Rom J Leg Med [21] 55-66 [2013]
DOI: 10.4323/rjlm.2013.55
© 2013 Romanian Society of Legal Medicine The paradigm of cingulate cortex globalization. Psychopathologic and
forensic implications
Gheorghe S. Dragoi1*, Petru Razvan Melinte1, Liviu Radu1, Octavian Buda2
_________________________________________________________________________________________
Abstract: The authors made a macro anatomic analysis of the variable landmarks on the medial face of 32 cerebral
hemispheres in order to evaluate the identity of gyrus cinguli and its origin from the surrounding neuronal cortical and subcortical structures. In the history of knowledge, gyrus cinguli belonged successively to: “the great limbic lobe” (Broca, 1878);
rhinencephalon (Turner, 1890); limbic system (Papez, 1937; Mac Lean 1954; Nauta, 1958); “cortical-hippocampus loop” (Miller,
1991). Nowadays the limbic paradigm is abandoned and since 1962 Kuhn has considered the limbic system obsolete. Based on
personal observations, the authors bring anatomic arguments to sustain the globalization paradigm for cingular cortex. Knowing
the variable landmarks is necessary for reconsidering the identity and origin of gyrus cinguli regarding the surrounding neuronal
structures and for understanding the connection derangements in general and forensic psychopathology.
Key Words: gyrus cinguli, limbic system, globalization paradigm for gyrus cinguli, passage crease.
I
n the history of neurosciences, gyrus cinguli
crossed many stages of knowledge regarding
its identity, its origin from the neuro anatomy subsystems
and its neurobiological globalization. For a long time,
gyrus cinguli was considered as an anatomic entity with
homogeneous structure. Gerdy (1839) [1] was the first
anatomist that integrated gyrus cinguli in a “ring shaped
convolution” that Broca (1878) [2] later called “the
great limbic lobe”; it included gyrus cinguli and gyrus
parahippocampalis. That new structure was bound to
olfaction sense. In that respect, Turner (1890) introduced
the term Rhinencephalon [3]. Limbic lobe was considered
as part of rhinencephalon (olfaction brain) that is actually
an ancestral structure achieving its complete development
in reptiles.
Papez (1937) noticed that gyrus cinguli is a
functional entity that must be integrated in emotional
neurological circuits [4]. He brings in the neuronal
mechanism of emotions including hypothalamus
in limbic lobe and consequently achieves the first
conception of globalization inside telencephalon and
diencephalon neuronal complex. Mac Lean (1954)
introduces and develops the concept of “limbic system”
by including the “amygdale” and “septum area” [5].
Based on experimental models, he studied the
mechanism of behavior. Nauta (1958) expands the concept
of “limbic system” by describing the mesencephalon
limbic areas [6].
He considered the habenular nuclei from
mesencephalon as passing bridges from prosencephalon
to mesencephalon. Thus, a new stage of globalization
appeared as the “prosencephalon-mesencephalon system”
was imposed. Miller (1991) expands the connections of
gyrus cinguli after including prefrontal cortex in a functional
complex known as “cortex-hippocampus loop” that also
comprised Brodman areas 24 and 32 from gyrus cinguli [7].
1) University of Medicine and Pharmacy of Craiova
* Corresponding author: Prof Dr., Member of the Romanian Academy of Medical Sciences, E-mail : [email protected]
2) Assoc. Prof., "Carol Davila" University of Medicine and Pharmacy, Dept. of History of Medicine, (&) National
Institute of Legal Medicine, Dept. of Forensic Psychiatry, Bucharest, Romania
55
G.S.Dragoi et al. The paradigm of cingulate cortex globalization. Psychopathologic and forensic implications
Pierre Nicolas Gerdy (1797-1856)
Pierre Paul Broca (1824-1880)
56
The assimilation of “limbic system” to
rhinencephalon is difficult to accept because some
anosmia animals have structures belonging to
limbic system and orbital frontal cortex that is
not included in rhinencephalon is an important
olfaction center with synapses inside thalamus.
