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天津医科大学临床医学院解剖组翻译
translated by Department of Anatomy, Clinical Medical College of Tianjin Medical University
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translated by Department of Anatomy, Clinical Medical College of Tianjin Medical University
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天津医科大学临床医学院解剖组翻译
translated by Department of Anatomy, Clinical Medical College of Tianjin Medical University
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欢迎来到犹他大学---神经解剖学实验室
>> Welcome to the University of Utah, neuroanatomy laboratory.
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来跟我进入，做一些大脑的解剖
We're going to go inside and do some dissections of the brain
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看一些重要的结构
and look at some of the important structures
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对于理解神经病学原理和定位
that are useful
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十分有用的知识
for understanding neurological principles and localization.
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学习神经解剖学及其各种曲折的神经束的目的
The purpose of neuroanatomy and all of its tortuous tracts is
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是为了让你学会神经病学定位
to allow you to do neurological localization.
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换言之，判断出病人的病灶
That is to say, decide where in the brain
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在大脑中的哪处
of your patient the disease process is occurring.
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这是你们理解大脑连续性的总目标
That's the total reason for most of you to want
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这是你们理解大脑连续性的总目标
to understand the connectivity of the brain.
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现在，让我们来看看大脑的外观
Now let's look at the surface of the brain.
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首先我们来介绍大脑不同的脑叶
We removed the coverings; the leptomeninges (the pia
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为了展示不同的脑叶
and the arachnoid) and I want to show you the different lobes
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我们移去了覆盖物---柔脑膜（蛛网膜和软脑膜）
of the brain as an introduction.
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此外,在这个大脑上,你可以看到脑干。
In addition, on this brain, you can see the brainstem.
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脑干从我探针所指位置起始
The brainstem extends from this region where my probe is,
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有点不好辨认, 一直延续到
a little bit difficult to see, down all the way here
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与脊髓相连的地方
to where the spinal cord was attached.
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此外，可以观察到小脑
In addition, you can see the cerebellum involved
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其和大脑皮质一样
with coordinated motor control as well as the surface
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参与运动的协调控制
with coordinated motor control as well as the surface
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参与运动的协调控制
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参与运动的协调控制
of the cerebral cortex.
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这是大脑的腹侧面
This is the ventral surface of the brain.
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这里最显而易见的特点是颞叶,
And the most prominent feature here is the temporal lobe,
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就是我指出的部位
which I am outlining.
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这是另一侧的颞叶。
Here is the temporal lobe on the other side.
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在它的前面是额叶的下面
And in front of it is the undersurface
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在它的前面是额叶的下面
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在它的前面是额叶的下面
of the frontal lobe.
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脑神经连接于此面
Cranial nerves are attached such as the visual optic nerve
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如视神经、面部感觉神经、三叉神经
and the sensory nerve from the face or trigeminal nerve
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和一些血管，比如基底动脉
and blood vessels, such as this large basilar artery,
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都连接于腹侧面
are running on the surface
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并且你还可以看到相对比较大的颈内动脉
or you can even see the large internal carotid artery.
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我们还会回来看看这些神经和动脉
We will come back and look at the nerves and the arteries
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并且更详细地讲解其他联系
and the other connections in greater detail, but I just want
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但现在我先讲解一下延髓、
to introduce you to the region of the medulla,
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脑桥和中脑
the pons, and the midbrain.
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它们一起组成了脑干
And together, they make up the brainstem.
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现在让我们看一下大脑的侧面
Let's look at the lateral surface now of the brain
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和这些形态各异的脑叶
and look at the different lobes.
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你已经看过颞叶的下面了
You already saw the inferior surface
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一直到这里
of the temporal lobe coming back to here and we just kind
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我们可以大概画条线
of arbitrarily draw a line and say
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这差不多就是颞叶的后部的终点了
that this is approximately the end
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这差不多就是颞叶的后部的终点了
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这差不多就是颞叶的后部的终点了
of the temporal lobe posteriorly and the tip
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of the temporal lobe posteriorly and the tip
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这是颞叶前部的尖端
of the temporal lobe posteriorly and the tip
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这是颞叶前部的尖端
of the temporal lobe anteriorly.
