ask pt to take a deep breath and then make a pitched aaah sound
should last > 20 sec
if less than 10 - big trouble
a few causes for dizziness
dif from vertigo - visual hallucinations
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
will damage to the cerebellum give vestibular findings?
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
the cortical association area's prefrontal cortex is responsible for...?
goal directed behavior
understanding outcomes of behavior (how joke --> laughter)
determining goal achievement
temporal lobe (one of the cortical association areas) is responsible for...?
visual task memory (watching someone do a motion)
visual recognition of complex patterns
area 22 sup temp gyrus does what?
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
occipital lobe's area 18 does what?
id of visual input
occipital lobe's area 19 does what?
how to use visual input
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
areas 5 and 7 of the parietal lobe are what?
the somatosensory association cortex
pariet-temporal-occipital junction is responsible for what?
agnosia basic def
lack of knowledge
difficulty w interpreting sensory info
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
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)
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
which part of brain is responsible for body image?
non-dominant parietal lobe
difficulties w body image --> what?
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
unilateral neglect - aka __, describe
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
inability to recognize one's own fingers from those of the examiner
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
is agnosia a motor or sensory problem?
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
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
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
visual object agnosia indictes lesion where?
visual association cortex of occipital lobe
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
where's the lesion if you have visual spatal agnosia?
right parietal lobe
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
aka facial agnosia
inability to recognize familiar faces, either of famous people or close relations
where's the lesion for prosopagnosia?
bilat medial temporal-occipital lobe
loss of movement organization in absense of seory, motor, or language problem
apraxia - where's the lesion?
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)
ideational apraxia - what's the lesion?
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
ideomotor apraxia - where's the lesion?
dominant parietal lobe lesions
3 types of apraxia
"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
constructional apraxia - where's the lesion?
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
if you hurt the temporal lobe you'll get...?
auditory processing troubles
language impairments (Wernicke's aphasia)
visual impairment - upper quantranopsia
impairments if you hurt the frontal lobe
loss of executive function
impairments if you hurt parietal lobe
mental status - calculation, spatial/perecptual orientation