Clinical Assessment of the Neurosurgical Patient’ Flashcards
What are the functions of the frontal lobe?
- Voluntary control of movement - precentral gyrus
- Speech – pars opercularis, pars triangularis
- Saccadic eye movements - frontal eye field
- Bladder control – paracentral lobule
- Gait – periventricular
- Higher order
–Restraint, Initiative, and Order (RIO)
Where do right and left handed people have their language dominance?
RIght handed people - language dominance is on left side
Left handed people - 60% of people will have their language dominance on the left side
How do you examine the frontal lobe?
•Inspection
–Decorticate posture
–‘Magnetic gait’
–Urinary catheter
–Abulia
•Pyramidal weakness
–UMN signs – weakness, increased tone, brisk reflexes, up-going plantar
–Pronator drift
- Saccadic eye movement
- Primitive reflexes
- Speech
Which part of the frontal lobe is responsible for restraint?
Orbitofrontal cortex
Which part of the frontal lobe is responsible for initiative?
Supplementary motor cortex / anterior cingulate
Associated with:
Lack of motivation
Apathy
Abulia (abscence of willpower or inability to act decisevely)
Depression
Which part of the frontal cortex is responsible for order?
Dorsolateral perfrontal cortex
- Ability to make an appointment and keep to time
- Ability to give coherent account of history
- Spell WORLD backwards
- Say as many words as possible with a particular letter
Where is Wernickes area in the brain?
In the frontal love, temportal lobe and the parietal lobe, posterior section of the superior temporal gyrus
USUALLY in the left hemisphere
Where is Broca’s area?
Region of the frontal lobe
What is the fucntion of wernickes area and Brocas area?
Wernickes (sensory speech area):
Associated with the processing of words being spoken
Helps us use the correct words to express our thoughts
Broca’s (motor speech area): Helps in the movements required to produce speech
What are the functions of the parietal lobe?
Primary somatosensory area
Multimodality assimilation
Visuospatial coordination
Language
Numeracy
How do we examine the parietal lobe?
Sensory inattention
Astereoagnosia - Inability to recognise an object by touch
Dysgraphasthesia - Inability to identify letters, numbers, or shapes drawn on skin
Two point discrimination
How do you examine the dominant side of the parietal lobe?
Gertsman’s syndrome
Dyscalculia: Severe difficulty in making arithmetical calculations
Finger anomia: The inability to identify one’s own or anothers fingers
Agraphia: The inability to write
Left/right disorientation
How do we examine for a lesion in the non-dominant parietal lobe?
Ideomotor apraxia: Unable to plan or complete actions that rely on semantic memory - They can explain how to perform an action but are unable to act out or imagine it (pretend to brush your teeth)
Ideational apraxia: Can’t pick out and select an appropriate motor programme, may complete actions in an inappropriate order such as putting shoes on before socks. May incorrectly use tools (might brush hair with a toothbrush)
Constructional apraxia - The inability to draw or construct simple configurations, such as intersecting shapes.
Dressing apraxia
Hemineglect
Loss of spatial awareness
What are the functions of the temporal lobe?
- Processes auditory input (Heschl gyrus)
- Language
- Encoding declarative long-term memory (hippocampus) – semantic/episodic
- Emotion (amygdala)
- Visual fields (Meyer’s loop)
Which lobes does the optic radiation travel through?
The parietal lobe
The occipital lobe
