2­5 Lateral (A) and medial (B) views of the cerebral hemisphereshowing the landmarks used to divide the cortex into its main lobes.

On the lateral aspect, the central sulcus (of Rolando) separatesfrontal and parietal lobes. The lateral sulcus (of Sylvius) forms the bor-der between frontal and temporal lobes. The occipital lobe is locatedcaudal to an arbitrary line drawn between the terminus of the parieto-occipital sulcus and the preoccipital notch. A horizontal line drawnfrom approximately the upper two-thirds of the lateral fissure to therostral edge of the occipital lobe represents the border between pari-etal and temporal lobes. The insular cortex (see also Figs. 2-46 on page45 and 3-1 on page 56) is located internal to the lateral sulcus. This part

of the cortex is made up of long and short gyri that are separated fromeach other by the central sulcus of the insula. The insula, as a whole, isseparated from the adjacent portions of the frontal, parietal, and tem-poral opercula by the circular sulcus.

On the medial aspect, the cingulate sulcus separates medial portionsof frontal and parietal lobes from the limbic lobe. An imaginary con-tinuation of the central sulcus intersects with the cingulate sulcus andforms the border between frontal and parietal lobes. The parieto-occipital sulcus and an arbitrary continuation of this line to the preoc-cipital notch separate the parietal, limbic, and temporal lobes from theoccipital lobe.

The Brain: Lobes 13

Central sulcus

Central sulcus

Precentral sulcus

Lateral sulcus

Paracentral sulcus

Cingulate sulcus

Corpus callosum

Marginal sulcus (marginalramus of the cingulatesulcus)

Parietooccipitalsulcus

Calcarinesulcus

Collateral sulcus

Fornix

Diencephalon

Postcentral sulcus

Parietooccipitalsulcus

Frontal

Lobes

Parietal

Temporal

Occipital

Limbic

Insular

Preoccipitalnotch

Preoccipital notch

B

A

14 External Morphology of the Central Nervous System

2­6 Lateral (A) and medial (B) views of the cerebral hemisphereshowing the more commonly described Brodmann areas. In general,area 4 comprises the primary somatomotor cortex, areas 3,1, and 2 theprimary somatosensory cortex, and area 17 the primary visual cortex.Area 41 is the primary auditory cortex, and the portion of area 6 in thecaudal part of the middle frontal gyrus is generally recognized as thefrontal eye field.

The inferior frontal gyrus has three portions: a pars opercularis, pars

triangularis, and a pars orbitalis. A lesion that is located primarily in ar-eas 44 and 45 (shaded) will give rise to what is called a Broca aphasia,also called expressive or nonfluent aphasia.

The inferior parietal lobule consists of supramarginal (area 40) andangular (area 39) gyri. Lesions in this general area of the cortex(shaded), and sometimes extending into area 22, will give rise to whatis known as Wernicke aphasia, also sometimes called receptive or flu-ent aphasia.

Precentral gyrus

Pars opercularis

Pars triangularis

Pars orbitalis

Posterior paracentral gyrus

Anterior paracentral gyrus

Cuneus

Calcarine sulcus

Lingual gyrus

Postcentral gyrus

Surpamarginal gyrus

Angular gyrus

5

41

42

5

18

19

47

3,1,2

4544

8

6 4

40

39

22

3,1,2

8 6 4

7

19

18

17

7

19

18

17

A

B

The Brain: Lobes 15

2­7 Lateral (A) and medial (B) views of the cerebral hemisphereshowing the somatotopic organization of the primary somatomotorand somatosensory cortices. The lower extremity and foot areas are lo-cated on medial aspects of the hemisphere in the anterior paracentral(motor) and the posterior paracentral (sensory) gyri. The remainingportions of the body extend from the margin of the hemisphere overthe convexity to the lateral sulcus in the precentral and postcentralgyri.

In general, the precentral gyrus can be divided into three regions:the lateral third representing the face area, the middle third represent-

ing the hand and upper extremity areas, and the medial third repre-senting the trunk and the hip. Lesions of the somatomotor cortex re-sult in motor deficits on the contralateral side of the body while lesionsin the somatosensory cortex result in a loss of sensory perception fromthe contralateral side of the body.

The medial surface of the right hemisphere (B) illustrates the posi-tion of the left portions of the visual field. The inferior visual quadrantis located in the primary visual cortex above the calcarine sulcus whilethe superior visual quadrant is found in the cortex below the calcarinesulcus.

Posrcentral gyrus (primary somatosensory cortex)Precentral gyrus (primary somatomotor cortex)

Posterior paracentral gyrus (somatosensory)Anterior paracentral gyrus (somatomotor)

Leftinferiorvisualquadrant

A

B

2­8 Dorsal view of the cerebral hemispheres showing the main gyriand sulci and an MRI (inverted inversion recovery—lower left) and aCT (lower right) identifying structures from the same perspective.

