Neurological Examination - Cortical Functions

Related Subjects: |Neurological History taking |Cortical functions |Motor System |Sensory System |Mental state Examination |Speech and Language Exam |Cranial nerves and examination |Assessing Cogniton

Cognition

• Covered elsewhere

Dysphasia

• Covered elsewhere under speech

Dyspraxia

• Inability to perform a complex motor task despite intact sensory and motor, coordination and cognition
• A sign mainly of left parietal damage but may be seen with dementias and othe neurodegenerative diseases
• Testing e.g. show how to comb your hair, strike a match, brush your teeth, wave goodbye
• Another test is to get the patient to recreated complex hand forms e.g. interlocking thumbs
• Important as these are functional movements which play and important part of activities of daily life and they will often be spotted and worked on by the OT with functional assessments

Dyslexia and Dysgraphia

• Inability to read and communicate by writing. Usually a dominant parietal lobe deficit
• Usually accompanies a language deficit. Those with dysphasia usually have matching dyslexia and dysgraphia too.

Apraxia

• Inability to do a specific skilled task despite normal cognition, no ataxia, normal vision, motor and sensory function
• Dressing apraxia - patient puts trousers on over head
• Comb your hair - unable to do so, Button up shirt.
• Functionally important as they can have implications on a patients ability to self-care
• Ideomotor apraxia due to a dominant parietal injury. Cannot perform complex tasks.

Agnosia

• Inability to recognise objects e.g. a 1 pound coin or a key in the hand
• Contralateral parietal defect

Anosognosia

• Patient does not comprehend that they have a neurological deficit.
• Seen with right cortical/parietal lesions most commonly strokes.
• Despite a marked left hemiparesis patient will try to get out of chair to walk - leads to falls/injury.
• Can lead to patients convincing unwary doctors they are fine and be discharged from A&E despite being unable to walk and actually should have been considered for thrombolysis.

Extinction

• When stimuli presented bilaterally either visually or sensorily e.g. touch only one side is appreciated
• Suggests a contralateral parietal lobe deficit