Stephen J. Schueler, M.D.

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Confusion Anatomy

To better understand confusion, it helps to understand the anatomy of the brain.

The brain is well protected by:

  • The scalp
  • The skull
  • The dura
    • A tough 3-layer sheath that surrounds the brain and spinal cord
    • Layers include the dura mater (strongest layer), arachnoid mater (middle layer), and pia mater (closest to the brain)

The brain is a complicated structure containing many parts. These include:
  • The cerebrum:
    • Made up of two cerebral hemispheres that are connected in the middle
    • It is the largest part of the brain
    • Each area of the cerebrum performs an important function, such as language or movement
    • Higher thought (cognition) comes from the frontal cortex (front portion of the cerebrum)
    • Outside of the cerebrum are blood vessels
    • There are fluid-filled cavities and channels inside the brain
  • The cerebellum:
    • Located in the lower, back part of the skull
    • Controls movement and coordination
  • The brainstem and pituitary gland:
    • Responsible for involuntary functions such as breathing, body temperature, and blood pressure regulation
    • Pituitary gland is the "master gland" that controls other endocrine glands in the body, such as the thyroid and adrenal glands
    • Pineal gland
  • The cranial nerves:
    • Twelve large nerves exit the bottom of the brain to supply function to the senses such as hearing, vision, and taste
  • The cerebral blood vessels:
    • A complicated system that supplies oxygenated blood and nutrients to the brain

The blood supply to the brain is divided into two main parts:
  • Anterior cerebral circulation:
    • The front of the brain is supplied by the paired carotid arteries in the neck.
  • Posterior cerebral circulation:
    • The back portion of the brain is supplied by the paired vertebral arteries in the spine.

Anatomy examples:
  • Carotid artery branches shown on arteriogram
  • Cerebral arteries viewed in cross-section through middle of brain
  • Cerebral arteries viewed from bottom of brain
  • Cerebral arteries on enhanced CT scan
  • Cerebral arteries on arteriogram

Last Updated: Dec 8, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Confusion References
  1. Cavaliere F, D'Ambrosio F, Volpe C, Masieri S. Postoperative delirium. Curr Drug Targets. 2005 Nov;6(7):807-14. [16305459]
  2. Lyons WL. Delirium in postacute and long-term care. J Am Med Dir Assoc. 2006 May;7(4):254-61. Epub 2006 Feb 3. [16698514]
  3. Turner S, Iliffe S, Downs M, Wilcock J, Bryans M, Levin E, Keady J, O'Carroll R. General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing. 2004 Sep;33(5):461-7. [15271637]
  4. Walker MP, Ayre GA, Cummings JL, Wesnes K, McKeith IG, O'Brien JT, Ballard CG. The Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale. Two methods to assess fluctuating confusion in dementia. Br J Psychiatry. 2000 Sep;177:252-6. [11040887]
  5. Woodrow P. Interventions for confusion and dementia. 4: Alternative approaches. Br J Nurs. 1998 Nov 12-25;7(20):1247-50. [9934030]
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