1) The document discusses signs associated with lesions in the frontal and parietal lobes. Tests are described to assess functions localized to these regions like motor skills, memory, attention, and language abilities. 2) Parietal lobe signs include sensory deficits, agnosias like finger agnosia, and apraxias involving how to complete tasks. Tests evaluate two-point discrimination, graphesthesia, and stereognosis. 3) Both lobes are involved in executive functions and attention. Tests mentioned include the Wisconsin Card Sorting Test, Trail Making Test, and Stroop Test.

1. Frontal and Parietal lobe sign
Dr Fakir Mohan Sahu
MCh Neurosurgery
AIIMS Bhubaneswar
08/02/2020

2. Frontal lobe sign

3. Functional region of the frontal lobe
• I Primary motor area
• II. Premotor area
• III. Frontal eye fields
• IV. Dorsolateral prefrontal cortex
• V. Orbital and basal areas
• VI. Supplementary motor area and anterior cingulated gyrus area

4. Clinical Assessment of frontal lobe sign
• History, Examination and formal tests :
Abnormal behavior, speech disorder, urinary incontinence, Frontal
gait(magnetic gait) , weakness of limbs
• Test sense of smell.
• Frontal release reflexes
Grasp reflex
Sucking reflex (pout, snout, rooting)
Palmo-mental reflex
Glabellar tap reflex

5. Emotional make-up and personality is best assessed by
history from family / friends & observation.
•Abstraction and judgment are assessed by proverb
interpretation and similarities.
•E.g explain in your own words the meaning of
•Don’t cry over spilled milk
•Similarity between mango and orange, car and airplane.

6. Attentionand memory
• Alternative sequence (e.g. copying MNMN)- Attention
• Motor Luria’s ‘fist-edge-palm’ test
• Go/no-go
• Digit span test: Measure of short term memory

7. Test for
perseveratio
n

9. To assess perseveration and abstract thinking.
Measure of executive function.
Consists of four key cards and 128 response cards.
Wisconsin Card Sorting Test(WCST)

10. Trail Making Test
• Test for visual attention and task switching.
.
• In Part A, the circles are numbered 1 – 25
• In Part B, the circles include both numbers (1 –
13) and letters (A – L); (i.e., 1-A-2-B-3-C, etc.).

11. Trail Making Test
A
C1
2
7
3 D
5 B
4
6

12. Stroop test

13. Parietal lobe sign

14. • CORTICAL SENSORY
SYNDROMES
• ASOMATAGNOSIAS
• APRAXIAS
• VISUAL DISORDERS
• AUDITORY NEGLECT
Parietal lobe lesion and sign

15. Tests for cortical sensations
A. Two point discrimination
: Calipers or compass
used.
Sites – Palms (8-15 mm)
Dorsum (2-3cm)
Back (3-4 cm).

16. B. Graphesthesia :
Done with pencil or swab stick.
sites – palms, fingers and face.
C. Stereognosis :
• No preliminary visual demo given.
• ex: key, pen or coin

17. ASOMATAGNOSIAS
• Inability to feel, recognize, or be conscious
of one’s own specific body parts or bodily
conditions.
ANOSAGNOSIA
• Denial of illness
HEMI NEGLECT
• Neglect on one side of body in dressing and
grooming.

18. GERSTMANN
SYNDROME1. Finger agnosia
2. Right-left confusion
3. Acalculia
4. Dysgraphia

19. Tests for finger agnosia
• Inability to name , point or recognize
fingers on oneself or others.
1. Non verbal finger recognition
2. Verbal finger recognition

20. Tests for right – left confusion
 Identification on self
.
 Crossed commands on self
 Identification on examiner
 Crossed commands on examiner
.

21. Tests for calculations
Components – Rote tables (add, multiply,
etc) Recognition of signs (+ , - , * )
Basic arithmetic(carrying, borrowing)
Spatial alignment of written
calculations
• Verbal rote examples : what is 4 plus 6 ?
• Verbal complex examples : what is 21 / 5 ?

22. • Written complex examples :
• Pt with rt.
hemisphere lesion
& left neglect.
• Pt with rt. parietal
hematoma –
showing poor
alignment and
calculation errors.

23. APRAXIA AND PARIETAL LOBE
• An inability to carry out a commanded task
despite the retention of motor and sensory
function

24. Types of apraxia
1. Ideomotor apraxia
2. Ideational apraxia
3. Bucco-facial apraxia
4. Constructional apraxia
5. Dressing apraxia

25. IDEOMOTOR APRAXIA (“how to do”)
• Most common type of apraxia
i. Buccofacial apraxia
ii. Limb apraxia
iii. Whole body apraxia

26. IDEATIONAL APRAXIA (“what todo”)
• Able to do individual tasks, but
cann't integrate them as a
whole.
• ‘Conceptual apraxia’ - inability to
recognise the use of objects.
(object agnosia)

27. CONSTRUCTIONAL APRAXIA
• Constructional ability/praxis
(visuoconstructive ability)
• Non dominant parietal lobe
• Area
17
IPL (kinesthetic analysis of visual
patterns done here)
Premotor
area

28. DRESSING APRAXIA
• Not a true apraxia.
• Combination of spatial disorientation
and visuospatial inattention.

29. VISUAL DISORDERS
• Optic radiation passes through Inferior part of
the parietal lobe – incongruous homonymous
hemianopia or an inferior quadrantanopia.
• Rt. angular gyrus - Left sided visual neglect.

30. AUDITORY NEGLECT
• In right parietal lesions are initially unresponsive to
voices or noises on the left side.
• Main lesion - right superior lobule.

31. Thank you