Neuroanatomy For The Psychiatrist: Textbook of Psychiatry

The American Psychiatric Publishing
TEXTBOOK OF PSYCHIATRY
Fifth Edition
Edited by Robert E. Hales, M.D., M.B.A., Stuart C. Yudofsky, M.D., Glen O. Gabbard, M.D.
© 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
CHAPTER 5
Neuroanatomy for the Psychiatrist
Katherine H. Taber, Ph.D., F.A.N.P.A.,

Robin A. Hurley, M.D., F.A.N.P.A.
Slide show includes…

Topic Headings
Tables and Figures
Key Points
The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 1
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
CHAPTER 5 • Topic Headings
CEREBRAL CORTEX
Frontal Lobe
Temporal Lobe
Parietal Lobe
Occipital Lobe
Basal Forebrain
SUBCORTICAL AREAS
SUBCORTICAL AREAS
Basal Ganglia
Caudate Nucleus
Putamen
Globus Pallidus
Substantia Nigra
Limbic System
Hippocampal Formation and
Parahippocampal Cortex
Amygdala
Mammillary Bodies
Thalamus
Hypothalamus
Pons
Cerebellum
CONCLUSION
CHAPTER 5 • Tables and Figures
Figure 5–1. Planes of section.
Figure 5–2. Anatomic orientations and directions.
Figure 5–3. Major divisions of the brain.
Figure 5–4. Lobes of the cerebral cortex.
Figure 5–5. Major gyri and sulci of the cerebral cortex.
Figure 5–6. Functions of the cerebral cortex.
Figure 5–7. Brodmann areas.
Figure 5–8. Variability in Brodmann areas.
Figure 5–9. Major subcortical structures.
Figure 5–10. Basal forebrain.
Figure 5–11. Sectional anatomy—axial atlas: dorsal frontal and parietal cortices.
Figure 5–12. Sectional anatomy—axial atlas: cingulate cortex.
Figure 5–13. Sectional anatomy—axial atlas: dorsal occipital and parietal cortices, caudate.
Figure 5–14. Sectional anatomy—axial atlas: insular cortex, basal ganglia, thalamus.
Figure 5–15. Sectional anatomy—axial atlas: orbital cortex, basal forebrain, hippocampus, midbrain.
Figure 5–16. Sectional anatomy—axial atlas: orbital cortex, hippocampus, amygdala, midbrain.
Figure 5–17. Limbic lobes.
Figure 5–18. Circuit of Papez.
Figure 5–19. Prefrontal cortex—surface anatomy and circuits.
Figure 5–20. Prefrontal cortex—sectional anatomy.
Table 5–1. Summary of functional anatomy pertinent to psychiatry
Summary Key Points
Figure 5–1 shows the planes of sections of the brain.
FIGURE 5–1. Planes of section.
Source. Used with permission from Mid-Atlantic Mental Illness Research, Education, and Clinical Center.
Figure 5–2 illustrates the terms used to describe directions and anatomic orientations of the brain.
FIGURE 5–2. Anatomic orientations

and directions.
Several sets of terms are used to describe
directions in the brain. Some of them are
invariant, whereas others are named relative
to a particular axis. Superior–inferior,
anterior–posterior, and medial–lateral do not
change. Rostral–caudal and dorsal–ventral
are relative.
Source. Used with permission from Mid-Atlantic Mental Illness

Research, Education, and Clinical Center.
Figure 5–3 shows the major divisions of the brain.
FIGURE 5–3. Major divisions of the

brain.
The major divisions of the brain are color-coded onto magnetic resonance images to provide overall
orientation. Origins of these divisions during development are presented in summary form.
FIGURE 5–3. (continued)
Figure 5–4 shows the lobes of the cerebral cortex.
FIGURE 5–4. Lobes of the cerebral cortex.

The highly infolded surface layer of
the brain, the cerebral cortex, is the
largest single division of the human
brain. Anatomists commonly divide
the cerebral cortex into four sections
or lobes: frontal, temporal, parietal,
and occipital. In addition, some
consider the limbic areas of the
cortex to comprise a fifth lobe,
whereas others include these areas
in the frontal and temporal lobes and
diencephalon. These five lobes are
color-coded onto both magnetic
resonance images and drawings of
the medial, lateral, and inferior
(bottom) views of the brain. Note that
the medial and posterior inferior
surfaces of the temporal lobe can
only be seen on the drawings of the
medial and inferior surfaces of the
brain. This is because the brain stem
and cerebellum (see Figure 5–3)
have been omitted from the drawings.
Source. Used with permission from Mid-Atlantic Mental

Illness Research, Education, and Clinical Center.
(continued)
Figure 5–5 shows the major gyri and sulci of the cerebral cortex.
FIGURE 5–5. Major gyri and sulci of the cerebral cortex.
An outfolding of the
cerebral cortex is called
a gyrus (plural is gyri), an
infolding is called a
sulcus (plural is sulci).
Some very large sulci are
called fissures. Although
all normal brains contain
many gyri and sulci, they
can vary considerably in
both extent and location.
Source. Used with permission from

