
6:59person just pushed me. If that person
7:01is short, skinny, maybe I would turn
7:03around and push him again. But I didn't
7:05inhibit myself because I think there
7:07are no consequences to what I'm doing.
7:10However, if I push Paul, well maybe I
7:11would push him a little bit and the seg
7:13would hit me hard, right? So there I
7:16inhibit, I suppress that executive act.
7:20Why? Because it could have consequences
7:22. I'm trying to eliminate the future,
7:25okay? Decision-making, error avoidance,
7:29etc. All this, current neuroscientists
7:32would say, is a prediction of the
7:34future or as my data mining teacher
7:37called it. All this is a Vallecian
7:41inference machine. You, who are already
7:44epidemiologists and statisticians
7:45according to your neuroanatomy exam
7:47results because you didn't do well in
7:49neuroanatomy, but you did pass in
7:51epidemics, without looking at anything
7:58in particular, the point in all this,
8:00the point in all this is that Vallecian
8:03statistics are based on obtaining new
8:05information, with which you recalculate
8:07the possibilities of something
8:09happening. And although we don't
8:13visualize it or conceptualize it that
8:15way, what we are doing in our
8:17prefrontal cortex is continually
8:19rethinking the possibilities that the
8:22future will change or happen as we are
8:24planning with the information we
8:26already have or with the new
8:28information we are obtaining. So, here
8:32we have a list of the executive
8:34functions and here we have a list of
8:36the cognitive functions that are
8:38performed in the prefrontal cortex. But
8:41if we want to simplify it, the
8:43prefrontal cortex is the main tool we
8:45have to try to predict the future, do a
8:48Vallecian statistical analysis and say,
8:50"There is a high possibility that this
8:52will go very badly, I better not do it.
8:55" Or if this turns out really well, I
8:57better do it. Now, let's differentiate
9:01a little bit according to the regions.
9:06The dorsolateral part has certain
9:08associated functions. The orbitofrontal
9:11part has certain associated functions
9:12and there is an overlapping part with
9:14the olympic lobe that we are going to
9:15talk about now. On the one hand, the
9:20dorsolateral cortex is the one that is
9:23related or linked to cognitive aspects,
9:26such as working memory, planning,
9:29tension or focus. The orbitofrontal
9:34cortex is linked to emotional aspects
9:36and, above all, to motivation.
9:42Sometimes, a subject may be
9:45particularly talented or skilled at a
9:48task and, however, the motivational
9:51aspects do not lead to effective
9:54results. Why? Because they simply did
9:58not have the clear intention of
10:00obtaining that good result. Let's say
10:02that they have all the cognitive
10:05characteristics to be able to obtain a
10:08good result, but the lack of motivation
10:10led them to not achieve that result. On
10:14the other hand, we can go in the
10:15opposite direction. Let's say that
10:18there is overmotivation. This
10:21overmotivation, which also has certain
10:23roots in biological behavior, is what
10:26we call impulses. Okay? I mean, we're
10:30not going to talk about such drastic
10:31impulses as maybe wanting to throw
10:33ourselves off a building, but we do
10:34have the impulse, for example, that
10:38someone tells you a joke and then maybe
10:42you can't help yourself and tell a
10:45defensive joke, right? Then that joke
10:49could be in bad taste, that was poor
10:52impulse control. Why? Because there was
10:55overmotivation. Let's go this far. I
10:58mentioned another example earlier, but
10:59the truth is that we thought it was too
11:01heavy, so I had to change it to a joke.
11:04Oh. Uh, finally, look, I'm going back
11:08here a little bit. I'm going back, it's
11:10not this way, this way, this way, this
11:11way, this way, this way, this way, this
11:13way, this way, this way, this way. Look
11:16at this area that I'm hitting on the
11:19screen, if you can recognize it, it's
11:21the Olympic sign. This kind of
11:23horseshoe or pincer shape that we have
11:25here is the Olympic logo. The anterior
11:30part is also linked to motivation, but
11:32the Olympic lobe in general terms, and
11:35we will see it in a few slides now, the
11:37Olympic lobe is more intensely linked
11:40to expression and emotional experience.
