Frontal Lobe Syndromes Flashcards
where do the major outgoing tracts involved in movement begin?
the primary motor cortex
which structures does the primary motor cortex receive information from?
premotor and supplemental motor areas
what do lesions in the primary motor cortex result in?
contralateral weakness or hemiplegia
what is constraint induced movement therapy?
- method of therapy where stroke patients have a cast on their good hand, forcing them to use the side of the body that was impacted by the stroke.
- Patients are forced to repeat a task until they can successfully complete it, in which case the task becomes more difficult.
- results only in motor system functioning
what is the premotor area/supplementary motor responsible for?
- fine motor movements
- sequenced movements
- critical for acquiring new motor skills
- sequencing the motor movements
what are the characteristics of ideomotor apraxia?
ask patient to do a skilled gesture and they can’t do it.
Better if they copy you, worse if you ask them
what are the characteristics of ideational apraxia?
patient can’t do a series of complex tasks such as making tea. Occurs from dementia, extensive left hemisphere damage, etc
what are the characteristics of conceptual apraxia?
impairment in object knowledge (semantic dementia) or impairment in action knowledge
what are the behavioural symptoms of diffuse damage to the prefrontal cortex?
- tangential (can’t keep on task)
- utilization behaviour (can’t help touching/using things)
- lack awareness of self (unaware of disfunction)
- paratonia (increase in muscle tone when someone tries to move a limb)
what are the neuropsychiatric symptoms of diffuse prefrontal cortex damage?
- personality changes
- pseudodepression (don’t initiate anything, look depressed)
- pseudopsychopathy (don’t understand other’s modes of thinking, no emotional understanding)
- reduplactive paramesia (belief that loved one is replaced by an alien)
what are the frontal release signs?
- glabelar reflex: don’t extinguish eye blink when tapped on forehead
- grasp reflex: grasp from hand stimulation
- palmomental reflex: ipsilateral contraction of muscle in chin from adverse stimulation of area of palm
- root reflex: move to suck with cheek stroke
- snout reflex: tap top lip, make a pucker
what does dorsolateral damage result in? what are the symptoms?
- results in dysexecutive syndrome, pseudodepressed syndrome
- symptoms include poor problem solving, abulia/amotivational, perseverative, and stimulus bound
what does orbitofrontal (inferior/ventral frontal) damage result in? what are the symptoms?
- results in disinhibited/pseudopsychopathic syndrome
symptoms include disinhibition, emotional lability, impulsivity, lack of social graces, personality changes, poor smell discrimination
what does medial frontal/cingulate gyrus damage result in? what are the symptoms?
- results in akinetic/apathetic syndrome
- symptoms include amotivation, not moving, mute (if bilateral), leg weakness, urinary incontinence
what is the memory profile of someone with dorsolateral prefrontal cortex damage?
temporal sequencing, retrieval deficit, inefficient encoding due to also having working memory problems
what are the characteristics of dorsolateral prefrontal cortex syndrome?
- concrete (don’t get idioms, metaphors, sarcasm, etc)
- reduced divergent thinking
- novel problem solving (can’t figure out the steps involved or plan ahead)
- subtle difficulties are not as evident and require a neuropsychological evaluation
- insight impaired
- anticipation of consequences impaired
- perseveration
- might not demonstrate learning from mistakes
- easily distractible
- somewhat a paucity of spontaneous speech
- if more severe, will demonstrate environmental dependency
how does dorsolateral prefrontal cortex syndrome affect episodic memory?
- learning slope more flat, can’t learn unrelated information
- strategies for encoding and retrieval might be impaired
- facts and events might be out of temporal sequence
what are the characteristics of severe ventral medial prefrontal cortex damage?
- akinesia
- adynamia
- anterograde amnesia (subcortical structure involvement; confabulation)
- incontinence
- paucity of spontaneous speech
what are the characteristics of milder ventral medial prefrontal cortex damage?
- theory of mind/social cognition impairment
- apathy
- adynamia even if patient has motivation for an activity
what are the symptoms of orbitofrontal cortex syndrome?
- disorganization
- disinhibition
- impulsive
- social impropriety
- pseudopsychopathy
- addictive behaviours
- illegal behaviours can occur
- poor judgement
- poor regulation of emotions
- hollow jocularity (think everything is funny)
- anosmia
