neuro eval lecture 7

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shmvii
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180172
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neuro eval lecture 7
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2012-10-27 11:24:03
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neuro eval lecture 7
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  1. how to test for breath duration
    • ask pt to take a deep breath and then make a pitched aaah sound
    • should last > 20 sec
    • if less than 10 - big trouble
  2. a few causes for dizziness
    • orthostatic hypertension
    • migraines
    • anxiety
    • disequilibrium

    dif from vertigo - visual hallucinations
  3. diff btwn facial presentations of a stroke and of a CN VII lesion
    • 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
  4. will damage to the cerebellum give vestibular findings?
    yes
  5. perception - def, and it requires ___areas to ineract w ___
    • ability to interpret sensory input, or to process visual, somesthetic, auditory info
    • requires cortical association areas interacting w primary sensory cortices
  6. the cortical association area's prefrontal cortex is responsible for...?
    • goal directed behavior
    • understanding outcomes of behavior (how joke --> laughter)
    • determining goal achievement
    • STM
    • Emoional responsiveness
  7. temporal lobe (one of the cortical association areas) is responsible for...?
    • memory prcessiong
    • auditory assciation
    • language comprehension
    • visual task memory (watching someone do a motion)
    • visual recognition of complex patterns
  8. area 22 sup temp gyrus does what?
    auditory association
  9. occipital lobe (a cortical association area) does what?
    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
  10. occipital lobe's area 18 does what?
    id of visual input
  11. occipital lobe's area 19 does what?
    how to use visual input
  12. parietal lobe (cortical association area) is responsible for what?
    • 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
  13. areas 5 and 7 of the parietal lobe are what?
     the somatosensory association cortex
  14. pariet-temporal-occipital junction is responsible for what?
    • polymodal sensory
    • language
  15. agnosia basic def
    • lack of knowledge
    • difficulty w interpreting sensory info
  16. agnosia - describe this condition
    • inability to interpret sensory inputs
    • it's an acquired condition
    • transduction, transmission, and perception are intact, but still can't recognize stim
  17. name for when you lack the perceptual ability to recognize stimuli & varieties of this
    • 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)
  18. auditory agnosia
    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
  19. body image
    • 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
  20. which part of brain is responsible for body image?
    non-dominant parietal lobe
  21. difficulties w body image --> what?
    intact movement skills, but difficulties w performing functional tasks due to inability to recognize "meaning"of the task
  22. somatotopagnosia
    • 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
  23. hemisomatotopagnosia
    impaired ability to recognize 1/2 of body
  24. unilateral neglect - aka __, describe
    • 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
  25. finger agnosia
    inability to recognize one's own fingers from those of the examiner
  26. tactile agnosia - def, caused by lesion where, how to test
    • 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
  27. is agnosia a motor or sensory problem?
    no, it's cognitive
  28. figure-ground test
    one object  another in a drawing - ask pt to point to the objects, the top, bottom, side
  29. visual agnosia
    • 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
  30. important to do before diagnosing visual agnosia
    • 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
  31. visual object agnosia (aka visual perception agnosia) def and how to test
    • inability to name of demonstrate use of a familiar object
    • give pt a familiar object and ask him to demonstrate its use
  32. visual object agnosia indictes lesion where?
    visual association cortex of occipital lobe
  33. visual spatial agnosia
    • 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
  34. where's the lesion if you have visual spatal agnosia?
    right parietal lobe
  35. design extraction test
    • 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
  36. prosopagnosia
    • aka facial agnosia
    • inability to recognize familiar faces, either of famous people or close relations
  37. where's the lesion for prosopagnosia?
    bilat medial temporal-occipital lobe
  38. apraxia
    loss of movement organization in absense of seory, motor, or language problem
  39. apraxia - where's the lesion?
    premotor
  40. ideational apraxia
    • 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)
  41. ideational apraxia - what's the lesion?
    • diffuse bilat brain damage (AD)
    • dominant lobe lesions
  42. ideomotor apraxia
    • inability to follow commands
    • spontaneous movements  are still intact
    • gestural commands may be superior to spoken commands
  43. ideomotor apraxia - where's the lesion?
    dominant parietal lobe lesions
  44. 3 types of apraxia
    • ideational
    • ideomotor
    • "special" - constructional, dressing
  45. constructional apraxia
    • inability to use visual info to complete a motor task
    • can't draw or construct simple figure, though may be able to copy
  46. constructional apraxia - where's the lesion?
    occipital lobe lesions
  47. dressing apraxia
    • 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
  48. if you hurt the temporal lobe you'll get...?
    • memory loss
    • auditory processing troubles
    • language impairments (Wernicke's aphasia)
    • visual impairment - upper quantranopsia
  49. impairments if you hurt the frontal lobe
    • apathy
    • disinhibition
    • perseveration
    • loss of executive function
    • Broca's aphasia
    • contralat hemiplegia
  50. impairments if you hurt parietal lobe
    • mental status - calculation, spatial/perecptual orientation
    • apraxias
    • negect
    • visual - homonymous hemianopsia
    • sensory - hemisensory deficit
  51. impairments if you hurt your ocipital lobe
    • visuo-spatial deficits
    • central blindness
    • visual hallucinations
    • hemianopia

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