11:45It turns out that this anterior part of
11:47the gyrus of the symbol is intensely
11:50connected to the prefrontal association
11:53area. So this intense connectivity
11:57makes that area considered an overlap,
11:59an overlap of functions. Oh, it's here,
12:05sorry, it's the number that it is. So,
12:10the anterior singular cortex is also
12:12involved in monitoring performance and
12:15attentional effort, especially linked
12:18to emotional aspects. Okay? So,
12:23although by definition the prefrontal
12:26cortex is the one that has connectivity
12:28with the dorsomedial nucleus of the
12:30thalamus, we find that in the cortex
12:32its boundaries can end up being
12:34somewhat diffuse; they can end up being
12:36diverse due to the participation it has
12:39with other areas linked, for example,
12:41in this case, with emotional functions.
12:52Yes, I colored the PC.
12:55Yes, I colored it pink.
12:57Yes.
12:57Okay. Look, according to Mesulan's
13:03classification, the last category of
13:05areas that we should be evaluating
13:07would be the paralimbic areas. In this
13:10case, there are two paralimbic areas
13:12and they are classified as rings.
13:15Notice that here we have one area that
13:17is pink.
13:18Yes,
13:19that pink area is basically the olimbic
13:21. It comes out. There I gave you an
13:23alternative name that was used
13:24historically, which was gyrofornicatus,
13:26but the truth is that the other day I
13:27was rereading it and nobody calls it
13:29that anymore. Well, what I do want you
13:31to remember is that the upper part is
13:33called the gyrus of the symbol and the
13:35lower part is called the
13:36parahippocampal gyrus. Okay, that does
13:39interest me. Ah, although this is the
13:44area with the highest density of
13:46Broadman areas in a smaller space,
13:48there is a tip that I have always liked
13:50to tell students that ultimately
13:51summarizes this entire Brockman mapping
13:53in this area. If you notice, we have a
13:57continuum from Broadman area 23 to area
14:0038. So, from 23 to 33 it is in the
14:02singulate gyrus and there are some
14:04exceptions, but those exceptions are in
14:07the parahippocampal gyrus or so it has
14:10already been completed from 23 to 33.
14:12Then from 34 to 37 it is in the
14:14parahippocampal gyrus and finally the
14:17temporal pole region which although it
14:20is not marked with this pretty pink
14:22color, also belongs to the limbic
14:24association area. It has the last area
14:28which is 38. We summarize Brockman's
14:30mapping from 23 to 38. It is in the
14:32limbic association area. We are doing
14:35well up to here. And those two that are
14:37not going over here.
14:41Ah, okay, okay. Let's go this far. So,
14:45regarding Brodman's mapping, the
14:47summarized way in which we can describe
14:49all this mapping is in the limbic
14:50association areas, we have Brodman's
14:52areas 23 to 38. So, so. Ask Dr. Ariel
14:58where each one of them is and see if I
15:00can answer you. Oh, sorry, I forgot a
15:05little section here. Briefly and
15:09specifically, what is the function of
15:10the limbic association areas? They are
15:13responsible for emotional experience
15:15and expression. How do we feel and how
15:18do we express those emotions? Let's go
15:22this far. Now if we pay attention to
15:26the lower part, let me zoom in a little
15:29bit. Let's go here. If we pay attention
15:33to the lower part, this area, this area
15:38is what we previously saw in the
15:40olfactory cortex as the entorhinal
15:42cortex. I don't know if I told you
15:45about the perfume example from high
15:47school, right?
15:49Yes. So, uh, aromas can have a greater
15:53connection, a more immediate connection
15:55with emotional memories. I mean, it
15:58doesn't have to be love. Uh, I don't
16:01know if I told you about someone who
16:02once told me, "The thing is, doctor,
16:03every time I fly to your dinners, it
16:05was your dinners, it wasn't a flower."
16:07And the thing is that his grandmother
16:09used to wear a perfume with that scent
16:11a lot. So, they would immediately smell
16:12that perfume and she would remember her
16:13grandmother. Didn't you tell them that
16:15example? Yes. Or have you seen Harry
16:17Potter? I think it's number three. Uh,
16:20when...Well, excuse me, it's just that
16:28my mom is forgetting about it, but then
16:29it's my daughter's thing, you have to
16:30respond quickly. Okay, I was telling
16:33you about the Harry Potter thing. Uh, I
16:35don't know if you've seen it, oh, yeah,
16:37I don't remember what movie it is. They
16:38prepare a love potion and the point is
16:40that when they prepare the love potion,
16:42the potion smells like what they love
16:44and then this Germayoni
16:47smells it and says, "It smells like
16:49toothpaste because his parents are
16:50dentists, so toothpaste reminds him of
16:52home." Or in my case, there are people
16:56who smell their spine with alcohol and
16:57it reminds them of hospitals and it
16:59even feels bad. And in my case I even
17:02feel like I'm at home, right? And
17:03you're also going to get used to the
17:05pain in your spine with alcohol. Let's
17:08go this far.