Those arguments justify why some authors separated
the olfaction system from limbic system (Rauber
Kopsch, 1987) [8]; Niuwenhuys et al., 1988 [9].
Nowadays the limbic paradigm was
abandoned and we witness a conceptual change
determined
by
neurobiological
research.
Kuhn (1962) considers that the limbic concept
belongs to the past and proposes to change it based
on the progress registered by imagistic sciences [10].
We consider that in order to fundament the
concept of cortex cinguli globalization, it is imposed
to also reconsider the classic methods for the study of
neuronal structures and especially the macroanatomic
dissection techniques. The reevaluation of gyrus cinguli
relations to the surrounding neuronal structures during
ontogenetic dynamics is imposed. Many problems of
structural and functional anatomy wait for their answer:
1. What is and what still represents “lobus
limbicus” from anatomic and topographic point of view
as it is named in International Nomina Anatomica [11]?
2. Can gyrus cinguli of limbic lobe be considered
as a neuronal structure that connects frontal, parietal
and temporal lobes?
3. Are there anatomic landmarks on the medial
face of cerebral hemispheres that allow for rigorous
tracing of gyrus cinguli borders?
4. What are the determining factors of genesis and
modeling of the landmarks present on the medial face
of cerebral hemispheres?
5. What is the neuroanatomical explanation for
“passage creases” between gyrus cinguli and frontal,
parietal and temporal lobes?
6. What are the neurobiological consequences
of the anatomic changes undergone by hemispheric
vesicles during ontogenesis?
7. What is the criterion that stands for the paradigm
of gyrus cinguli globalization?
Our research proposes itself to know the passage
neuronal structures from gyrus cinguli to the lobes from
the medial side of cerebral hemisphere. The results
of those observations are imperiously needed for the
evaluation of neuronal connection paths and stand at the
base of globalization concept involving gyrus cinguli.
We considered as objectives the macro anatomic
analysis of location and relations of gyrus cinguli and
of space distribution of “passage creases” towards the
adjacent areas. Equally, we studied the morphogenesis
of medial cerebral hemispheres landmarks as location
of gyrus cinguli.
Romanian Journal of Legal Medicine Materials and methods
The study of landmarks variability on the
medial face of cerebral hemispheres and the analysis
o gyrus cinguli relations was achieved on 32 cerebral
hemispheres obtained from 16 brains. The analysis of
landmarks morphogenesis was carried out on 12 fetus –
6 of them being fixed in 10% formaldehyde solution and
having their cephalic extremities sectioned at different
successive planes.
The study of the development from
lisencephalon to gyrencephalon was achieved on 8
brains extracted from skulls and then fixed 5% saline
formaldehyde solution. The relations of anterior
cerebral artery branches were evaluated both on fetus
encephalon (6 cases) and on adult brains (4 cases).
The macroanatomic imagery was performed
with a digital camera Canon EOS Mark II equipped
with macro ultrasonic lens EF 100 mm, F/2,8. Images
processing was possible using Professional Digital
Photo Software and Adobe Photoshop CS4.
Results
The knowledge of variable landmarks on the
medial face of cerebral hemispheres is necessary for
the reevaluation of identity and origin of gyrus cinguli
regarding the adjacent neuronal structures. The analysis
of the landmarks was achieved by establishing the
distribution of the grooves between gyri, the location and
relations of gyrus cinguli with the surrounding lobes by
means of “passage creases” during ontogenesis dynamics.
A. Macroanatomic analysis of gyrus cinguli
location and relations
The analysis of location and relations of gyrus cinguli is
tightly bound to the heterogeneous space distribution of
grooves that participate to the landmarks of medial face
of cerebral hemispheres.
1. Analysis of the distribution of grooves on the
medial side of cerebral hemispheres
An important number of grooves is present
and limit compartments on the medial side of cerebral
hemispheres: sulcus cinguli, sulcus corpori callosi,
sulcus subparietalis, sulcus parietooccipitalis, sulcus
paracentralis, sulcus calcarinus and sulcus intralimbic
(Fig. 1 A-H). We had particular attention for sulcus
cinguli.
