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Higher mental function

Higher mental function






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    Higher mental function Higher mental function Presentation Transcript

    • CNS EXAMINATION: HIGHER MENTAL FUNCTION & CRANIAL NERVES Pratap Sagar Tiwari, Lecturer, Internal Medicine, NGMC
    • 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
    • HIGHER MENTAL FUNCTION 1. Appearance & Behaviour 2. Level of consciousness : 3. Congnitive functions • Memory & attention • Speech & language • Cortical functions GCS MMSE
    • CORTICAL FUNCTION Examination of • Frontal lobe • Parietal lobe • Temporal Lobe • Occipital lobe
    • MEMORY & ATTENTION Memory • Remote memory • Recent memory Attention • Serial 7s • Word backward
    • SPEECH & LANGUAGE • Dysarthria • Dysphasia
    • DYSARTHRIA • Motor inability to speak, abnormality in articulation. • Could be due to local tongue causes, facial muscles, disruption of neuromusculature etc
    • 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.
    • TYPES OF DYSARTHRIA • Flaccid dysarthria • Spastic dysarthria • Hypokinetic dysarthria • Ataxic dysarthria
    • 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.
    • SPASTIC DYSARTHRIA: PSEUDOBULBAR PALSY • UMN disorder affecting tongue, pharynx and facial muscles. • Jaw jerk may be brisk • Contracted spastic tongue • Hot potato voice.
    • HYPOKINETIC DYSARTHRIA • Hypokinetic dysarthria: as in Parkinsonism • Monotonous speech , low volume voice
    • ATAXIC DYSARTHRIA • Ataxic Dysarthria: Cerebellar dysarthria • Slow,slurred scanning speech • Ataxic gait • Other features of Cerebellar dysfunction
    • DYSPHASIA: TYPES • Broca’s aphasia • Wernicke’s aphasia • Global aphasia • Conduction Aphasia
    • 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”
    • WERNICKES APHASIA • (posterior superior dominant temporal lobe): Broddmann Area: 22 • Sensory, non expressive/receptive and fluent with loss of comprehension.(wordy)
    • 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.
    • SUMMARY Repetition Naming Fluency Transcortical motor Transcortical sensory Broca Normal mild Non Fluent Normal mod Fluent Poor mod Non Fluent Wernicke Poor mild Fluent
    • 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
    • MMSE Total score: • 21-24: mild cognitive dysfunction • 10-20: moderate • Less than 10 : Severe • Eg 26/30 or 24/30 (blind)
    • 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
    • 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
    • PARIETAL LOBE : • Sensory • Dominant • Non dominant
    • 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)
    • TEMPORAL LOBE : • Memory • Seizure: complex partial seizure • Wernickes aphasia
    • 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
    • References: • Hutchinsons • Mcleods • Pictures taken from the internet