17:09Yes. Okay. Well, there's only one,
17:14there's a half-truth in what I just
17:16told you. The cortex, the limbic cortex
17:20or areas are two rings. The outer ring
17:23is precisely the one in charge of
17:25emotional experience and expression and
17:27it's the one located in the sympathetic
17:29gyrus, the paracampal gyrus and the
17:31temporal pole. These are the outer ring
17:36, but if we keep moving forward we find
17:39the deep ring. Okay? The deep ring is
17:44not so unknown either. The deep ring in
17:48terms of cortex would be formed mainly
17:50by the hippocampal complex. And this
17:54thin line of cortex that surrounds the
17:56corpus callosum is called the inducium
17:58grisum. Now, what does this deep ring
18:02do? It is in charge of aspects such as
18:06memory. It includes aspects such as
18:08memory. Listen, notice that we are more
18:13likely to remember certain events
18:16linked to emotions than to remember an
18:20event in a simple way. For example,
18:26they say that it is fashionable to have
18:28a teacher who is but, but it has a
18:30certain neuroscientific basis. If the
18:32student is learning and then has
18:34satisfactory emotional experiences, it
18:37is more likely that this will be
18:40consolidated in their memory than if
18:43they simply spoke with the most robotic
18:46voice in the world and told you about
18:48it on a slide. So, this also impacts
18:51their learning. Now, theoretically it
18:55should also work the other way around,
18:57and the theory also says that if they
18:58were like ugly memories, then you would
19:00remember them more intensely, but it's
19:01not like I'm going to take out my stick
19:03and start beating everyone so that they
19:05remember, right? That thing about
19:07writing with blood entering. Well,
19:08there is a neuroscientific basis, but
19:10it's not very ethical, right? Let's go
19:13this far.
19:14Yes, we'll go this far.
19:20Yes,
19:22zoom in.
19:25Okay. This, and this is the last slide
19:28related to functional topography. Look,
19:32I usually always tell students, this,
19:34sometimes with the prefrontal cortex
19:37they are too motivated, but for the
19:39clinician, for the clinician in general
19:41terms, it is not useful, it is not
19:43practical to be learning specific
19:45segment by specific segment of the
19:48prefrontal cortex. Why? First, because
19:52vascularly there are rarely impacts so
19:54specific that they have very easily
19:56identifiable symptoms. In the end,
19:59these functions do not have
20:01super-specific areas in the prefrontal
20:03cortex either. So the functions of the
20:05prefrontal cortex are studied in a
20:07diffuse and generalized way and that is
20:09how the clinical physician deals with
20:11it. The neurosurgeon may have other
20:14reasons, but in general terms, that
20:16makes the subject of the frontal cortex
20:18a little disappointing in terms of
20:19functional topography. So far,
20:23questions, right? Apparently not. Well,
20:27then let's move on to part number three
20:34. We are almost finished with the brain
20:35. We only need part four. Well, part
20:38three and part four. We are going to
20:42talk about the formations of white
20:44matter. Note that under the cerebral
20:47cortex we have white matter, which I
20:49have already mentioned that white
20:51matter is white because it has this
20:52myelin, which is rich in phospholipids
20:55and that gives it a whitish appearance
20:57similar to butter. So during the time
21:05of Queen Marie Antoinette, I don't know
21:10if you have heard that this lady had
21:11many people executed and beheaded. This
21:15was Louis 'wife, what I always forget
21:17was Louis. What number? I think it was
21:20Louis X, but I don't remember what his
21:22Louis 14 was. Okay. So, Marie
21:24Antoinette was Louis XIV's wife and
21:26during their reign they ordered the
21:31beheading of many of the crown's
21:32enemies. There was a doctor named
21:35Félix Big d'Asir and then Félix Big
21:38d'Asir, who they also say had his love
21:40affair with Marie Antoinette, but we're
21:42not up for that gossip right now. They
21:46say that Félix Big, because of his
21:48closeness to the queen, would ask her
21:50for the heads of the decapitated. Some
21:54would put them on poles and in the
21:55Bastille, they would display their
21:57heads in a very grotesque way, but
21:59others would simply throw their heads
22:00into the open. So he saw an opportunity
22:04and began dissecting the heads of the
22:07victims of this marriage and was the
22:10first to discover, I mean, check, check
22:13, at the time, in its historical
22:15context, it had not been clearly
22:17described that there was an area of
22:20white matter just below the large area
22:23of gray cortex. So, he makes an
22:26exhaustive description and simply that
22:29area of a large amount of white matter
22:32below the cortex is called the
22:34semiovale center in honor of the
22:36descriptions of VIP de Aciro. Perhaps
22:40from this perspective it is not so
22:42noticeable that it is a semiovale thing
22:44, but now from this perspective you can
22:46see a little better that semiovale
22:48shape that Big describes. Let's go up
22:52to here now. At that moment all he did
22:54was say, there is enough white matter
22:56there and that was it. There was no
22:58more. Over time, new dissection
23:02techniques are developed and these
23:05dissection techniques allow us to
23:07determine where the white matter fibers
23:10go from. So it turns out that the three
23:15main groups or categories of directions
23:17that lead to these white matter fibers,
23:20there are some that go from the cortex
23:23of one hemisphere to the contralateral
23:25hemisphere and these are called
23:27interhemispheric or commissural fibers.
