Frontal Lobe Syndromes

Question 1

where do the major outgoing tracts involved in movement begin?

Answer 1

the primary motor cortex

Question 2

which structures does the primary motor cortex receive information from?

Answer 2

premotor and supplemental motor areas

Question 3

what do lesions in the primary motor cortex result in?

Answer 3

contralateral weakness or hemiplegia

Question 4

what is constraint induced movement therapy?

Answer 4

• 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

Question 5

what is the premotor area/supplementary motor responsible for?

Answer 5

• fine motor movements
• sequenced movements
• critical for acquiring new motor skills
• sequencing the motor movements

Question 6

what are the characteristics of ideomotor apraxia?

Answer 6

ask patient to do a skilled gesture and they can’t do it.

Better if they copy you, worse if you ask them

Question 7

what are the characteristics of ideational apraxia?

Answer 7

patient can’t do a series of complex tasks such as making tea. Occurs from dementia, extensive left hemisphere damage, etc

Question 8

what are the characteristics of conceptual apraxia?

Answer 8

impairment in object knowledge (semantic dementia) or impairment in action knowledge

Question 9

what are the behavioural symptoms of diffuse damage to the prefrontal cortex?

Answer 9

• 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)

Question 10

what are the neuropsychiatric symptoms of diffuse prefrontal cortex damage?

Answer 10

• 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)

Question 11

what are the frontal release signs?

Answer 11

• 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

Question 12

what does dorsolateral damage result in? what are the symptoms?

Answer 12

• results in dysexecutive syndrome, pseudodepressed syndrome
• symptoms include poor problem solving, abulia/amotivational, perseverative, and stimulus bound

Question 13

what does orbitofrontal (inferior/ventral frontal) damage result in? what are the symptoms?

Answer 13

• results in disinhibited/pseudopsychopathic syndrome
  symptoms include disinhibition, emotional lability, impulsivity, lack of social graces, personality changes, poor smell discrimination

Question 14

what does medial frontal/cingulate gyrus damage result in? what are the symptoms?

Answer 14

• results in akinetic/apathetic syndrome

- symptoms include amotivation, not moving, mute (if bilateral), leg weakness, urinary incontinence

Question 15

what is the memory profile of someone with dorsolateral prefrontal cortex damage?

Answer 15

temporal sequencing, retrieval deficit, inefficient encoding due to also having working memory problems

Question 16

what are the characteristics of dorsolateral prefrontal cortex syndrome?

Answer 16

• 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

Question 17

how does dorsolateral prefrontal cortex syndrome affect episodic memory?

Answer 17

• 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

Question 18

what are the characteristics of severe ventral medial prefrontal cortex damage?

Answer 18

• akinesia
• adynamia
• anterograde amnesia (subcortical structure involvement; confabulation)
• incontinence
• paucity of spontaneous speech

Question 19

what are the characteristics of milder ventral medial prefrontal cortex damage?

Answer 19

• theory of mind/social cognition impairment
• apathy
• adynamia even if patient has motivation for an activity

Question 20

what are the symptoms of orbitofrontal cortex syndrome?

Answer 20

• 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