We identified sulcus cinguli as a curve, line
space that separates gyrus cinguli from the following
surrounding structures: gyrus frontalis medialis, lobules
paracentralis and precuneus (Fig. 1A; C–E). One can
easily notice its S italic shape trajectory that gives
almost straight intermediate branches. The origin of
sulcus cinguli is under the rostrum and knee of corpus
Vol. XXI, No 1(2013)
callosum. From here it continues at the periphery of
gyrus cinguli (Fig. 1 ; 2).
Its posterior part has an ascending curve
trajectory and surrounds lobules paracentralis on its
inferior and posterior margins at an almost 90 degrees
angle. It then climbs vertically, sometimes discreetly
oblique towards posterior to the superior margin of
cerebral hemisphere, 8-9 cm posterior from the central
groove extremity (Rolando). In this part, sulcus cinguli
is deep and crenelated. It is crossed, preferably at its
direction change points, by “passage creases” from
gyrus cinguli to lobus frontalis, lobules paracentralis
and precuneus (Fig.1; 2 ). In one case, we met a small
notch oriented posteriorly, started from the second
curve of sulcus cinguli where it becomes ascendant and
communicates with sulcus subparietalis (Fig. 1 F).
2. Analysis of gyrus cinguli location and
relations
When examining the medial face of cerebral
hemispheres we identified gyrus cinguli as a prominent
cortical structure that cross the space between corpus
callosum and frontal, parietal and temporal lobes
(Fig. 1). In some hemispheres we noticed the
continuity of gyrus cinguli to precuneus creating an
image compared to a “rooster ridge” (Fig. 1 A; C-F).
Analyzing the gyrus cinguli trajectory we observed
its formation in front of rostrum corpus callosum as a
narrow portion bound to subcallosal gyrus (Fig. 1). Then
it has an arched trajectory that surrounds successively:
genu corpus callosum, truncus corporis callosum and
splenium corpori callosum where it continues to gyrus
parahippocampalis through ithmus gyri cinguli that is
actually a real “passage crease”. In many cases, the gyrus
cinguli surface is crossed by superficial grooves parallel
to the general direction of the gyrus and we sometimes
identified transverse or stellate notches determined by
the relation to the blood vessels. The inferior face of
gyrus cinguli is in contact with arteria pericallosa and
Lancisi nerves (Fig. 6).
B. Macroanatomic analysis of “passage
creases” space distribution
“Passage creases” are well visible on the medial
face of cerebral hemispheres after leptomeninges
removal. They act like continuity bridges between gyrus
cinguli and the gyri from the adjacent lobes: cingulifrontal; cinguli-parietal; cinguli-temporal (Fig. 3).
We identified three “passage creases” between
gyrus cinguli and frontal lobe and we named them
according to their topographic location: inferior
cinguli-frontal, anterior cinguli-frontal and posterior
cinguli-frontal. “The inferior cinguli-frontal passage”
unites the anterior and inferior origin of gyrus cinguli to
the inferior part of medial frontal gyrus. “The anterior
57
G.S.Dragoi et al. case I
The paradigm of cingulate cortex globalization. Psychopathologic and forensic implications
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case II
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Figure 1. The variable position of cerebral grooves and the variable relations of gyrus cinguli to the adjacent structures
on the medial
side of left
cerebral
hemisphere.
1. Lobulus
Sulcus parietooccipitalis.
3. Precuneus.
4. Sulcus
Figure
1. The
variable
position
ofoccipitalis.
cerebral2. grooves
and the variable
relations
subparietalis. 5. Sulcus cinguli – ramus marginalis. 6. Lobulus paracentralis. 7. Sulcus cinguli. 8. Gyrus cinguli. 9.
of gyrus
cinguli 10.toSulcus
the paracentralis.
adjacent 11.
structures
on the 12.medial
side 13.
of A.left
cerebral
Gyrus
frontalis medialis.
Sulcus intralimbicus.
