Week 3 Flashcards
How do you examine if the higher centers are functioning?
-Determine the paitents handedness (left or right)
- Orientation
- Speech examination
-frontal lobe examination
-parietal lobe examination
_temporal lobe examination
-Occidental lobe examination
Handedness: dominant hemisphere
Ask patient if left or right-handed Note: 94% Right-handed persons -Dominant Left hemisphere 60% Left-handed persons -Left dominant 30% Left-handed persons -Mixed dominant 10% Left-handed persons -Right dominant
Orientation
Check if patient is oriented in time, place and person.
This can be assessed using:–Folstein’sMini-Mental State Examination (MMSE) –The Blessed Six Item Orientation-Memory-Concentration Test.•MMSE is the best tool for the examination of orientation/mental status
Dysphasia (Speech)
Disturbance in understanding or production of language or a language disorder marked by deficiency in the generation of speech, and sometimes also in its comprehension.–Dominant hemisphere lesion.–Auditory dysphasia = spoken word–Alexia = written word–Speech disorder is either fluent or non-fluent
Fluent (speech)
Sentences are of normal length and words flow easily but words are used incorrectly and speech is difficult to understand. Patient uses paraphrasias, e.g., literal paraphrasia, verbal paraphrasia and/or neologisms.
Non-fluent (speech)
Speech slurred and lacks fillers (and, the, so, to) therefore sounds like a telegram.
Dysarthria (Speech)
Difficulty with articulation.–Caused by Cerebellar disease, bulbar palsy, pseudobulbar palsy, extrapyramidal disease.–Differentiation is difficult in terms of the quality of speech alone. –Diagnosis can usually be made by the associated neurological abnormalities.
Dysphonia (Speech)
Altered quality of voice
- caused by layngeal disease, recurrent layngeal nerve palsy, hysteria, myopathy
How do you conduct a speech test?
To Conduct Speech Test: 1.Introduce yourself and shake hands. 2.Free speech: How long have you been in hospital? What sort of work do you do? 3.Comprehension: Do you understand what I am saying? •Close your eyes (1-step command). •With your right finger touch your nose and then your ear (2-step command). •I would like you to pick up this piece of paper, fold it in half and then place it back on the bed/table (3-step command). 4. Repetition/Dysarthria assessment: •Please repeat after me “No ifs, ands or buts”“West Register Street”“British Constitution” •Repeat ‘PUH’ (lip weakness), ‘TUH’ (tongue) ‘KUH’ (palate)5. Naming objects: Shirt, sleeve, cuff, button. Watch, band, face, hand, tell time6. Reading : “Read what it says on this card and do what it says”7. Writing : “Please write a sentence”
Defects in the frontal lobe manifests as
-Personality change (abulia (decreased initiation and spontaneity)
–Impaired concentration/attention–Changes in emotion, judgment, memory
–Inability to pursue goals, carelessness about personal habits
–Persistent or alternating irritability and euphoria
–Disinhibition
Anosmia - loss of the sense of smell
Proverb interpretation (a rolling stone gather no moss)
•Gait apraxia-marked unsteadiness in walking (wide-based, feet appears glued to the floor resulting in shuffling)
•Primitive reflexes: grasp, pout and snout, suck, palmo-mental
–The presence of many of these reflexes is associated with diffuse cerebral disease involving frontal lobe and frontal association areas.
–Causes include dementia, encephalopathy and neoplasm.
•Incontinence
•Expressive dysphasia (Dominant: Broca’sarea)
Parietal lobe examination
1) dominant
Defects in the dominant parietal lobe manifest as “Gerstmann’ssyndrome” –Acalculia(Inability to perform simple arithmetic calculations e.g. serial subtraction of 7 or 3 from 100)–Agraphia (Inability to write)–Left-Right disorientation–Finger Agnosia (Inability to name fingers)Note: It can only be diagnosed if higher centres are intact (not applicable in dementia)
Parietal lobe examination
2) non-dominant
Defects in the non-dominant parietal lobe manifest as:–Spatial neglect (clockface; ask patient to fill in the numbers on an empty clock face)–Dressing Apraxia (Turn patient’s shirt inside out, inability to put it on again)–Constructional Apraxia (Ask patient to copy an object you have drawn e.g. house, tree).
Parietal lobe examination
3) non-localizing
Defects in the parietal lobe (irrespective of dominance) manifest as:–Touch-localization (Tactile extinction: is ability to feel a stimulus when it is applied to each side separately, but not one side when both sides are stimulated).–Cortical sensory loss i.e., Proprioception, 2-point discrimination (3 cm on the hand, 0.6 cm on fingertips, 4-6 cm on the leg).
Temporal lobe examination
Defects in the temporal lobe manifest as:
•Short Term Memory (STM) loss –4 words recall e.g.,•honesty, brown, tulip, eyedropper or •name, address and 3 flowers•Long Term Memory loss (LTM)–‘When did WWII start? … finish? (1939 to 1945)
•Confabulation–Patient makes up story to fill in gaps in their memory (Have we met before?) –Typical of Korsakoff’spsychosis (amnesic dementia)
•Loss of memory for events before the onset of illness (retrograde amnesia)
•Inability to memorise new information (common in alcoholics due of loss of nerve cells in thalamic nuclei and mammilarybodies)
•Other causes -head injury, tumours, anoxic encephalopathy, or encephalitis.
- Dysphasia
Occipital lobe examination
Defects in the occipital lobes manifest as •Inability to (3‘Rs’)
–Recognize faces (prosopagnosia)
–Read (alexia) –Recognize objects (visual agnosia)
•”Cortical” blindness (bilateral) •Topographical amnesia (inability to recall the spatial cues necessary to navigate previously familiar terrain, or new place.