23:32On the other hand, there are white
23:34matter fibers that go from one
23:35hemisphere to the same hemisphere, just
23:37in another area. These are called
23:41association fibers. And finally we have
23:44fibers that go from the cortex to other
23:47structures. These are called projection
23:50fibers. So if they connect from side to
23:53side, they are commissural. If they
23:56connect on the same side, they are
23:57called association fibers and if they
23:59connect the cortex with other
24:01structures that are hierarchically
24:03lower, then they are called projection
24:05fibers. Note that here I put
24:09hierarchically lower because it is
24:11possible that the lower areas of the
24:13cortex are anatomically below the basal
24:15ganglia, but they can connect with the
24:17basal ganglia. So how do we make that
24:21distinction? Okay, in the hierarchy,
24:23the basal nucleus is below the cortex,
24:26which is why we use the word
24:27hierarchical. Let's talk about the
24:31commissural or interhemispheric fibers.
24:36So, the most notable by far is that
24:39green structure called the corpus
24:42callosum. Okay? Corpus callosum.
24:47Additionally, in this illustration, and
24:49let me clarify, I exaggerated the size
24:51of the structures because they are so
24:53small that they are barely
24:54distinguishable. So, in yellow we have
24:57the exaggerated anterior commissure, in
25:00blue the exaggerated posterior
25:01commissure, and in red the fornix.
25:04Exaggerated so that they can even be
25:08seen. The point is that by far the
25:11corpus callosum carries almost all the
25:13interhemispheric fibers of the cortex.
25:17Practically 90%of those fibers are
25:19found there in the corpus callosum. I
25:24deliberately left this image in English
25:26, well, the description of the image,
25:28uh, because I like a play on words that
25:29is not very well understood in Spanish.
25:34Look, first this red area is called the
25:37face or peak of the corpus callosum.
25:40We're doing well up to here. Well, the
25:43yellow area is called the knee. Genu
25:47means knee. Okay? So, gomio or genio or
25:52genu means knee. And we have it marked
25:55in yellow. Now, the green portion. Tell
25:58me in Spanish, what would the green
26:00portion be called? Corpus
26:02of the queero. It's
26:05the body of the body, right? So it's
26:07like a, it's not so noticeable in
26:09English because it's body of corpus
26:11kayosum, but in Spanish it's the body
26:13of the body, okay? Okay. Body of the
26:15corpus callosum in green, which is
26:16almost the entire structure. And
26:19finally in the back we have the rim or
26:21essemio of the corpus callosum in blue.
26:26And at least I think we're going to
26:29leave it here, but at least I don't
26:31know if they've ever told you what es
26:33pleno means. They have an organ here
26:37called es pleno.
26:38Vaso,
26:39right? Vaso is the colloquial name we
26:42say in Spanish, but the word spleno
26:45means bandage. So, the glass is
26:48supposedly called that because it's
26:50shaped like a compress. Imagination.
26:54Now, this one is shaped like a
26:57rolled-up bandage. I mean, you see that
27:01when you buy bandages they're rolled up
27:03like this, that little circle. Well,
27:06pretend that this is a rolled-up
27:07bandage. So, that's why it's supposedly
27:10called imagination. Let's go over here.
27:15Okay. This one, and we'll leave it here
27:18for today. Doubts, questions,
27:20clarifications, complaints. Dead too.

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