Higher Centers

Question 1

What are the first components of a higher centres examination?

(the ones you test before going onto specific lobes)

Answer 1

Introduction

Consent

General Inspection

Orientation (Time person place)

Handedness

Speech

Question 2

What disorders of speech are you looking for in a high centres exam?

Answer 2

Dysarthria
Dysphasia
Dysphonia

Question 3

What is the difference between dyarthria vs dyphasia vs dysphonia?

Answer 3

Dysphasia = dominant higher centre disorder in the use of symbols for communication

Dysarthria = difficulty with articulation

Dysphonia = altered quality of the voice with reduction in volume as a result of vocal cord disease

Question 4

What are specific tasks you ask a patient to do, in order to test speech?

Answer 4

Describe the room (free speech)

Follow three step command (comprehension)

Repeat “no ifs ands or buts (repetition)

Say a difficult phrase: “British constitution”

say “ka ka ka, la la la, ma ma ma” (dysarthria)

Question 5

What lobes do you test in the high centres exam?

Answer 5

Dominant Parietal
Non dominant Parietal
Both parietal
Temporal
Frontal

Question 6

What do you test for when looking for a dominant parietal lobe lesion?

Answer 6

ALFA
Alcalculia
Left-right Disorientation
Finger agnosia
Agraphia

Question 7

What is it called if the patient is not able to complete any of the tasks related to dominant parietal lobe function, but other higher centres are intact?

Answer 7

Gerstman’s syndrome

Question 8

What do you test for in the NON-dominant parietal lobe?

Answer 8

Dressing apraxia
Constructional apraxia
Spatial neglect (draw a clock)

Question 9

What do you test for in both dominant parietal lobes?

Answer 9

• Sensory inattention
• Visual inattention
• Astereognosis
• Agraphesthesia

Question 10

What is asterognosis?

Answer 10

inability to recognise an object by touch

Question 11

What is agraphesthesia?

Answer 11

inability to recognise a number drawn on hand

Question 12

What do you test for in the temporal lobe?

Answer 12

recall

long term memory

Question 13

What do you test for in the frontal lobe?

Answer 13

• Primitive reflexes
• Interpretation of common proverbs
• Behaviour
• Gait apraxia

Question 14

What are some primitive reflexes you might test for?

Answer 14

palmomental - where the lips curl when you run you fingernail along the thenar eminence

Glabella tap - keep blinking when you hit them in the head

Snout and pout – touch the top of their lip, touch the side of their mouth

Question 15

Having tested all the lobes what are some bonus things you could say you’d test in a higher centres exam?

Answer 15

• Opthalmoscope
• CN
• Mini mental

Question 16

If there is agraphaesthesia, visual inattention, what lobe does that imply a deficit in?

Answer 16

dominant parietal