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然后我们选择一个脑沟
And then we look for a sulcus on the surface of the brain.
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脑回就是表面的这些沟裂
Sulci are these grooves and the surface structures
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这些弯曲的表面结构就是脑回
that are coiled are the gyri.
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这些就是脑沟和脑回
So we have sulci and we have gyri.
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脑回都有名字，但是大多数都不需要记忆。
The gyri have names but we're not going to learn most of them.
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然而，这有一个主要的沟--中央沟
However, this major sulcus, the central sulcus, because it runs
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因为它从中线一直向下
from the midline all the way
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延续到颞叶旁的外侧裂
down to the lateral fissure separating it
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延续到颞叶旁的外侧裂
from the temporal lobe,
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中央沟把前方的额叶
this central sulcus separates frontal lobe in front of it
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和后方的顶叶分开
from parietal lobe behind it.
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非常有趣的是
And very interestingly, the cortex involved
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中央沟前方的皮质参与控制随意运动
in voluntary movement is in front of the central sulcus.
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中央沟后面的脑回皮质和第一躯体感觉有关
And the cortex involved with primary somatic sensation
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中央沟后面的脑回皮质和第一躯体感觉有关
from your body is the gyrus behind the central sulcus.
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这是额叶
So, this is frontal lobe.
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这是顶叶
This is parietal lobe.
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这是一般运动皮层，
This is motor cortex in general,
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这是一般感觉皮层.
and this is sensory cortex in general.
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所以我们只是在搞清所在方位.
So we're just getting our bearings.
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额叶进一步分裂
The frontal lobe is further sort of divided and it's hard
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很难看出区别
to see the distinction, but this band along here is the superior
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这条脑回是额回
to see the distinction, but this band along here is the superior
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这条脑回是额回
frontal gyrus, then we have the middle frontal gyrus,
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这是额中回
frontal gyrus, then we have the middle frontal gyrus,
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这是额下回。
and the inferior frontal gyrus.
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运动皮质区在中央前回的前面
The motor cortex in front of this precentral gyrus,
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之所以这样叫它，是因为其位于中央沟的前方
as we call it because it's in front of the central sulcus,
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它是左脑的一个区域
is an area involved,in the left hemisphere,
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我们现在看的这部分是运动性语言区
which we're looking at, with the production of speech.
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你可能之前听说过
And you may have heard of it before,
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它叫Broca's区
it's called Broca's area.
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额叶的其余部分要么是运动功能，
The rest of the frontal lobe is either motor function,
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要么是计划性运动, 或管理功能
planning motor function, or executive functions
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比如判断和计划
such as judgment and planning.
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现在让我们看看顶叶。
Let's look at the parietal lobe now.
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顶叶和枕叶被顶区和枕区之间的
The parietal lobe is separated from the occipital lobe
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很多小裂隙构成的大致的线分隔的
by an arbitrary line that we draw between the parietal
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很多小裂隙构成的大致的线分隔的
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很多小裂隙构成的大致的线分隔的
and the occipital regions,these little notches here.
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如果我在这里显示,
So if I were to display here,
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我会说“大概在枕叶”。
I would say that approximately his is the occipital lobe.
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枕叶对人类很重要。
The occipital lobe is very important to humans
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因为这个叶参与视觉刺激信号的处理
because this lobe is involved
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因为这个叶参与视觉刺激信号的处理
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因为这个叶参与视觉刺激信号的处理
with visual information processing.
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我们有一个精妙的大脑,
It's a wonderful brain that we have,
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作为人类，
and we are very specialized as humans for visual computation,
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我们非常擅长视觉处理、定位和分析
and we are very specialized as humans for visual computation,
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我们非常擅长视觉处理、定位和分析
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我们非常擅长视觉处理、定位和分析
orientation and analysis.
