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Scientific foundations Of neuropsychiatry > Focal Neuropsychiatric Syndromes > Flashcards

Focal Neuropsychiatric Syndromes Flashcards

1
Q

What are the divisions of the prefrontal cortex?

A

Dorsolateral
Medial
Ventromedial

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2
Q

What do lesions in the DLPFC lead to?

A

Classic dysexecutive syndrome
Difficulties in: Planning, organisation, idea generation, inflexibility, poor abstraction skills

Lack of concern for the past or for future consequences of actions

Forced utilisation behaviour may be seen (environmental dependency)

Psychometric testing is preserved

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3
Q

What are typical causes of DLPFC lesions?

A

Tumours
Cerebrovascular accidents
Frontal neurodegeneration

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4
Q

What is the frontal lobe paradox?

A

Psychometric testing is preserved but in the real world deficits in function will show

Tests are not ecologically valid

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5
Q

What are typical causes of Orbital PFC lesions?

A

Traumatic brain injury (road accidents, rotational force)
Frontal tumours
Multiple sclerosis
Frontal neurodegeneration
Anterior cerebral artery stroke

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6
Q

What are lesions in the orbital PFC associated with?

A

Behavioural problems: disinhibition, restlessness, impulsiveness, euphoria, aggression, inappropriate social behaviour impaired empathy, impaired theory of mind

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7
Q

Why might damage to orbital prefrontal cortex be unseen with functional imaging?

A

May be due to diffuse white matter damage

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8
Q

What is damage to the medial prefrontal cortex associated with?

A

Apathy and loss of initiative
Diminished motor activity
Indifference and reduced social interest
Hyperorality
Loss of insight

Bilateral missions lead to akinetic mutism

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9
Q

What are causes of damage to the medial prefrontal cortex?

A

Trauma
Hydrocephalus
Anterior cerebral artery occlusions
Tumours of the thalamus, 3rd ventricle, hypothalamus, and pituitary

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10
Q

What are some tests of frontal lobe function?

A

Luria’s motor sequencing - organisation of rapid sequence motor tasks

Desk tap test - cognitive flexibility

Proverb interpretation - abstract reasoning

Similarities/differences - abstract reasoning

Verbal fluency - testing phonemic or semantic verbal fluency

Cognitive estimates - testing ability to estimate

Stroop test (coloured words) - response inhibition

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11
Q

What is the function of the parietal lobe?

A

Perception of external space, proprioception, body image and agency

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12
Q

What is the effect of a lesion to the non dominant parietal lobe?

A

Disturbed body image
Impaired sense of position
Disowning of body parts (asomatognosia)
Dyscalculia
Neglect of left side of external space

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13
Q

What problems are lesions to the dominant parietal lobe associated with?

A

Anterior lesions - primary motor dysphasia
Posterior lesions - primary sensory dysphasia

Astereoagnosia - cannot name object based on feel (in hand) but can name when seen

Agraphesthesia - numbers or letters written on the skin may not be recognised as by touch

Parieto-occipital - visual agnosia

Cortical sensory loss
Impaired sensory localisation
Sensory and visual inattention

Contralateral hemiparesis
Contralateral homonymous lower quadrantopia

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14
Q

What are some clinical tests of parietal lobe function?

A

Drawing a clock face - neglect
Recognition of familiar object by touch - astereognosia
Reading - neglect
Writing - dysgraphia
Arithmetic - dyscalculia
Dressing - apraxia
Visual field examination - quadrantopia

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15
Q

What is the function of the ventromedial temporal lobe?

A

Emotional regulation (limbic system)

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16
Q

What is the function of the lateral temporal lobe?

A

Functionally complex neocortex:
Language
Hearing
Learning
Facial recognition

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17
Q

How might temporal lobe epilepsy present?

A

Deja vu
Jamais vu
Hallucinations: auditory, gustatory, visual

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18
Q

What would a lesion at the actuate fascicles cause?

A

Conduction aphasia caused by disconnection between Wernicke’s and Broca’s areas

Presents as: problems with repetition

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19
Q

What would lesions on the non-dominant temporal lobe cause?

A

Visuospatial problems
Prosopagnosia - recognition of faces (fusiform gyrus)
Receptive aprosody - comprehension of the emotional tone of speech
Phonagnosia - recognition of familiar voices

20
Q

Where would a lesion be that leads to Wernicke’s aphasia?