Note the area of infarction representing the territory of the anteriorcerebral artery (ACA).

16 External Morphology of the Central Nervous System

Longitudinal fissure

Superior frontalsulcus (SFSul)

Precentralsulcus (PrCSul)

Precentralgyrus (PrCGy)

Centralsulcus (CSul)

Postcentralgyrus (PoCGy)

Postcentral sulcus

Occipital gyri

Superior parietal lobule

Supramarginalgyrus

Centralsulcus (CSul)

Precentralgyrus (PrCGy)

Middle frontalgyrus (MFGy)

Superior frontalgyrus (SFGy)

Anteriorcerebralarteries

SFGy

CSul

PoCGy

MFGy

SFSul

PrCSul

PrCGy

Falxcerebri

ACAterritory

18 External Morphology of the Central Nervous System

2­11 Lateral view of the left cerebral hemisphere showing theprincipal gyri and sulci and an MRI (inversion recovery) identifyingmany of these structures from the same perspective.

CSul

PrCSul

MFGy

IFSul

POrb

PTr

PoP

LatSul

PrCGy

CSul

PoCSul

OGy

MTGy

STGy

STSul

PoCGy

Precentral sulcus (PrCSul)

Superior frontal gyrus

Superior frontal sulcus

Middle frontal gyrus (MFGy)

Inferior frontal sulcus (IFSul)

Inferior frontal gyrus:

Pars opercularis (PoP)

Pars triangularis (PTr)

Pars orbitalis (POrb)

Lateral sulcus (LatSul)

Superior temporal gyrus (STGy)

Superior temporal sulcus (STSul)

Middle temporal gyrus (MTGy) Preoccipital notch

Occipitalgyri (OGy)

Angular gyrus

Interparietal sulcus

Supramarginal gyrus

Superior parietal lobule

Postcentral sulcus (PoCSul)

Central sulcus (CSul)

Precentral gyrus (PrCGy)

Postcentral gyrus (PoCGy)

20 External Morphology of the Central Nervous System

2­14 Ventral view of the cerebral hemispheres and diencephalonwith the brainstem caudal to midbrain removed and two MRIs (inver-

sion recovery—lower left; T2-weighted—lower right) showing manystructures from the same perspective.

Middlecerebralartery

Hypothalamus

Anteriorcerebralartery

Cerebellum

Temporal lobe

Un

CC

OlfSul

OrbGy

GyRec

OpTr

MB

IPF

Col

OpTr

Un

IPF

CA

Col

Olfactory bulb

Gyrus rectus (GyRec)

Olfactory tract

Optic nerve

Optic chiasm

Optic tract (OpTr)

Interpeduncularfossa (IPF)

Inferior temporalgyrus

Crus cerebri (CC)

Substantia nigra

Cerebralaqueduct (CA)

Colliculi (Col)

Frontal pole

Olfactory sulcus (OlfSul)

Orbital gyri (OrbGy)

Temporal pole

Infundibulum

Uncus (Un)

Mammillarybody (MB)

Parahippocampalgyrus

Collateral sulcus

Occipitotemporalgyri

Lingual gyrus

Occipital gyri

Occipital pole

22 External Morphology of the Central Nervous System

2­17 Ventral view of the cerebral hemispheres, diencephalon,brainstem, and cerebellum and two MRIs (both T1-weighted images)that shows structures from the same perspective. A detailed view of theventral aspect of the brainstem is seen in Figure 2-20 on page 24.

 Olfactory bulb

Orbital sulci

Gyrus rectus (GyRec)

Olfactory tract

Basilar pons (BP)

Occipitotemporalsulcus

Occipitotemporalgyri

Glossopharyngealnerve

Flocculus

Vagus nerve

Medulla

Decussationof pyramids

Frontal pole

Longitundinal fissure

Olfactory sulcus (OlfSul)

Orbital gyri (OrbGy)

Temporal pole (TPole)

Uncus

Parahippocampalgyrus

Collateralsulcus

Middle cerebellarpeduncle (MCP)

Facial nerve

Vestibulocochlearnerve

Abducens nerve

Olive (inferior); olivary eminence

Cerebellum (Cbl)

BP

GyRec OlfSul

OrbGy

Tpole

Trigeminalnerve

MCP

Fourthventricle

Cbl

BP

24 External Morphology of the Central Nervous System

2­20 Detailed ventral view of the diencephalon and brainstemwith particular emphasis on cranial nerves and related structures. Thedots on the left side represent the approximate position of the roots of

the hypoglossal nerve on that side; the general position of the (spinal)accessory nerve is shown on the right by the dark line.