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所以我们有四个（口误读成三个）脑叶。
So we have our four（not three） lobes, occipital lobe involved
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和视觉有关的枕叶、和多种感觉输入整合处理有关的顶叶
So we have our four（not three） lobes, occipital lobe involved
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和视觉有关的枕叶、和多种感觉输入整合处理有关的顶叶
with vision, parietal lobe involved with sensation
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和视觉有关的枕叶、和多种感觉输入整合处理有关的顶叶
and integration of multiple modes of sensory input,
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具有运动和高级指令功能的额叶
and the frontal lobe with motor and higher order function.
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最后是这里的颞叶
And this temporal lobe that is down here is very much involved
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它和听觉信息有关
with auditory information,which is coming
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它一直延续到我拉开的脑沟里
in to this fissure here that I'm pulling down.
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这是外侧裂。
This is the lateral fissure.
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听觉信息、声音会传导到两个大脑半球
And auditory information,sound, comes to both hemispheres
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然后在这里处理
and is processed here,and this area behind it,
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这后面的区域
and is processed here,and this area behind it,
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颞上回
the superior temporal gyrus,this back part here is involved
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这后面的部分，参与形成理解语言的功能（Wernick's 区)
the superior temporal gyrus,this back part here is involved
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这后面的部分，参与形成理解语言的功能（Wernick's 区)
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这后面的部分，参与形成理解语言的功能（Wernick's 区)
in the comprehension of language (Wernicke's area).
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所以现在我们有两种语言区域
So you've got twolanguage areas,
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一个是语言理解区，一个是运动语言区
an interpretative language area and a production language area.
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当我们研究脑卒中的后果时,
And when we study the consequences of cerebral stroke,
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我们会看到有时中风可以损伤一个区域
we'll see that some strokes can knock out one area
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患者说出的话让人听不懂什么意思
and you'll have problems producing intelligible speech,
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然而患者可以理解别人表达的意思
while other areas leave you hearing perfectly fine
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但不能理解听到的句子
but not understanding what you're hearing,
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其他损伤或有破坏性的中风
and other lesions or damaging strokes that involve all
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如果损伤到了全部这些区域，可以导致严重的后果
of this area can leave you with a large deficit
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我们称之为完全性失语症。
which we call a global aphasia.
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失语症是一种语言障碍。
Aphasia is a language disturbance.
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颞叶除了具有听觉功能以外
The temporal lobe in addition
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每个大脑半球在脑回下方的这个区域
to having an auditory function has an area underneath this
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是形成新记忆所必须的区域
gyrus here, which is required in one hemispheres
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是形成新记忆所必须的区域
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是形成新记忆所必须的区域
for forming new memories.
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它叫做海马体，但是这里我们看不到。
It's called the hippocampus but is not visible here.
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所以，颞叶和听觉和新记忆形成有关。
So, temporal lobe, auditory and new memories, occipital lobe,
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枕叶和视觉信息处理识别有关。
visual information, processing,and recognition, parietal lobe,
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顶叶和面部和身体的躯体感觉有关。
somatic sensation from the face and the body, frontal lobe,
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额叶和躯体随意运动、计划、判断、启动适应行为和停止不适应的行为有关。
motor execution voluntarily,planning, and execution
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额叶和躯体随意运动、计划、判断、启动适应行为和停止不适应的行为有关。
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额叶和躯体随意运动、计划、判断、启动适应行为和停止不适应的行为有关。
of appropriate judgment and actions.
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两个大脑半球并非完全相同的
The two hemispheres are not identical, and later,
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一会我们会谈到大脑半球各自独特的区域
we'll talk about special localizations
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一会我们会谈到大脑半球各自独特的区域
between the hemispheres.