A. Pericallosa.
Callosomarginalis.
S=SPLENIUM;
G=GENU.
Macrophotos
by Canon
EOS Mark
II Digital Camera.
Ultrasonic
Lens, EF
100 mm, F/2,8.
hemisphere.
1. Lobulus
occipitalis.
2. Sulcus
parietooccipitalis.
3. Macro
Precuneus.
4. Sulcus
subparietalis.
58
5. Sulcus cinguli – ramus marginalis. 6. Lobulus paracentralis. 7. Sulcus cinguli. 8. Gyrus cinguli. 9.
Gyrus frontalis medialis. 10. Sulcus paracentralis. 11. Sulcus intralimbicus. 12. A. Pericallosa. 13. A.
Romanian Journal of Legal Medicine Vol. XXI, No 1(2013)
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Figure 2. Cerebral cortex landmarks continue from the medial to the superior-lateral face of left cerebral hemisphere. 1.
Passage occipitotemporal.
2. Passage cuneo-cinguli.
3. Passage cingulotemporal.
4. Passage
posterior.
5. Passage
Figure 2. Cerebral
cortex landmarks
continue from
the cinguloparietal
medial to the
superiorcinguloparietal anterior. 6. Lobulus paracentralis. 7. Passage cingulofrontal posterior. 8. Passage cingulofrontal anterior. 9.
lateralcinguli.
face 10.
of Sulcus
left cerebral
hemisphere
. 1. Passage
occipitotemporal.
2. Passage
cuneo-cinguli.
3.
Sulcus
supraorbitalis
(Broca). 11. Passage
cingulofrontal
inferior. 12. Passage
parieto-frontal.
13. Sulcus
centralis
(Rolando).
Macrophotos
by
Canon
EOS
Mark
II
Digital
Camera,
Macro
Ultrasonic
Lens,
EF
100
mm,
F/
2,8.
Passage cingulotemporal. 4. Passage cinguloparietal posterior. 5. Passage cinguloparietal anterior. 6.
Lobulus paracentralis. 7. Passage cingulofrontal posterior. 8. Passage cingulofrontal anterior. 9. Sulcus59
cinguli. 10. Sulcus supraorbitalis (Broca). 11. Passage cingulofrontal inferior. 12. Passage parieto-
G.S.Dragoi et al. The paradigm of cingulate cortex globalization. Psychopathologic and forensic implications
A
B
C
Area 30. Retrosplenial Cingulate Cortex
Area 31. Dorsal Posterior Cingulate
Area 23. Ventral Posterior
(RSC). Passage cingulotemporal. Localed
in the isthmus of cingulated gyrus.
Visuospatial orientation. Memory acces.
Retrosplenial amnesia
Cortex ( d PCC ). Passage
cinguloparietal dorsal. Thalamic inputs
from anterior thalamic nuclei.
Visuospatial processing
Cingulate Cortex ( v PCC ). Passage
cinguloparietal ventral. Connections
with insula. Visuospatial processing,
memory and attention.
Z
dorsal
PCC / ACC
area 23 (vPCC)
Z
caudal
area 24 (vACC)
rostral
ventral
area 31 (dPCC)
area 32 (dACC)
area 30 (RSC)
area 25 (sACC)
X
D
Y
E
Area 25. Subgenual Anterior
Cingulate Cortex ( s ACC ). Passage
Cingulofrontal inferior. Talamic
projections . Information relevant for
olfaction and autonomic reglation.
Area 24. Ventral Anterior
Cingulate Cortex ( v PCC ). Passage
cingulofrontal posterior.
Talamocortical projections.
Cingulofrontal connections
F
Area 32. Dorsal Anterior Cingulate
Cortex ( d ACC ). Passaage
Cingulofrontal anterior.
Talamocortical projections.
Information for olfaction.
Figure 3. Location of Brodmann cortical areas on the space sectors of gyrus cinguli. A. Retrosplenial Cingulate Cortex (RSC) B.