Mid-Atlantic Mental Illness Research,
Education, and Clinical Center.
(continued)
Source. Used with permission from Mid-Atlantic Mental Illness Research,

Education, and Clinical Center.
Figure 5–6 shows the functions of the cerebral cortex.
FIGURE 5–6. Functions of the cerebral cortex.
(continued)
Figure 5–7 presents a general mapping of the Brodmann areas.
FIGURE 5–7. Brodmann areas.
In the early part of the twentieth century,

Brodmann defined cortical areas based on
features such as the size, shape, and
distribution of neurons (cytoarchitecture).
An approximation of these areas is
provided in these illustrations. Versions of
this system are still widely used (Zeki
2005). Although useful, it is important to
always keep in mind that Brodmann’s work
was based on analysis of a single brain.
Brains vary greatly in size, shape, and
folding patterns. Research has shown that
there is a wide range in the extent of a
specific Brodmann area when compared
across individuals (see Figure 5–8). Thus,
such maps should be used only as
extremely general guides.

Figure 5–8 presents a simplified variability map for Brodmann area 17 (primary visual cortex).
FIGURE 5–8. Variability in Brodmann areas.
Multiple studies have compared the extent of particular Brodmann areas across individuals (Amunts et al.
2000, 2004; Uylings et al. 2005). There is considerable variability, even in areas dedicated to essential sensory
functions, such as primary visual cortex (Brodmann area 17). Individuality is even greater in areas subserving
more complex functions. Variability (or probability) maps have been created by transforming each studied brain
into a common anatomic space, so that the areas can be superimposed. This illustration is a simplification of
published variability maps for Brodmann area 17 (primary visual cortex), which borders the calcarine sulcus in
the occipital lobe. The colors indicate the number of individual brains (out of 10 brains) that overlapped.
Figure 5–9 shows the major subcortical structures, color-coded to match the sectional axial atlas
presented in Figures 5–11 through 5–16.
FIGURE 5–9. Major subcortical structures.
An illustration of the major subcortical structures is color-coded to match the axial atlas (Figures 5–11 through 5–16).
Figure 5–10 shows the basal forebrain.
FIGURE 5–10. Basal forebrain.
The basal forebrain area (basal nucleus of Meynert, nucleus of the diagonal band, septal nuclei) contains
many cholinergic neurons. The general location of this important region and its projections to cortical and
subcortical areas are indicated on sagittal (left image) and coronal (right image) magnetic resonance
images.
Figures 5–11 through 5–16 present a sectional axial atlas, color-coded to the major subcortical
structures depicted in Figure 5–9.
FIGURE 5–11. Sectional anatomy—

axial atlas: dorsal frontal and
parietal cortices.
Axial T1-weighted magnetic resonance image

with major gyri, sulci, and lobes labeled.

axial atlas: cingulate cortex.
Axial T1-weighted magnetic resonance

image with major gyri, sulci, and lobes
labeled.

axial atlas: dorsal occipital and
parietal cortices, caudate.
Axial T1-weighted magnetic

resonance image with major gyri,
sulci, and lobes labeled.

axial atlas: insular cortex, basal
ganglia, thalamus.
Axial T1-weighted magnetic resonance

image with major gyri, sulci, and lobes
labeled.

axial atlas: orbital cortex, basal
forebrain, hippocampus, midbrain.


axial atlas: orbital cortex,
hippocampus, amygdala, midbrain.


Figure 5–17 shows the limbic lobes, color-coded to match the summary of subcortical structures
(see Figure 5–9) and the sectional axial atlas (see Figures 5–11 through 5–16).
FIGURE 5–17. Limbic lobes.
The location and names of the structures that make up the outer (surface of brain) and inner (deep
structures) limbic lobes are illustrated on schematic diagrams of the medial surface of the right cerebral
hemisphere. Structures are color-coded to match the summary of subcortical structures (see Figure 5–9)
and the sectional axial atlas (see Figures 5–11 through 5–16).
Figure 5–18 shows the circuit of Papez, color-coded to match the summary of subcortical structures
(see Figure 5–9) and the sectional axial atlas (see Figures 5–11 through 5–16).
FIGURE 5–18. Circuit

of Papez.
A schematic diagram of the
emotion and memory circuit of
Papez is color-coded to match
the summary of subcortical
structures (Figure 5–9) and the
sectional axial atlas (Figures
5–11 through 5–16). The
location and extent of the
anterior cingulate cortex (light
gold) is indicated on a sagittal
midline drawing of the brain.
The locations of the remaining
structures are shown on a
coronal magnetic resonance
image.
Source. Used with permission from Mid-