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但是我想先说明一点
But right now, I just want to point to the fact,
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两个大脑半球是被一些纤维连结在一起的
the two hemispheres are held together by a large band
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我们称其为胼胝体
of fibers called the corpus callosum.
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我这里有一个大脑的冠状切面
What I have here is a coronal section through the brain.
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我们已经把大脑取出，然后做了冠状切
What we've done is we've taken our brain and we've sliced it
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它是从这里切开的
like through this way, and so,
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这叫冠状面或额状面
this is called a coronal or frontal section.
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我先把它放在这里
And I'm going to rest it here
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以便你能看到大脑内部的结构
so that you can see the internal structure of the brain.
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我们还会详细讨论这个问题
We'll deal with this in more detail, but right now,
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你可以看到这些脑回
you can see that those gyri that we were looking at,
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还有其间凹陷的脑沟
and the sulci, the dips in between,
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都很容易分辨
can be easily distinguished.
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脑回表面有一层米黄色的覆盖物
And the gyri are covered with a nice layer, beige in color,
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那些就是大脑皮层的灰质
and that is your gray matter, as we say, of the cerebral cortex.
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可能叫米色质更贴切
Maybe we should have called it beige matter.
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在它们下面颜色较浅的区域
And beneath it is a lighter area,
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我们称之为白质
which we call the white matter.
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一般来说，灰质由细胞胞体组成，包括神经元和神经胶质
In general, gray matter consists of cell bodies,both neurons and
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一般来说，灰质由细胞胞体组成，包括神经元和神经胶质
and glia, and white matter is axons.
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白质则是神经元的轴突
and glia, and white matter is axons.
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神经轴突是神经元的突起
Axons are the processes of neurons either coming
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有上行到达大脑皮层的
to the cerebral cortex or leaving the cerebral cortex
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也有下行至大脑下部的低位结构的
to the cerebral cortex or leaving the cerebral cortex
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也有下行至大脑下部的低位结构的
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也有下行至大脑下部的低位结构的
and descending to lower brain structures.
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关于脑白质还有一个例子
An example of white matter here is this band
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那就是胼胝体的纤维
of fibers called the corpus callosum.
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正是胼胝体把两个大脑半球连接在一起
It was that band that held the two hemispheres together
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当我们往下看
when we were looking down through
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胼胝体构成了大脑纵裂池的底
that interhemispheric fissure, the base of that was this band
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它联系起了两个大脑半球的相似或相同的区域
of white matter connecting similar areas or homotopic areas
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它联系起了两个大脑半球的相似或相同的区域
of one hemisphere with the other and this is a way
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of one hemisphere with the other and this is a way
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正是以这种方式，左右脑半球得以沟通联络
of one hemisphere with the other and this is a way
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正是以这种方式，左右脑半球得以沟通联络
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正是以这种方式，左右脑半球得以沟通联络
that the right and the left hemispheres can communicate.
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此外，两个半球之间还可以通过
In addition, they can communicate through structures
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这种像桥一样的深层结构来联络
like this deep area, you noticed it's beige,
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这是一个叫做丘脑的结构
A deep structure called the thalamus.
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在这里,我们可以看到颞叶
And here, we can see the temporal lobe
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我们刚刚看过了它的表面
that we were looking at on the surface.
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注意这里,如果我把这部分拉下来一点
Notice here, if I prop this up and pull it down a little bit,
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你可以看到这个刚刚从侧面看到过的巨大的外侧裂
you can see that large lateral fissure that we saw
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你可以看到这个刚刚从侧面看到过的巨大的外侧裂
on the lateral surface,
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也就是说这是颞叶的一部分
that means that this is the temporal lobe.
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我们甚至可以看到血管。
We can even see a blood vessel in there.
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这里还有一部分皮层被埋在了大脑半球的深层
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这里还有一部分皮层被埋在了大脑半球的深层
This bit of cortex buried underneath the hemispheric
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This bit of cortex buried underneath the hemispheric
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位于颞叶和顶叶之间
temporal and parietal lobes is the insula.