A

Posterior superior temporal lobe

21
Q

Where is the olfactory cortex located?

A

Uncus and parahippocampal gyrus

22
Q

How might seizures affecting the middle and inferior temporal gyri present?

A

Complex hallucinations
Aberrant salience attributions to neutral perceptions

23
Q

What would bilateral hippocampal lesions lead to?

A

Anterograde amnesia

24
Q

What would bilateral amygdala lesions lead to?

A

Loss of fear

25
Q

What syndrome might bilateral medial temporal lobe lesions lead to?

A

Kluver-Bucy
Placidity
Hypersexuality
Hyperorality
Hypermetamorphosis: compulsive exploration of environment
Inability to learn from aversive stimuli

26
Q

What are some clinical tests for temporal lobe function?

A

Speech comprehension - receptive aphasia and aprosodia
Repetition - conduction aphasia
Writing/reading
Verbal memory
Non verbal memory - Rey Osterreith Complex Figure Test

27
Q

What is the Rey Osterreith Complex Figure Test, and what does it test?

A

Test of non verbal memory

Patient copies complex figure and then is asked to reproduce the same figure 45 minutes later

28
Q

What area would likely be damaged in contralateral homonymous upper quadrantopia?

A

Temporal lobe (deep)

29
Q

contralateral homonymous lower quadrantopia?

A

Parietal lobe (deep)

30
Q

How might damage to the corona radiata present?

A

Mild contralateral heniparesis

31
Q

How common are posterior cortical artery strokes?

A

5% of all territory strokes - very common

32
Q

What do lesions of the primary visual cortex lead to?

A

Visual blind spots (scotoma)
Partial blind spots (amblyopia)

33
Q

What syndrome might bilateral occipital lesions present as?

A

Balint syndrome:

Inability to perceive the visual field as a whole (simultanagnosia)
Difficulty fixating the eyes (oculomotor apraxia)
Inability to move the hand to a specific object (optic ataxia)

34
Q

What would extensive bilateral occipital cortex lesions lead to?

A

Cortical blindness

35
Q

Why might someone with cortical blindness have “blind sight”?

A

Accessory visual pathway (superior colliculi and pulvinar bodies) are still working

36
Q

What syndrome might bilateral occipitoparietal lesions lead to?

A

Charcot-Wilbrand
Loss of ability to create mental images (aphantasia)

37
Q

To what clinicians might post cortical atrophy be presented first?

A

Ophthalmologists, opticians, neurologists

First symptoms are deterioration of visual function
Pathology predominantly affects the occipital lobe

Commonly caused by Alzheimer’s, dementia with Lewy bodies, corticobasal degeneration or Creutzfeldt-Jakob disease

38
Q

How do visual areas in epilepsy differ from migraine?

A

Visual auras in epilepsy last seconds
Visual auras in migraine may precede the migraine by up to an hour

39
Q

What are come clinical tests of occipital lobe function?

A

Visual field testing, including detection of object movement - anopias (hemianopia, quadrantopia)
Naming of familiar objects - visual agnosia
Reading ability - alexia
Interpretation and description of complex visual image -simultanagnosia

40
Q

What are symptoms of thalamus dementia?

A

Amnesia
Confusion
Flat affect
Apathy
Personality changes
Hallucinations

41
Q

What is the function of basal ganglia?

A

Release of inhibition of thoughts or behaviour

42
Q

What are the components and function of the ventral striatum?

A

Caudate, putamen, nucleus accumbens
Emotional regulation and goal directed behaviour (addictions)

43
Q

What are some features of cerebellar cognitive affective syndrome?

A

Executive dysfunction
Spatial cognition deficits
Language and effect problems
Personality changes
Disinhibition

44
Q

What are the functions of the reticular formation of the brain stem?

A

Movement
Pain modulation
Wakefulness
Alertness
Arousal

45
Q

What famous brain stem condition might ventral pons injury cause?

A

Locked in syndrome

46
Q

What functions does the Raphe nuclei control (what functions does serotonin affect)?

A

Mood/affect
Sleep
Aggression
Appetite
Neuroendocrine functions

47
Q

What is seen in pseudobalbar affect?

A

Pathological laughter or crying

Scientific foundations Of neuropsychiatry (26 decks)

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