Atlantic Mental Illness Research, Education,
and Clinical Center.
FIGURE 5–18. (enlarged)
Figure 5–19 depicts the
surface anatomy and circuits
of the prefrontal cortex.
FIGURE 5–19. Prefrontal

cortex—surface anatomy
and circuits.
In psychiatry, the prefrontal cortex

is generally divided into three
principal areas, each having
reciprocal connections with
subcortical structures that form
corticosubcortical circuits. These
circuits are formed by chains of
neurons with cell bodies in gray
matter structures (both cortical and
subcortical) connected by the
axons that form the white matter.
Recently, the evidence supporting
a similar reciprocal circuit to the
cerebellum has been strengthened,
although the functions of this circuit
are still controversial.
Source. Used with permission from Mid-Atlantic

Mental Illness Research, Education, and Clinical
Center.
Figure 5–20 shows the
sectional anatomy of the
prefrontal cortex.
FIGURE 5–20. Prefrontal cortex

—sectional anatomy.
The frontal lobe circuits are crucial to

many higher-order behaviors,
including memory, planning, and
socially appropriate behavior. These
circuits are believed to be segregated
throughout their course, with injury at
any point producing a characteristic
syndrome (e.g., injury to the
dorsolateral prefrontal cortex or to the
dorsomedial thalamus could both
produce deficits in executive function).
In the white matter and at the various
subcortical nuclei, the pathways are
very close together. Brain injury (e.g.,
stroke, ischemia, trauma) may involve
more than one circuit, resulting in a
mixture of deficits.

Table 5–1 presents a summary of functional anatomy pertinent to psychiatry.
TABLE 5–1. Summary of functional anatomy pertinent to psychiatry
Source. Nolte 2002; Tranel 2002.

(continued)
TABLE 5–1. (continued)
(continued)
(continued)
(continued)
(continued)
(continued)
CHAPTER 5 • Key Points
 The dorsolateral prefrontal region is important for cognition, executive

function, and focused attention.
 The orbital prefrontal region is important for social conduct, insight, judgment,
and mood.
 The mesial region of the temporal lobe contains the hippocampus, the
parahippocampus, and the amygdala.
 The hippocampal complex is the key to memory formation and storage
functions.
 The parietal lobe is important for sensation, speech production/conduction,
and deficit recognition.
 The basal ganglia are critical for suppression/modulation of involuntary
movements and contribute to memory, cognition, behavior, and mood.
 The thalamus is the key “relay station” for memory, emotion, cognition,
behavior, motor, and sensory functions.
 The hypothalamus modulates physiological response to emotional stimuli,
temperature control, sleep, water metabolism, hormone secretion, satiety,
and circadian rhythms.
(continued)
CHAPTER 5 • Key Points (continued)
 The pons contains the locus coeruleus (norepinephrine production) and

portions of the reticular formation (alertness).
 The cerebellum is important for equilibrium and fine motor coordination and
is associated with cognition.

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The American Psychiatric Publishing

Neuroanatomy for the Psychiatrist

Katherine H. Taber, Ph.D., F.A.N.P.A.,

Slide show includes…

FIGURE 5–1. Planes of section.

FIGURE 5–2. Anatomic orientations

Source. Used with permission from Mid-Atlantic Mental Illness

FIGURE 5–3. Major divisions of the

FIGURE 5–4. Lobes of the cerebral cortex.

Source. Used with permission from Mid-Atlantic Mental

FIGURE 5–5. Major gyri and sulci of the cerebral cortex.

Source. Used with permission from

Source. Used with permission from Mid-Atlantic Mental Illness Research,

FIGURE 5–6. Functions of the cerebral cortex.

FIGURE 5–7. Brodmann areas.

In the early part of the twentieth century,

Source. Used with permission from Mid-Atlantic Mental Illness

FIGURE 5–8. Variability in Brodmann areas.

FIGURE 5–9. Major subcortical structures.

FIGURE 5–10. Basal forebrain.

FIGURE 5–11. Sectional anatomy—

Axial T1-weighted magnetic resonance image

Source. Used with permission from Mid-Atlantic Mental Illness

Axial T1-weighted magnetic resonance

Source. Used with permission from Mid-Atlantic Mental Illness

Axial T1-weighted magnetic

Source. Used with permission from Mid-Atlantic Mental

Axial T1-weighted magnetic resonance

Source. Used with permission from Mid-Atlantic Mental Illness

Axial T1-weighted magnetic resonance image

Source. Used with permission from Mid-Atlantic Mental Illness

Axial T1-weighted magnetic resonance image

Source. Used with permission from Mid-Atlantic Mental Illness

FIGURE 5–17. Limbic lobes.

FIGURE 5–18. Circuit

Source. Used with permission from Mid-

FIGURE 5–19. Prefrontal

In psychiatry, the prefrontal cortex

Source. Used with permission from Mid-Atlantic

FIGURE 5–20. Prefrontal cortex

The frontal lobe circuits are crucial to

Source. Used with permission from Mid-Atlantic Mental

TABLE 5–1. Summary of functional anatomy pertinent to psychiatry

Source. Nolte 2002; Tranel 2002.

 The dorsolateral prefrontal region is important for cognition, executive

 The pons contains the locus coeruleus (norepinephrine production) and

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