Applied neuroscience Flashcards by Rachel Dobson

Triad in Balint’s syndrome

Simultanagnosia
Optic ataxia
Oculomotor apraxia

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What is simultanoagnosia?

Inability to attend to more than 1 item of a complex scene at a time

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What is optic ataxia?

Inability to guide reaching/pointing despite adequate vision

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What is oculomotor apraxia?

Inability to voluntarily direct saccades to a visual target

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How does balint’s syndrome occur?

Bilateral damage to superior parieto-occipital region

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Causes of balint’s syndrome (4)

CO poisoning
Watershed infarction
Leucodystrophy
Posterior cortical variant of AD

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A lesion in which area is associated with acquired prosopagnosia?

Bilateral occipto-temporal region (FUSIFORM GYRUS)

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What causes alexia without agraphia?

Infarction to left posterior cerebral artery affecting splenium of corpus callosum and left visual cortex

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Is the speech fluent in Broca’s aphasia?

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Which test is used in animal models of depression?

Forced swim test - measure effect of antidepressant drugs

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Which test can differentiate organic from psychiatric stupor?

Caloric testing - ocular nystagmus present in psychiatric stupor & tonic deviation in organic

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Damage to which cranial nerve would cause nystagmus in horizontal gaze only?

Abducens

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4 primary symptoms of Gerstmann syndrome

Dysgraphia/agraphia
Dyscalcula/acalculia
Finger agnosia
Right-left disorientation

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Lesion to which area is associated with Gerstmann syndrome

Dominant angular and supramarginal gyri (parietal lobe)

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Symptoms of Wallenberg syndrome

Ipsilateral facial numbness
Diplopia
Ataxia

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Which patients might struggle with Wisconsin card sorting test?

Person with damage to frontal lobe or caudate

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What are the hold tests in the WAIS?

Vocabulary
Information
Object assembly
Picture completion

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What are the non-hold tests in WAIS?

Block design
Digit span
Similarities
Digital symbol

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How is deterioration quotient derived in WAIS?

Difference between hold and non-hold scores

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What are hold tests in WAIS supposed to be resistant to?

Age-related decline so they may be sensitive for organic brain damage such as dementia

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In which type of cognitive decline may somebody retain full insight into their cognitive difficulties?

Vascular dementia

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Which test can be used to assess response inhibtion?

Go-no go test

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The clinical sign of finger-nose ataxia is seen in lesions of which structure?

Inferior olivary nucleus

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What does the inferior olivary nucleus do?

Serves motor coordination via projecting fibres to the cerebellum

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What does the Hayling sentence completion test measure?

Response initiation and suppression

Poor performance in Hayling's sentence completion test suggests

Frontal deficits | Has set-shifting deficits

Damage to which part of the brain is associated with forced utilisation behaviour?

Orbitofrontal lobe

What is forced utilisation behaviour?

When an object is placed in front of a subject, they will use the object even when instructed not to do so

What are some examples of frontal lobe function tests?

1. Verbal fluency tests 2. Category tests 3. Trail making test 4. Wisconsin card sorting test 5. Stroop colour word interference test

If a patient demonstrates neglect, what part of the brain is usually affected?

Right hemisphere - often inferior parietal or prefrontal regions

What is the ability to recognise a number/letter scratched into skin called?

Graphesthesia

What symptoms may somebody have with dorsolateral prefrontal syndrome?

``` Poor planning ability Cognitive dysfunction Poor impulse control Explosive outbursts Inappropriate behaviour ```

What 3 criteria are needed to be met to diagnosis vegetative state?

1. Cycles of eye opening and closing 2. Complete lack of awareness of self or environment 3. Complete or partial preservation of hypothalamic and brainstem funtion

Absence of ankle jerk with upgoing plantars noted in

Subacute combined degeneration of the spinal cord

In frontotemporal dementia, what type of memory is relatively preserved?

Episodic - day to day memory

A reduction in score on Seashore Musical Aptitude test may be seen in what type of brain lesion?

Right temporal lobe

What is a lesion of the ventromedial frontal cortex associated with?

Apathy - pseudodepressive syndrome

What is semantic paraphrasia?

Mis-selection of words due to semantic confusion e.g. apple for orange

What is phonemic paraphrasia?

Word sounds similar to what was intended e.g. shark and sharp

Frontal lobe tests

``` Similarities Lexical fluenxy Luria motor test Go-on go test Cognitive estimates Trail making test ```

Normal forward score in digit span

7+/- 2

Normal backwards score in digit span

5+/-1

Parietal lobe tests (8)

``` Copying shapes Identifying fingers Calculation ability Graphaesthesia Right left orientation Stereognosis 2 point discrimination Visual inattention ```

Features of unilateral frontal lobe lesion (6)

``` Contralateral spastic hemiplegia Slight elevation of mood Frontal release signs Ansomia Motor speech disorder with agraphia Loss of verbal fluenxy ```

Features of bilateral frontal lobe lesion

Bilateral hemiplegia Spastic bulbar (pseudobulbar) palsy Abulia Decomposition of gait and sphincter incontinence

What is a gelastic seizure?

Epileptic fit of incessant laughter not necessarily euphoria

Which lesion could result in a gelastic seizure?

