3. The underlying structural organization of the brain is not readily apparent. A variety of different approaches have been developed for defining, differentiating, and naming parts of the brain. Some of these systems are based on surface anatomical features (for example, orbitofrontal cortex, medial frontal cortex, and dorsolateral cortex), some on cellular pathology (Brodmann’s areas), others on the functional relationships of brain structures (such as the visual system, extrapyramidal system). These various approaches do not necessarily correspond directly to one another.
4. Unlike organs such as the liver, lungs, or kidneys that have repeating functional units, the brain is an extraordinarily complex organ in which each cubic millimeter is unique.
5. No part of the brain is an island, unconnected from other parts of the brain.
6. Learning to visualize the brain requires an appreciation of the relationship of various structural features in relation to one another in 3-dimensional space.
7.Increasing complexity becomes apparent as one turns up the magnification on any area of the brain. For example, in current MRI images, one voxel represents the summation of activity of over a million neurons. Another example would be the hippocampus, which is an extraordinarily complex structure, a veritable universe in and of itself, and one of only 2 regions in the brain where new neurons are generated.
8.Two neuroanatomical realities coexist: all brains have common features, and each brain is unique.
9.Neuroanatomy is nonverbal, spatial information rather than verbal, narrative information. For help in learning this material, there now are numerous on-line resources and apps (such as the 3D Brain from Cold Spring Harbor Laboratory), some of which present rotating images of brain structures that facilitate appreciation of the brain in 3 dimensions.1
10. Even the best websites and textbooks of neuroanatomy are essentially schematic versions or maps, a first-level organization of vast amounts of information. A more complete picture of neuroanatomy would include the brain’s vascular structures and meninges, neuronal dendritic and axonal links, as well as the distribution of neurotransmitters and of glial cells (which are as numerous as neurons).
Benefits of learning neuroanatomy
So, why would a psychiatrist put in all the effort that is required to learn neuroanatomy?
One might be persuaded to learn neuroanatomy because the brain is the organ basis of psychiatry. Therefore, neuroanatomical literacy is part of the basic academic fund of information that contributes to one’s professional identity.
In addition, understanding localization expands one’s diagnostic acumen. While “locating the lesion” is widely recognized as a fundamental skill for neurologists, all physicians need to be familiar with the signs and symptoms of focal CNS disorders (such as strokes or brain tumors) that patients may exhibit. For psychiatrists, it is crucial to be able to recognize the behavioral manifestations of localized lesions. Word salad or Wernicke’s aphasia? Somatic symptom disorder or multiple sclerosis? Panic disorder or limbic seizures?
Dr. Schildkrout is Assistant Professor of Psychiatry, Part-time, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA. She is the author of 2 books, Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders and Masquerading Symptoms: Uncovering Physical Illnesses That Present as Psychological Problems.
1. Cold Spring Harbor Laboratory. 3D Brain. 2016. https://itunes.apple.com/us/app/3d-brain/id331399332?mt=8. Accessed February 2, 2017.
2. The Accreditation Council for Graduate Medical Education, The American Board of Psychiatry and Neurology. The Psychiatry Milestone Project. July 2015. https://www.acgme.org/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf.
3. Schildkrout B. How to move beyond the Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases. J Nerv Mental Dis. 2016;204:723-727.