Dorsal posteriorFigure
Cingulate3.Cortex
(d PCC).of
C. Brodmann
Ventral Posteriorcortical
Cingulateareas
Cortex (v
Subgenual
anterior
Location
onPCC).
the D.
space
sectors
of Cingulate
Cortex (sACC). E. Ventral anterior Cingulate Cortex (v ACC ). F. Dorsal Anterior Cingulate Cortex (dACC). Macrophotos by
cinguli.
A. Camera,
Retrosplenial
CingulateLens,
Cortex
(RSC) B.
Dorsal posterior Cingulate Cortex
Canongyrus
EOS Mark
II Digital
Macro Ultrasonic
EF 100mm,
F/2,8
60
(d PCC). C. Ventral Posterior Cingulate Cortex (v PCC). D. Subgenual anterior Cingulate
Cortex (sACC). E. Ventral anterior Cingulate Cortex ((v ACC ). F. Dorsal Anterior Cingulate
Cortex (dACC). Macrophotos by Canon EOS Mark II Digital Camera, Macro Ultrasonic Lens,
Romanian Journal of Legal Medicine Vol. XXI, No 1(2013)
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Figure 4. Horizontal sections through fetus head. One can notice the simultaneous presence of cerebral cortex landmarks
on the faces of cerebral hemispheres. 1. Lobus temporalis. 2. Lobus insularis. 3. Lobus frontalis. 4. Fissura longitudinalis
Figureinterventricularis.
4. Horizontal
sections
through
head. One
can8. notice
the
cerebri. 5. Foramen
6. Ventriculus
lateralis.
7. Cornu fetus
frontale (Ventriculus
lateralis)
Cornu temorale
(Ventriculus lateralis). Macrophotos by Canon EOS Mark II. Digital Camera, Macro Ultrasonic Lens EF 100, F /2,8.
simultaneous presence of cerebral cortex landmarks on the faces of cerebral
hemispheres. 1. Lobus temporalis. 2. Lobus insularis. 3. Lobus frontalis. 4. Fissura longitudinalis61
cerebri. 5. Foramen interventricularis. 6. Ventriculus lateralis. 7. Cornu frontale (Ventriculus lateralis)
G.S.Dragoi et al. The paradigm of cingulate cortex globalization. Psychopathologic and forensic implications
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Figure 5. Evolution from lisencephalon to gyrencephalon explained by genesis and evolution of cortical grooves and gyri.
Figure 5. Evolution
from
lisencephalon
to occipitalis.
gyrencephalon
explained
by paracentralis.
genesis
1.Lobus frontalis.2.Fossa
lateralis cerebri.3.
Lobus
temporalis 4.Lobus
5. Gyrus Cinguli.
6. Lobulus
7. Sulcus cinguli. 8. Gyrus frontalis medialis. 9. Sulcus centralis. 10. Sulcus lateralis. 11. Sulcus parietooccipitalis.
andPrecuneus.
evolution
of cortical
grooves
1.Lobus
frontalis.2.Fossa
lateralis
Lobus
12.
Macrophotos
by Canon
EOS and
Markgyri.
II Digital
Camera.
Macro Ultrasonic
Lens cerebri.3.
EF 100mm,
F/2,8.
temporalis 4.Lobus occipitalis. 5. Gyrus Cinguli. 6. Lobulus paracentralis. 7. Sulcus cinguli. 8. Gyrus
frontalis medialis. 9. Sulcus centralis. 10. Sulcus lateralis. 11. Sulcus parietooccipitalis. 12. Precuneus.
Macrophotos by Canon EOS Mark II Digital Camera. Macro Ultrasonic Lens EF 100mm, F/2,8.
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Romanian Journal of Legal Medicine Vol. XXI, No 1(2013)
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Figure 6. The contribution of anterior cerebral artery to the genesis of landmarks on the medial face of left cerebral hemisphere.
1.Lobus occipitalis. 2.Lobus temporalis 3.Gyrus Cinguli. 4. Lobus frontalis. 5.Arteria pericallosa. 6.Arteria callosomarginalis.