Left prefrontal

Features of unilateral temporal lobe lesion

Homonymous upper quadrantanopia Wernicke's aphasia Impairment of auditory verbal learning

What is hypermetamorphopsia?

Compulsion to attend to all visual stimuli

When would you see hypermetamorphopsia?

Bilateral temporal lobe lesions

When would you see kluver-bucy syndrome?

Bilateral temporal lobe lesions

Age for WAIS-III

16-89

What can you use to measure IQ of somebody aged <16?

Wechsler Adult Intelligent Scale for Children III

How many subtests is WAIS composed of?

How many verbal tests in WAIS?

How many performance tests in WAIS?

What is unique about Raven's progressive matrix?

Test for IQ that is independent of education and cultural influences

Which test can you use to test premorbid IQ?

National Adult Reasing Test

What does the stroop test measure?

Set shifting abilities & response inhibition

Which tests test set-shifting ability and therefore executive functioning? (4)

Trail making test Wisconsin card sorting test Hayling test Brixton task

What is the most widely used memory test battery for adults?

Wechsler Memory Scale-Revised

What would you see in amnesic condition on Weschler Memory Scale?

Low memory quotient and relatively preserved IQ

What test could you use to test short-term visual memory?

Benton visual retention test - show a figure for 10 seconds then patient draws it from memory

What neurocognitive deficits might you see in schizophrenia?

Lower IQ Short term memory disturbance Deficits in higher order reasoning Poor scores on category test, Wisconsin card sort test and Trail B of Halstead-Reitan Battery

What needs to be intact for arousal?

Ascending reticular activating system

Intact functioning of which lobe is required for maintenance of attention?

Right frontal lobe

What is stupor?

Patient appears to be asleep but when vigorously stimulated may become alert as manifested by eye opening and ocular movement

Damage to which area causes akinetic mutism

Diencephalic or bilateral anterior cingulate damage

How is akinetic mutism characterised?

``` Immobility Eye closure Little or no vocalisation Sleep wake cycles are seen Absence of spasticity and rigidty ```

What does a vegetative state result from?

Isolated actions of the ARAS and the thalamus

How can you differentiate akinetic mutism from vegetative state?

In vegetative state, there will be spasiticity and rigidity

Locked in syndrome results in paralysis from which level?

Below the level of the 3rd nerve nuclei

Location of executive function

Dorsolateral frontal lobe

What 3 things can memory be divided into?

1. Short term 2. Long term 3. Sensory

What can long term memory be further divided into?

1. Declarative/explicit | 2. Non-declarative/implicit

What can explicit memory be further divided into?

Semantic | Episodic

What can implicit memory be further divided into?

Procedural memory Associative Non-associative Priming

What can sensory memory be further divided into?

Haptic - acquired through touch Iconic - acquired through sight Echoic - acquired through auditory stimuli

What is episodic memory?

Personal experiences

What is semantic memory?

Stores info about facts

Which part of brain used for encoding declarative verbal memories?

Left hippocampus

Which part of brain used for encoding non-verbal memories?

Right hippocampus

Key area of semantic memory?

Anterior temporal lobe

What memory deficit may be seen in somebody with Parkinson's disease

Deficit in procedural memory with preservation of declarative

What is long-term potentiation?

Strengthening of connection between 2 neurons on repeated communication

What is long term potentiation mediated by?

NMDA mediated Ca2+ entry in glutamate neurons

What memory loss is seen in transient global amnesia?

Pronounced anterograde and variable retrograde amnesia

Feature of dissociative amnesia

Episodic memory loss - retrograde only

Does repetition require high-level processing?

When can repetition occur?

If broca's, wernicke's and arcuate fascisulus are intact

Fluency, repetition, comprehension and naming in Wernicke's

F - intact R - lost C - lost N - lost

Fluency, repetition, comprehension and naming in Broca's

F - lost R - Lost C - intact N - lost

Fluency, repetition, comprehension and naming in conduction aphasisa

F - intact C - lost R - intact N - lost

Fluency, repetition, comprehension and naming in transcortical sensory aphasia

F - intact R - intact C - lost N - lost

Fluency, repetition, comprehension and naming in transcortical motor aphasia

F - lost R - intact C - intact N - lost

What sign is virtually diagnostic of corticobasal degeneration?

Progressive, isolated limb apraxia

What is the most common type of apraxia?

Ideomotor

What is ideomotor apraxia?

Disorder of goal-direted movement - patient knows what to do but not how to do it

Which area is implicated in ideomotor apraxia?

Left hemisphere - frontal and parietal association areas

What is Marchiafava-Bignami disease due to?

Symmetrical demyelination and necrosis of corpus callosum and adjacent anterior commissure

What does lesion of CN III result in?

Paralysis of ipsilateral upper eyelid and pupil Unable to aDduct and look up or down Pupil turned out

Paralysis of which CN results in diplopia in more than 1 direction?

CN III

What does the trochlear nerve innervate?

Superior oblique muscle - can look down

If patient complains of double vision on horizontal gaze, which CN is likely damaged?

Abducens

In caloric testing, what happens when you use cold water?

Nystagmus to opposite side

In caloric testing, what happens when you use warm water?

Nystagmus to same side