neuro eval lecture 7

• ask pt to take a deep breath and then make a pitched aaah sound
• should last > 20 sec
• if less than 10 - big trouble

• orthostatic hypertension
• migraines
• anxiety
• disequilibrium

dif from vertigo - visual hallucinations

• stroke: lower half of contralat side of face will be limp
• CNVII: top and bottom of same side of face as the lesion will be limp

yes

• ability to interpret sensory input, or to process visual, somesthetic, auditory info
• requires cortical association areas interacting w primary sensory cortices

• goal directed behavior
• understanding outcomes of behavior (how joke --> laughter)
• determining goal achievement
• STM
• Emoional responsiveness

• memory prcessiong
• auditory assciation
• language comprehension
• visual task memory (watching someone do a motion)
• visual recognition of complex patterns

auditory association

visual association (knowing the long round red and white thing is a marker, and how it can be used)

• id of visual input
• how to use visual input

id of visual input

how to use visual input

• areas 5 and 7 are the somatosensory assocation cortex (feels something - smooth, spikey...)
• interface sensory and motor cortices
• process spacial aspects of the env
• R hemisphere - body image & tactile discrim

 the somatosensory association cortex

• polymodal sensory
• language

• lack of knowledge
• difficulty w interpreting sensory info

• inability to interpret sensory inputs
• it's an acquired condition
• transduction, transmission, and perception are intact, but still can't recognize stim

• agnosia - can't interpret, perceive, or recognize, despite presence of normal sensation
• can be agnostic for a specific modality (visual, auditory, tactile) or subcategory (facial)

can't make sense of a sound - hear a fire siren but only know it's loud and high pitched, hear crying and not know what it means

• adquired mental image about the body formed by sysnthesis of sensory info
• ideas of where body stops and starts
• asqured throught memory of previous body positions,movements, rels to objects

non-dominant parietal lobe

intact movement skills, but difficulties w performing functional tasks due to inability to recognize "meaning"of the task

• a type of body image agnosia
• loss of ability to id body as a whole, or recognize relationship of body parts
• forgetting, ignoring, denying, disowning, or misperceiving the body entirely or partially -- not sure if this is somatotopagnosia or just another kind of body image agnosia

impaired ability to recognize 1/2 of body

• hemispatial neglect
• impaired attention ot 1/2 of body, inability to attend to this part
• not a denial of it, just a lack of sensation of awareness - its an "ignoral" issue
• NOT agnosia

inability to recognize one's own fingers from those of the examiner

• inablility to recognize objects by touch, despite presense of intact sensory, and inability to synthesize tactile and proprioceptive info -- texture, size, wt etc 
• caused by a lesion in the contralat parietal lobe
• test w graphesthesia or stereognosis

no, it's cognitive

one object  another in a drawing - ask pt to point to the objects, the top, bottom, side

• inability to interpret visual stim despite intact visual sensory apparatus
• pt can perceive stim, even describe things, but can't recognize the function, structure, purpose

• must rule out visual acuity and muscle problems
• this probably goes for diagnosing any agnosias - got to check the pt's motor and sensory first

• inability to name of demonstrate use of a familiar object
• give pt a familiar object and ask him to demonstrate its use

visual association cortex of occipital lobe

• inability to perceive spatial rels btwn  objects or btwn objects and self
• unable to follow familiar path
• unable to orient to objects in space
• impaired ability to judge distance
• poor depth perception

right parietal lobe

• ex - find triangles on a page (they should be oriented differently and interspersed w other shapes) -testing the ability to perceive 2 identical objects in different positions and to id differeing objects
• it's a visuo-spatial test for agnosia

• aka facial agnosia
• inability to recognize familiar faces, either of famous people or close relations

bilat medial temporal-occipital lobe

loss of movement organization in absense of seory, motor, or language problem

premotor

• cannot form the concept of an action
• inability to form the plan or idea for a specific movement
• can stll describe the action
• seen in inability to complete a typical multistep command
• pt will make spatial and temporal errors with a task (ex - pick up pen, write name, put paper in env)

• diffuse bilat brain damage (AD)
• dominant lobe lesions

• inability to follow commands
• spontaneous movements  are still intact
• gestural commands may be superior to spoken commands

dominant parietal lobe lesions

• ideational
• ideomotor
• "special" - constructional, dressing

• inability to use visual info to complete a motor task
• can't draw or construct simple figure, though may be able to copy

occipital lobe lesions

• specific form of apraxia w difficulty w sequencing of motor actions needed for dressing
• pt will show up w shirt on backwards, buttoned wrong, etc

• memory loss
• auditory processing troubles
• language impairments (Wernicke's aphasia)
• visual impairment - upper quantranopsia

• apathy
• disinhibition
• perseveration
• loss of executive function
• Broca's aphasia
• contralat hemiplegia

• mental status - calculation, spatial/perecptual orientation
• apraxias
• negect
• visual - homonymous hemianopsia
• sensory - hemisensory deficit

• visuo-spatial deficits
• central blindness
• visual hallucinations
• hemianopia