Anatomic Syndromes Flashcards
Frontal Lobe Syndromes
Orbitofrontal Syndrome
Dorsolateral Frontal/Convexity Syndrome
Mesial Frontal Cortical Syndrome
Broca’s aphasia
Orbitofrontal Syndrome - anatomical function
the orbitofrontal area is involved with involuntary action, decision making, and socially appropriate behavior
Orbitofrontal Syndrome - Exam
socially inappropriate behavior including Witzelsucht (joking addiction), disinhibition, echopraxia, and utilization behavior (reaching out and using objects in the environment in an automatic behavior i.e. reflexively picking up a phone and bringing it to your ear)
Witzelsucht
joking addiction
utilization behavior
reaching out and using objects in the environment in an automatic manner i.e. reflexively picking up a phone and bringing it to your ear
Dorsolateral Frontal/Convexity Syndrome - anatomical function
involved with executive functions, working memory, and selective attention
Dorsolateral Frontal/Convexity Syndrome - Exam
poor attention, motor programming, and immediate recall
Good test to evaluate for dorsolateral abnormalities?
Wisconsin Card Sorting Test
Mesial Frontal Cortex Syndrome - AKA
medial frontal cortex or anterior cingulate circuit syndrome
Mesial Frontal Cortex Syndrome - anatomical function
the mesial frontal cortex mediates motivated behavior, such as initiation of movement or speech
Mesial Frontal Cortex Syndrome - exam
amotivation, apathy, and akinesis. Akinetic mutism can be seen in bilateral lesions. patients can be incontinent and may only eat or drink when fed.
Mesial Frontal Cortex Syndrome - treatment
methylphenidate
Mesial Frontal Cortex Syndrome - lesion
posterior inferior frontal gyrus
Broca’s aphasia - lesion
posterior inferior frontal gyrus
Temporal Lobe Syndromes
Kluver-Bucy Syndrome
Prosopagnosia/Visual agnosia
Capgras delusion
Apperceptive prosopagnosia
Associative prosopagnosia
Wernicke’s aphasia
Kluver-Bucy Syndrome - Lesion
bilateral temporal lesions involving the amygdala
Kluver-Bucy Syndrome - Exam
Hypermetamorphosis (urge to touch everything), compulsive eating, and hypersexuality
Prosopagnosia/Visual agnosia
failure to identify objects and faces by visual identification
note: may be able to do so by voice
Capgras delusion - Lesion
fusiform gyrus, occipito-temporal cortex
more often associated with right hemispheric lesions than left
Capgras delusion - exam
variant of prosopagnosia in which a patient believes that a friend, spouse, or a close family member has been replaced by an imposter
Apperceptive prosopagnosia - lesion
right occipital temporal area
apperceptive prosopagnosia - exam
impaired object recognition. They are unable to recognize faces. However, they may be able to recognize people based on non-face clues (i.e. clothing, skin color, or voice)
Associative prosopagnosia - lesion
right anterior temporal area, more often bilateral
associative prosopagnosia - exam
impaired object identification. can copy images but cannot identify an image
Wernicke’s aphasia - lesion
superior temporal gyrus
Parietal Lobe Syndromes
Dominant Parietal Lobe
- Agraphesthesia
- Astereogonsis
- Ideomotorapraxia
- Gerstmann’s syndrome
Non-dominant Parietal Lobe
Balint’s Syndrome
agraphesthesia
inability to recognize letters or numbers drawn by fingertip on the patient’s skin
astereogonsis
inability to recognize object by touch
ideomotorapraxia
impaired understanding of tool functions i.e. can identify a key but can’t explain what a key does
Gerstmann’s syndrome - lesion
dominant inferior parietal lobe, AKA dominant angular and surpamarginal gyrus of the parietal lobe
Gerstmann’s syndrome - exam
agraphia, acalculia, finger agnosia, and left/right confusion
Non-Dominant Parietal Lobe - Lesion
non-dominant angular and supramarginal gyrus
Non-Dominant Parietal Lobe - Exam
Anosognosia (unaware of deficit or illness)
Sensory or receptive aprosodia (impaired ability to perceive emotions in others)
Hemineglect
Dressing apraxia
Balint’s syndrome - lesion
bilateral parietal-occipital lobes
Balint’s syndrome - exam
Triad
Optic ataxia: the inability to move the hand properly to perform voluntary tasks
Oculomotor apraxia: the inability to voluntarily fixate eyes to specific locations
Simultagnosia: the inability to focus on multiple objects
Balint’s syndrome - pathophysiology
watershed infarcts, multiple embolic strokes, or PRES
Occipital Lobe Syndromes
Anton Syndrome
Achromatopsia
Anton Syndrome - Lesion
bilateral posterior cerebral artery territory infarction. Can also be seen in PRES
Anton Syndrome - Exam
Cortical blindness (the patient has true blindness, but they deny the presence of this blindness)
- Patients will often confabulate in response. For example, if asked to identify the color of something, rather than saying “I can’t see,” they may say “it’s blue.”