6. The(Pars
contribution
of anterior
cerebral artery
to anterior).
the genesis
of landmarks
7. ArteriaFigure
cerebri anterior
postcommunicalis).
8.Rami paracentralis
(A.cerebri
9. Ramus
precunealis (A.
cerebri
anterior).
Macrophotos
by
Canon
EOS
Mark
II
Digital
Camera
Macrolens
Ultrasonic
Lens
EF100mm,
F/2,8.
on the medial face of left cerebral hemisphere. 1.Lobus occipitalis. 2.Lobus temporalis 3.Gyrus
Cinguli. 4. Lobus frontalis. 5.Arteria pericallosa. 6.Arteria callosomarginalis. 7. Arteria cerebri anterior63
(Pars postcommunicalis). 8.Rami paracentralis (A.cerebri anterior). 9. Ramus precunealis (A. cerebri
G.S.Dragoi et al. The paradigm of cingulate cortex globalization. Psychopathologic and forensic implications
cinguli-frontal passage” originates at the level of genu
corporis callosum, crosses sulcus cinguli and unites
with medial frontal gyrus. “The posterior cinguli-frontal
passage” is lunate shaped and is located posteriorly
from the anterior cinguli-frontal passage. It unites gyrus
cinguli to gyrus paracentralis anterior. We noticed the
presence of two “cinguli-parietal passage creases” that
was easy to identify and name based on topographic
criterion: ventral and dorsal cinguli-parietal.
“The
ventral
cinguli-parietal
passage”
originates at the level of splenium and truncus corporis
callosum and makes the connection to the ventral part
of precuneus under sulcus subparietalis. “The dorsal
cinguli-perietal passage” originates ventrally from
sulcus cinguli and unites gyrus cinguli to the dorsal part
of precuneus above sulcus subparietalis.
“The cinguli-temporal passage” originates
behind splenium corpori callosum and unites with gyrus
parahippocampalis. This passage was named “isthmus
gyri cinguli” in the international anatomic terminology.
C. Morphogenetic analysis of the landmarks
on the medial side of cerebral hemispheres
When examining the horizontal sections
through the cephalic extremity of fetus aged between
4-8 months old antepartum, allowed us to visualize the
cavity and walls of the lateral ventricles.
As the cerebral hemispheres grow from
posterior to superior, we noticed its relation to the brain
stem and its proximity to the medium sagittal plane.
The internal face of cerebral hemisphere is plane while
the external one increases its convexity (Fig. 4 A, B).
Between the two internal faces of cerebral hemispheres
is fissure longitudinalis cerebri where one can find falx
cerebri (Fig.4 H).
The cerebral hemisphere walls change during
ontogenesis. Initially its thickness and structure are
homogeneous without landmarks (Fig. 4 A, B).
Analyzing the serried sections through fetus
head one can easily noticed the existence of two parts
in the structure of cerebral hemisphere walls: cerebral
cortex that will expand enormously and a basal part that
will form thalamus and corpus striatum (Fig. 4).
As the cerebral hemispheres curve around
corpus striatum, the posterior extremity becomes
oriented inferiorly. Cerebral cortex has an anterior or
frontal part and a posterior inferior or temporal part.
We noticed how the frontal part prolongs to anterior
and the temporal part towards posterior. The central
part of cerebral hemisphere does not expand as much
as its extremities; in this manner appears a vertical
depression limited up, down and posterior by frontal,
parietal and temporal cerebral cortex. This depression is
fossa lateralis cerebri (Sylvius) where there is the island
lobe (Reil) (Fig. 4; 5 A, B).
In the beginning it has the shape of a circular or
64
oval excavation with its inferior extremity towards the
olfaction region. Due to the intense growth of cerebral
hemisphere towards anterior, the axis of fossa lateralis
cerebri becomes from vertical, oblique posterior and
inferiorly and the depression deepens (Fig. 5 A, B, G).
It covers by the growing frontal and temporal
regions hiding the island lobe.