Gyrus rectus

Infundibulum

Mammillary body

Interpeduncularfossa

Basilar pons

Trochlear nerve (cranial nerve IV)

Trigeminal nerve(cranial nerve V)

Middle cerebellar peduncle(brachium pontis)

Flocculus

Olive (inferior);olivary eminence

Retroolivary sulcus(postolivary sulcus)

Choroid plexus

Preolivary sulcus(exit of XIIth Nr.)

Pyramid

Anterior median fissure

Decussationof pyramids

Olfactory tract

Optic nerve(cranial nerve II)

Optic chiasm

Optic tract

Oculomotor nerve(cranial nerve III)

Crus cerebri

Parahippocampalgyrus

Abducens nerve(cranial nerve VI)

Facial nerve(cranial nerve VII)

Intermediate nerve

Vestibulocochlear nerve(cranial nerve VIII)

Glossopharyngeal nerve(cranial nerve IX)

Vagus nerve(cranial nerve X)

Hypoglossal nerve(cranial nerve XII)

Accessory nerve(cranial nerve XI)

Brs of posterior inferiorcerebellar artery

26 External Morphology of the Central Nervous System

2­23 View of the ventral aspect of the diencephalon and part of thebrainstem with the medial portions of the temporal lobe removed.

Note structures of the hypothalamus, cranial nerves, and optic struc-tures, including the lateral geniculate body.

Lateral geniculatebody

Crus cerebri

Trochlear nerve

Optic tract

Optic chiasm

Optic nerve

Infundibulum

Trigeminal nervemotor root

Trigeminal nervesensory root

Basilar pons

Abducens nerve

Pyramid

Preolivary sulcus

Middle cerebellarpeduncle

Vestibulocochlearnerve

Facial nerve

Olive (inferior),olivary eminence

Retroolivary sulcus(postolivary sulcus)

2­22 Lateral view of the left side of the brainstem emphasizingstructures and cranial nerves on the ventral aspect of the thalamus and

brainstem. Compare with Figure 2-24 on the facing page. The cere-bellum and portions of the temporal lobe have been removed.

Anterior cerebralartery

Optic nerve

Optic chiasm

Optic tract

Posterior perforated substance

Trochlear nerve

Lateral geniculate  body

Medial geniculate body

Middle cerebellar peduncle

Vestibulocochlear nerve

Olfactory tract

Medial olfactory stria

Lateral olfactory stria

Anterior perforated substance

Infundibulum

Mammillary body

Crus cerebri

Basilar pons

Trigeminal nerve

Abducens nerve

Facial nerve

Pyramid

28 External Morphology of the Central Nervous System

2­26 Midsagittal view of the right cerebral hemisphere and dien-cephalon, with brainstem removed, showing the main gyri and sulciand two MRI (both T1-weighted images) showing these structuresfrom the same perspective. The lower MRI is from a patient with asmall colloid cyst in the interventricular foramen. When compared tothe upper MRI, note the enlarged lateral ventricle with resultant thin-ning of the corpus callosum.

A colloid cyst (colloid tumor) is a congenital growth usually dis-covered in adult life once the flow of CSF through the interventricularforamina is compromised (obstructive hydrocephalus). The patientmay have headache, unsteady gait, weakness of the lower extremities,visual or somatosensory disorders, and/or personality changes or con-fusion. Treatment is usually by surgical removal.

Rhinal sulcus

Anterior paracentral gyrus (APGy)

Precentral sulcus (PrCSul)

Paracentral sulcus (ParCSul)

Cingulate sulcus(CinSul)

Superior frontal gyrus (SFGy)

Cingulate gyrus (CinGy)

Sulcus of corpuscallosum (SulCC)

Paraterminal gyri

Parolfactory gyri (ParolfGy)

Temporal pole UncusParahippocampal gyrus

Occipitotemporal gyri

Isthmus of cingulate gyrus

Lingual gyrus(LinGy)

Calcarine sulcus(CalSul)

Cuneus (Cun)

Parieto­occipitalsulcus (POSul)

Precuneus (PrCun)

Marginal sulcus (MarSul)

Posterior paracentral gyrus (PPGy)

Central sulcus (CSul)

PrCSul

ParCSul

SulCC

CinGy

CinSul

ParolfGy

APGy

CSul

PPGy

MarSul

PrCun

POSul

Cun

CalSul

LinGy

MarSul

POSul

CalSul

Internal cerebralvein

SFGy

Corpus callosum

Colloid cyst

30 External Morphology of the Central Nervous System

2­29 A midsagittal view of the right cerebral hemisphere and di-encephalon with the brainstem and cerebellum in situ. The MRI (T1-weighted image) shows many brain structures from the same perspec-tive.

