2. FOR EG :
•
Patient is conscious, cooperative and well oriented to person place & time. His/her GCS is
15/15.
•
Patient’s memory and attention is intact and speech and language is normal. His/her
MMSE is 28/30
3. HIGHER MENTAL FUNCTION
1.
Appearance & Behaviour
2.
Level of consciousness :
3.
Congnitive functions
•
Memory & attention
•
Speech & language
•
Cortical functions
GCS
MMSE
8. DYSARTHRIA
•
Motor inability to speak, abnormality in articulation.
•
Could be due to local tongue causes, facial muscles, disruption of neuromusculature etc
9. DYSPHASIA
•
Higher order inability to speak, disorder in encoding and decoding the language. Usually
associated to left hemisphere lesion.
•
Four components: fluency, comprehension, repetition and naming
•
Naming is affected in all forms of dysphasia.
11. FLACCID DYSARTHRIA/ BULBAR PALSY
•
Bulbar refers to medulla oblongata and bulbar palsy denotes any weakness of muscles
that is supplied by 7,9,10,12th cn from the pons and medulla.
•
Dysphagia also occurs.
•
Palatal weakness with nasal voice
•
Myasthenia gravis and polyneuropathies also cause flaccid dysarthria. In MG ,fatigue
becomes evident as the patient talks.
12. SPASTIC DYSARTHRIA: PSEUDOBULBAR PALSY
•
UMN disorder affecting tongue, pharynx and facial muscles.
•
Jaw jerk may be brisk
•
Contracted spastic tongue
•
Hot potato voice.
16. BROCA’S APHASIA
•
(Dominant frontal lobe): Brodmann Area:44,45
•
Motor, Expressive, non fluent , agrammatic aphasia with intact comprehension (broken
speech)
•
Eg for “I take dog for a walk” .patient will say “I.. dog.. walk”
17. WERNICKES APHASIA
•
(posterior superior dominant temporal lobe): Broddmann Area: 22
•
Sensory, non expressive/receptive and fluent with loss of comprehension.(wordy)
18. Conduction Aphasia:
•
fluent and intact comprehension but poor repetition and naming
Global Aphasia( large dominant hemispheric lesion involving frontal, temporal and parietal
area)
•
produce few recognizable words and understand little or no spoken language.
Global aphasics can neither read nor write.
•
Persons with global aphasia are often mute or reduced to a few stereotyped words or
sounds.
20. COGNITIVE FUNCTION: MMSE
O Orientation
Place
Time
10
R
Registration
Name 3 objects
3
A
Attention & calculation
Serial 7 / Word backward
5
R
Registration Recall
Recall previously named 3 objects
3
L
Language
3 stage command
Name two objects
Read and follow
Draw a pentagon
Repitition
Write a sentence
9
23. FRONTAL LOBE:
Functions:
•
Executing functions
•
Personality (eg apathy)
•
High level processing of motor tasks
•
Note: Apathy or impassivity is a state of indifference, or the suppression of emotions such
as concern, excitement, motivation and passion.
•
Apathy Abulia Akinetic mutism
24. FRONTAL LOBE
Check for
•
Abstraction :say a proverb and judge for interpretation
•
Estimation : ask to estimate a height
•
Self cued test: ka baata aaune animal ko names
Praxis:
•
Simultaneous simple motor task: fist open and close
•
Limb kinetic apraxia: copy finger position like peace sign
•
Ideomotor apraxia: ask how you d blow a kiss
Expressive dysphasia, Urinary incontinence, change in personality
Frontal release signs
•
Pouting reflex/facial reflex
•
Palmomental reflex
•
Grasp reflex
26. PARIETAL LOBE :
1.
Sensory: check for drift, Astereognosis, Agraphesthesia
2.
Dominant: RAAF and Language
3.
Non dominant: (spatial cognition)
•
Hemisensory neglect: anosognosia (left hand doesn’t belong to body)
•
Constructional Apraxia :as in MMSE
•
Dressing apraxia: doesn’t dress left half of body
•
Extinction: ignore stimulus on left side
•
(primitive reflex also)
28. OCCIPITAL LOBE:
•
Visual agnosia: failure to recognize object despite preserved acquity
•
Visual anosognosia:( Anton syndrome): denies he is blind but collides while walking.
•
Prosopagnosia: inability to recognize similar faces
•
Micropsia
•
Macropsia
•
Visual hallucinations
•
Ballint syndrome: oculomotor apraxia: failure to look around the object within the visual
field