The growth of cerebral cortex is rapid and
massive. In a 3 months old fetus we noticed that the
occipital lobe already completely covers diencephalon
(Fig. 5 A). At 5 months it covers the quadrigeminal
plate and at 8 months completely covers cerebellum.
On the medial side, cortex creasing determines
two folds almost parallel to each other and parallel to
the superior border of cerebral hemisphere.
D. Analysis of the relations between the
branches of anterior cerebral artery and the landmarks
on the medial side of cerebral hemispheres
Dissection of the branches of anterior cerebral
artery in pars postcommunicales (Segmentum A2)
allowed us to evaluate the vascular relations to corpus
callosum, gyrus cinguli and gyri from frontal and
parietal lobes. One can easily observe the existence of
two arterials semi rings: one inferiorly, around corpus
callosum and the other one superiorly (Fig. 6).
From pericallosum ring we visualized
paracentral,
precuneus
and
parietooccipital
branches. Callosum-marginal semi ring gives frontal
(anteromedial, intermediomedial, posteromedial),
cingular and paracentral branches. All the arterial
branches occupy the grooves between the neuronal
structures.
Discussions
There are many variable criteria that can impose
the globalization paradigm for cortex cinguli: 1. The
macroanatomic criteria ensures the knowledge of the
grooves that border gyrus cinguli from the surrounding
gyri; 2. The criteria of Talairach coordinates system
(1988) [12] that allows us to locate different cerebral
structures including Brodmann areas; 3. The criteria
of cell architecture (Brodmann) [13]; 4. The anatomic
and functional criteria (Papez 1937 [4], Mac Lean 1954
[5]); 5. The criteria of ablation experiments (Kluver
lobectomy) [14].
In this paper we dealt with the morphologic
study of the medial side of cerebral hemispheres and
we visualized and evaluated the location of gyrus
cinguli, its relations and especially its connections to
the adjacent cerebral cortex that belongs to frontal,
parietal and temporal lobes. Gyrus cinguli is involved
in the determination of the landmarks on the medial
side of cerebral hemispheres and this fact imposes
the reevaluation of the classic anatomy descriptive
Romanian Journal of Legal Medicine and topographic data. The diversity of non-invasive
research methods for brain study inevitably lead to the
abandon of macroanatomic dissection that stood at the
base of real knowledge of cerebral cortex landmarks.
Analyzing our observations, we stated a great
variability of the sulcus cinguli trajectory especially
in its ascending or terminal part, known as “ramus
marginalis” in the International Nomina Anatomica.
We noticed that this groove can split sending a branch
to precuneus or it can send a posterior branch that
continues to sulcus subparietalis.
On the superior border of cerebral hemisphere,
it engages sometimes in a part of the root of superior
parietal gyrus. Eberstaller (1899) [15] saw the existence
of three types of gyrus cinguli: 1. Simple groove
(68%) more frequent in the right hemisphere, where
it is straight and continuous except for some short
and transverse “passage creases” that do not alter its
shape; 2. Double groove (30%) more frequent in the left
hemisphere where it is double and consequently so is the
medial frontal gyrus; 3. Fragmented groove (2%) that is
interrupted by two or more “passage creases”. Poirier
(1899) [16] considers that the double type groove is
much likely to be determined by a new groove – the
intralimbic groove that tend to split gyrus cinguli in two.
The presence of “passage creases” is a macro
anatomic reality. Regis (1994) [17] tried to map them.
Nevertheless, an architectural map based on grooves
and gyri and having a functional signification is far from
being admitted. The complexity and the variability of
grooves and gyri only allows for a rough mapping as
each area could include numerous functional parts.
Paul Mac Lean (1990) [18] made the first step
for the elaboration of globalization paradigm involving
gyrus cinguli. He stated the “Triune Brain” evolutionary
theory according to which, in humans, there are in fact
three inherited brains: 1. The reptilian brain implemented
in the control of reflexes and primitive behavior; 2.