Anterior paracentral gyrus (APGy)

Paracentral sulcus (PCSul)

Superior frontal gyrus (SFGy)

Body of corpus callosum (BCorC)

Sulcus of thecorpus callosum (SulCorC)

Cingulate gyrus (CinGy)

Cingulate sulcus (CinSul)

Septum

Rostrum of corpus callosum (RCorC)

Fornix (For)

Midbrain tegmentum (MidTeg)

Basilar pons (BP)

Pontine tegmentum (PonTeg)

Central sulcus (CSul)

Posterior paracentral gyrus (PPGy)

Marginal sulcus (MarSul)

Precuneus (PCun)

Splenium of corpus callosum (SplCorC)

Parieto­occipitalsulcus (POSul)

Cuneus (Cun)

Lingual gyrus (LinGy)

Calcarine sulcus (CalSul)

Cerebellum (Cbl)

Tonsil of cerebellum (Ton)

Medulla (Med)

APGyPCSulSFGy

BCorC

SulCorC

CinGy

CinSul

GCorC

RCorC

For

MidTeg BP PonTeg

CSul

PPGy

MarSul

PCun

SplCorC

POSul

Cun

LinGy

CalSul

Cbl

TonMed

Genu of corpuscallosum (GCorC)

The Brain: Gross Views, Vasculature, and MRI 31

2­30 A midsagittal view of the right cerebral hemisphere and di-encephalon with the brainstem in situ focusing on the details primarilyrelated to the diencephalon and third ventricle. The MRI (T1-weighted

image) shows these brain structures from the same perspective. Hyth� hypothalamus.

Body of fornix (For)

Septum pellucidum (Sep)

Interventricular foramen

Column of fornix

Anteriorcommissure (AC)

Lamina terminalis

Infundibulum (In)

Supraoptic recess

Optic chiasm (OpCh)

Optic nerve

Infundibular recess

Mammillary body (MB)

Hypothalamic sulcus

Oculomotor nerve

Interpeduncular fossa (IpedFos)

Basilar pons (BP)

Massa intermedia

Dorsal thalamus (DorTh)

Choroid plexus of third ventricle

Stria medullaris thalami

Habenula

Suprapinealrecess

Posteriorcommissure

Pineal (P)

Superiorcolliculus (SC)

Quadrigeminalcistern (QCis)

Inferiorcolliculus (IC)

Cerebralaqueduct (CA)

Anterior medullary velum (AMV)

Fourth ventricle (ForVen)

Posterior inferior cerebellar artery

Medulla

DorTh

Internal cerebral vein

P

Tentorium cerebelli

QCis

IC

SC

AMV

ForVen

CABPIpedFos

For

Sep

AC

Hypothalamus

OpCh

In

Pituitary gland

MB

HythHyth

32 External Morphology of the Central Nervous System

2­31 Rostral (A, superior surface), caudal (B, inferior surface),and an inferior view (C, inferior aspect) of the cerebellum. The viewin C shows the aspect of the cerebellum that is continuous into thebrainstem via cerebellar peduncles. The view in C correlates with su-perior surface of the brainstem (and middle superior cerebellar pe-duncles) as shown in Figure 2-34 on page 34.

Note that the superior view of the cerebellum (A) correlates closely

with cerebellar structures seen in axial MRIs at comparable levels (D,E). Structures seen on the inferior surface of the cerebellum, such asthe tonsil (F), correlate closely with an axial MRI at a comparable level.In G, note the appearance of the margin of the cerebellum, the generalappearance and position of the lobes, and the obvious nature of themiddle cerebellar peduncle. All MRI images are T1-weighted.

Anteriorquadrangularlobule

Posteriorquadrangularlobule

Hemisphere

Hemisphere

Anteriorlobe (AntLb)

Horizontalfissure

Flocculus (Fl)

Tonsil (Ton)

Nodulus

Cerebellar peduncles:

Superior (SCP)Middle (MCP)Inferior Primary fissure

AntLb

MCP

Fl

Posteriorlobe (PostLb)

Basilar pons (Bpon)

Medulla (Med)Flocculus (Fl)

Tonsil (Ton)

Biventerlobule

Gracilelobule

Inferiorsemilunar

lobule

Bpon

AntLb

SCP

Fourth ventricle

Med

Med

Ton

PostLb

PostLb

Ver

Primaryfissure

Anteriorlobe (AntLb)

Midbrain

Posteriorsuperior

fissure

Superior semilunarlobule

Vermis (Ver)

Vermis (Ver)

Colliculi:

SuperiorInferior

A

B

C

D

E

F

G