HIgher Centres Examination

Question 1

Parietal Lobe Function tests

DOMINANT

Answer 1

Lesion causes Gertsmanns syndrome which consists of the following:

• Alcalculia
  = Test by asking serial 7s
• Agraphia
  = Test by asking them to write a sentence
• Right/Left disorientation
  = Test by asking patient to show you their left and right hands. If done correctly, ask them to touch left ear with right hand etc.
• Finger Agnosia
  = Test by asking them to show you their pinky finger, their pointer finger and their thumb

NOTE: Gertsmanns syndrome is only diagnosed if the other higher centres are intact.

Question 2

Parietal Lobe Function Tests

NON dominant

Answer 2

Graphaesthesia
Test = draw numbers or letters on the skin with a pointed object

Sensory and visual inattention
Test = when one leg or arm is tested at a time sensation is normal however when done simultaneously only normal side is felt. Deficit is contralateral to lesion

Visual Field testing

Astereognosis
Test = ask patient to recognise an object placed in their hand with eyes closed

Two point discrimination
Test = Use a compass to see the distance that patient can discriminate as two seperate points (3cm on hand is normal)

Dressing and constructional apraxia
Test = Patient Copies an object that you draw (house/tree), Turn patients shirt inside out and hand it to them back to front- see if they can dress

Spatial neglect
Test = Fill in the numbers on a blank clock face (can also be a sign of dominant lobe deficits)

Question 3

Temporal Lobe Function tests

Answer 3

Short term and Long term memory tests

Short:
- Give them 3 things to remember, they should initially repeat these words and then distract with another task before asking them to repeat it again

Long:
- Ask a general knowledge question, such as “When did World War II end” or “Which country was hit with nuclear bombs in World War II?”

Test for confabulation = Ask patient if they have met you before

Question 4

Frontal Lobe Function Tests

Answer 4

Cause changes in:
- emotion, memory, judgement, carelessness about personal habits and disinhibition

Tests:
Proverb Interpretation
= Ask the patient what you mean by “Kill two birds with one stone”- if there is an issue then they will give you a concrete/literal answer

Primitive Reflexes
- Grasp reflex
(run fingers across palm of patients hand- will grasp on side that is contralateral to lesion)

• Palmomental reflex
  (ipsilateral contraction of the mentalis muscle when you stroke the thenar eminence firmly- causes lifting of the lower lip)
• Pout and Snout reflex
  (stoking or tapping hammer over the upper lip produces pouting of the lips- not a localising sign)