Achromatopsia - lesion
inferior lip of the occipital lobe, often bilateral
- could also present from a lesion to the thalamus
achromatopsia - exam
color blindness
Limbic Lobe Syndromes
Apathy
Apathy - lesion
anterior cingulate
Apathy - exam
bilateral lesions can cause akinesis and mutism
Subcortical Syndromes
Alexia without Agraphia
Limb Kinetic Apraxia
Alexia without Agraphia - lesion
splenium of the corpus callosum and unilateral occipital lobe
- can be seen after a unilateral posterior cerebral artery stroke
Alexia without Agraphia - exam
inability to read, but with retained ability to write
Limb Kinetic Apraxia - Lesion
anterior corpus callosum
Limb Kinetic Apraxia - exam
inability to perform tasks when aked (i.e. unable to brush hair when given a brush)
Brainstem Syndromes
Benedikt
Claude
Dejerine
Locked in
Marie-Foix
Mollaret’s
Millard-Gubler
Nothnagle
Parinaud
Wallenberg
Weber
Benedikt syndrome - lesion
tegmentum of midbrain
Benedikt syndrome - symptoms
CN III palsy (ipsilesional), ataxia, tremor, and weakness (contralesional)
Claude syndrome - lesion
tegmentum of midbrain
Claude syndrome - symptoms
CN III palsy (ipsilesional), ataxia, tremor, and vertical gaze palsy (contralesional)
Dejerine syndrome - lesion
medial medulla
Dejerine syndrome - symptoms
CN XII palsy (ipsilesional), hemiplegia and sometimes loss of position and vibration (contralesional)
Locked In Syndrome - lesion
central pons
Locked In Syndrome - symptoms
bilateral paralysis below neck
Marie-Foix - lesion
rostral pons. AICA and circumferential basilar perforators
Marie-Foix - symptoms
contralateral hypoesthesia to pain and temperature (spinothalamic tract). ipsilateral ataxia (MCP). Contralateral hemiparesis (corticospinal tract)
Mollaret’s syndrome - lesion
Dentate nucleus, inferior olive, red nucleus
Mollaret’s syndrome - symptoms
palatal myoclonus
Millard-Gubler syndrome - lesion
caudal medial pons
Millard-Gubler syndrome - symptoms
CN VI and VII palsy (ipsilesional), weakness (contralesional)
Nothnagle syndrome - lesion
tectum of midbrain
Nothnagle syndrome - symptoms
CN III palsy (ipsilesional), ataxia, and vertical gaze palsy (contralesional)
Parinaud syndrome - lesion
dorsal midbrain
Parinaud syndrome - symptoms
paralysis of upward gaze and accommodation
Wallenberg syndrome - lesion
lateral medulla
Wallenberg syndrome - symptoms
ataxia, loss of pain and temperature for face, weakness of soft palate, larynx and pharynx, Horner’s (ipsilesional), loss of pain and temperature for body (contralesional)
Weber syndrome - lesion
medial midbrain
Weber syndrome - symtpoms
CN III palsy (ipsilesional), weakness, and vertical gaze palsy (contralesional)
Charles Bonnet Syndrome - lesion
seen in patients with severe vision loss secondary to a variety of pathologies (stroke, macular degeneration, etc)
Charles Bonnet syndrome - exam
complex visual hallucinations without other psychopathology, and with the self-awareness that the hallucinations are not real
Geschwind syndrome - lesion
controversial disorder thought to occur in some patients with temporal lobe epilepsy
- some researchers question whether it actually exists
Geschwind syndrome - exam
presents as a personality syndrome with hypergraphia (compulsive writing), hyper-religiosity, and atypical sexuality (usually hyposexuality)
Alien hand syndrome - exam
presents with uncontrolled movements of an extremity, in the modern era most often seen in corticobasal degeneration, prion disease, and strokes
Alien hand syndrome - frontal variant
dominant hemisphere lesion of supplementary motor area or medial prefrontal cortex
presents with right hand impulsively grabbing, groping, and manipulating objects. also can have utilization behavior
usually follows an ACA stroke
alien hand syndrome - callosal variant
commonly due to callosal hemorrhage, demyelination, or surgery
often has “intermanual conflict” (antagonizing movements of the two hands)
often there are other disconnection symptoms present like apraxia, agraphia, or alexia
Alien Hand Syndrome - posterior variant
secondary to a non-dominant parietal lobe (posterior postcentral gyrus) lesion
Associated with a strong feeling of estrangement from the affected limb, and abnormal posturing as well as “levetation” of the limb
the variant is the one most commonly caused by corticobasal degeneration, Creutzfeld-Jakob disease, or stroke
