Neurocognitive syndromes copy final

2. 1. Dominant hemisphere
2. Non dominant hemisphere
3. Frontal lobe
4. Occipital lobe
5. Bedside neurocognitive assesment

3. 1. Focal lesion = focal defect
2. False localization
3. Disconnection syndromes
4. Hemispheric specialization :
• Handness
• Lateralization onset

4. • Broca’s ( Fluency )
• Prefrontal and supplementary motor ( syntax )
• Werneck’s ( comprehension )
• Tempoparietal ( lexicon )
• Angular gyrus ( reading )
• Arcuite fasiculus ( werneck’s  broca’s )
• Carpus callosum ( Lt  Rt = emotional )
• Subcortical ( thalamus / BG )

5. • Most commonly MCA ( S.Division ) infarct
• ↓ fluency
• ↓ syntax
• ↓ prosody
• ↓ repitition
• ↓ naming
• Reading / writting : effortful / agrammer
• Comprehension intact
• Associated with dysarthia & faciobrachial hemiparesis
+/- depression with apraxia

6. • Most commonly MCA ( I.Division ) infarct
• ↓ comprehension
• Lexical : meaningless / paraphasia & neologism
• ↓ repitition
• ↓ naming
• normal fluency
• normal prosody & syntax
• Comprehension intact
• Read / write : effortful / agrammer
• Associated with homonous hemianopia +/- agitation & paranoid
with apraxia

7. • Recovery pattern :
• Global  broca’s or wernick’s  transcortical
motor or sensory  anomic

8. 1. Gertsmann syndrome
2. Apraxia
3. High order deafness :
• Cortical deafness
• Non verbal auditory agnosia
4. Alexia & Agraphia :
• Most commonly associated with aphasia
• Alexia with agraphia ( angular gyrus lesion )
• Agraphia without aphasia ( inferior parietal lobule lesion
• Alexia vs dyslexia
5. Disconnectoin syndromes
• Conduction aphasia
• Alexia without agraphia
• Pure word deafness
• Agraphia of the lt dominant hand

9. • Hemineglect syndromes : Anosognosia & asomatognosi
• Vasiopatial orientaion : integrate multiple sensory input 
processed in non dominant dorsal parieto-occipital-
temporal area ( where center )
• General attention : cortical & subcortical
• Rt. Hemisphere : Lt. Attention & Rt. Attention >>> Lt.
Hemisphere .

10. I. Sensory
• Tactile > visual > auditory neglection
• Sensory Extinction
• Allesthesia
• Hemianopia vs visual neglection
II. Motor
• Motor extinction
• Allokinesia
• Spatial akinesia
• Encephalic pt  tactile response

11. III. Combination sensory & motor testing :
• Pen & paper tests : line bisection test / cancellation tasks
• Drawing clock face
IV. Conceptual :
• Anosognosia
• Asomatognosia
• Anosodiaphoria
V. Other manifistations :
• Psychiatric manifestations
• Bilateral ptosis
• Receptive & expressive aprosody
• Rare syndromes : Capgras / Fregoli / Reduplicative paramnesia

12. • Dysfunction ( 5 P’s )
• PPersonality dysfunctions
• PParaparesis
• PParatonia
• PPositive primitve reflexes
• Gait APPraxia
• DDx :
• Diffuse : Hydrocephalus, Binswinger ,Toxic, Anoxia
• Local : Tumar, ACA-MCA Watershed, A.comm
aneurym/compression
• Mimikers : PD, Depression, Catatonia

13. I. 1ry visual cortex
• Hallucination/ migrain aura
• Anton’s syndrome
• Normal fundus , no RAPD
II. I. occipito-temporal syndromes ( what ? )
• Proposognosia
• Achromatopsia
• Color agnosia
• Metamophopsia
• Palinopsia
III. L. parieto-occipital Syndromes ( Where ? )
• Balint Syndrome : ( simultanognosia / optic ataxia / ocular apraxia )
• Cerebral akinetopsia

14. • Alertness
• Orientation
• Attention and concentration
• Memory
• Frontal exécutive fonctions
• Dominant hemisphere functions
• Non dominant hemishere functions
• MMSE

16. • 45 years old lady K/C/O secondary progressive MS
• Admitted with involuntary movement
• Past Hx
• Started relapsing remitting multiple neurological symptoms since
2002
• Diagnosed as PPMS & Started on INF B injection but was not
compliant
• Since 2008 disease started to be more progressive , became
epileptic
• Started on novantron but again didn’t complete the coarse
• Gradualy became demented
• MRI Brain requested

17. • Hereditary spastic paraparesis
• Leukodystrophies
• Mitochondrial syndromes
• CADASIL