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temporal and parietal lobes is the insula.
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我们叫它岛叶
temporal and parietal lobes is the insula.
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我们不打算详细解释它，但它确实有个名字
We're not going to deal with that but it does have a name.
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这里有一些脑皮质被埋了起来
It's where the cortex got buried
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使得脑结构更加复杂
as it became more and more convoluted.
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这是顶叶或皮质运动区。
This is parietal or it could be motor cortex.
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我不能根据单独的切面判断出这部分属于额叶还是顶叶
I can't tell for the isolated section exactly if we're
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我不能根据单独的切面判断出这部分属于额叶还是顶叶
in the frontal lobe or the parietal lobe.
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这并不重要。
It doesn't really matter.
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记住,我们已经讲过
And remember, I told you that one of the functions
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颞叶除了听觉区域以外
of the temporal lobe in addition
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还有参与记忆形成的区域
to the auditory region was an area involved in memory.
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这个区域叫做海马体，
That area is called the hippocampus and it's curled
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它就卷曲在颞叶的内侧
That area is called the hippocampus and it's curled
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它就卷曲在颞叶的内侧
up here right in this medial part of the temporal lobe.
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其他你能在横截面或冠状面上看到的主要结构是
The other major structure you see in a cross section
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是像这样，就是这些在大脑里的洞
like this, or coronal section, are these holes in the brain,
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一个在这，一个在这，一个在这，这里也有一小部分，还有这里
one here, one here, one here, a little bitty one here, and here.
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这些结构参与构成脑室系统,
These formed part of the ventricle system,
00:12:26
我们将进一步探索,但是现在,
which we will explore further, but right now,
00:12:29
只需要知道里面充满了脑脊液。
just know that they are filled with cerebral spinal fluid.
00:12:35
还有柔脑膜，或者叫软脑膜和蛛网膜
And the leptomeninges or the pia and the arachnoid
00:12:40
就在表面上，如果我们能放大一点
on the surface, if we can zoom in a little bit,
00:12:43
我们可以看到它们精巧的覆盖在脑表面上
we can see them delicately covering the surface
00:12:47
我们可以看到它们精巧的覆盖在脑表面上
00:12:48
我们可以看到它们精巧的覆盖在脑表面上
of the brain.
00:12:49
最主要的,我希望你仔细观察这个大脑脑干。
The main thing I want you to see on this brain is the brainstem.
00:12:53
所以,这是我们之前在这里看到的小脑
00:12:53
所以,这是我们之前在这里看到的小脑
So, this is the cerebellum that we saw before up to the side
00:12:58
So, this is the cerebellum that we saw before up to the side
00:12:58
我们刚提到过，脑干在正中央
and the brainstem recall was in the middle.
00:13:01
这里，正中矢状面上可以清楚看到脑干
Here, we have the brainstem on a midsagittal.
00:13:05
这是从正中切开的
This is cut in the middle.
00:13:07
这是正中矢状切面
So this is a midsagittal section.
00:13:09
这是一小部分延髓
Here's a bit of the medulla.
00:13:10
这是脑桥，其表面有基底动脉
Here is the pons with the big basilar artery creeping
00:13:14
这里是中脑，它一般难以见到
up over it and here is the midbrain often hard to see.
00:13:18
最后,这里还有比较深层的结构，如丘脑
And finally, then we have deep structures such as the thalamus
00:13:22
还可以看到很多血管，像大脑前动脉
and we can see many of the vessels
00:13:24
还可以看到很多血管，像大脑前动脉
like the anterior cerebral artery here as well as spaces
00:13:26
like the anterior cerebral artery here as well as spaces
00:13:27
和这部分的脑室系统
like the anterior cerebral artery here as well as spaces
00:13:29
和这部分的脑室系统
00:13:30
和这部分的脑室系统
such as the ventricular system
00:13:32
我们还会更加详细地讨论脑室结构
which we'll look at in more detail.