The paleomammalian Brain implicated in emotionally
motivated behavior; 3. Neocortex and Neocerebellum
– The neomammalian Brain – implemented in logic
thinking and learning. MacLean (1993) [19] considers
the cingular thalamic compartment of the limbic system
as specific to mammals as a mediator of behaviors
present during games, maternal caring, audio and vocal
communication between mother and child. He draws
the attention towards the role of education in human
behavior development and concludes that “a man must
be judged after his behavior”.
The clarification of gyrus cinguli cortex
subdivisions for integrating the knowledge, emotional
and motor processes, needs the gathering of all data
regarding anatomic cell architecture, connections,
psychological behavior, electrophysiology and lesions.
The division of gyrus cinguli cortex was done
by Brodmann (1909) [13] based on anatomic criteria
Vol. XXI, No 1(2013)
without taking into consideration the functions of
those regions. Brodmann [13] described two regions in
gyrus cinguli: anterior (ACC) and posterior (PCC). The
anterior region (ACC) is the frontal part of gyrus cinguli.
It includes a ventral (vACC) and a dorsal (dACC) area
involved in vegetative functions (arterial blood pressure
regulation and heart rhythm), cognitive, decision and
emotion. The anterior cortex of gyrus cinguli was
divided anatomically in a dorsal and a ventral part.
The dorsal part (dACC) includes Brodmann
area 32 strongly interconnected to prefrontal cortex
(49/9), parietal cortex (7) and motor areas. It is
associated to the functions of voluntary mental control
and rational thinking. Based on NEUN criteria (Neuron
specific Nuclear binding protein), area 32 was divided
in three locations: subgenual (s32), pregenual (p32) and
dorsogenual (d32).
The ventral part (vACC) contains area 24 and
is connected to amygdaloidal complex, grey matter
around the aqueduct, accubens nucleus, hypothalamus,
anterior island and orbital frontal cortex. It is involved
in the evaluation of emotional information and is the
site for free will. Equally it intervenes in physiologic
emotional reactions: horripilate (“chicken skin”),
vascular changes and pupils’ dilation.
The stimulation of this region can cause stop of
breath and inhibition of voluntary motility.
The posterior region is the parietal temporal
part of gyrus cinguli. It includes Brodmann areas
23, 31 and 30. Area 23 (vPCC) is the ventral part of
posterior cingular cortex. It is bound to space vision
processing. Area 30 (RSC) is the retro-splenius part of
posterior cingular cortex. It is involved in space vision
orientation.
In psychopathology there are some anatomic
and functional derangements regarding gyrus cinguli:
depression, obsession, attention deficit, panic,
neuropathic and functional pain, schizophrenia,
Parkinson disease, Alzheimer disease as well as
posttraumatic stress [20-23]. In posttraumatic stress
disorder, neural structures of the limbic system are
involved: corpus amygdaloideum, anterior cingulated
cortex (ACC) and hippocampus.
Anterior cingular cortex is responsible for
visceral pain syndrome. Areas 24 and 32 receive
impulses from amygdale and sometimes from
hypothalamus. All the ACC areas send their fibers to
the grey matter around the aqueduct while area 25 also
sends to solitary tract nucleus.
Conclusions
1. Macro anatomic analysis of the medial face of
cerebral hemispheres offers the knowledge of the variable
landmark (grooves, gyri) but also of interconnectivity
potential of cerebral cortex by “passage creases” [24].
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G.S.Dragoi et al. The paradigm of cingulate cortex globalization. Psychopathologic and forensic implications
2. The existence of a great phenotype variability
concerning grooves and gyri system stereo distribution
represents an important obstacle in functional and/or
architectural mapping of cingular cortex.
3. The diversity of noninvasive imagistic methods
to evaluate the encephalon and the reconsideration of
data obtained after macroscopic dissection open new
perspectives for the globalization paradigm of cerebral
cortex structures.
4. Knowing the development stages from
lisencephalon to gyrencephalon allows the understanding
of the interconnection networks between limbic system
neuronal structures.
5. Understanding the derangements involving
behavior and adaptive processes is dependent on the
knowledge of specific connections between prefrontal
cortex and anterior subdivisions of cingular cortex.
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