CLINICAL NEUROLOGY

1. Higher mental function

2. Anatomical areas- functions
• Perisylvian net work –language
• Parietofrotal network- spatial cognition
• Occipito temporal –face &object recognition
• Limbic net work – retentive memory
• Pre frontal net work – attention& behavior

3. Mental status examination
When
• Known brain lesions
• Suspected brain lesions
• Psychiatric patients
• Vague behavioral complaints

4. History &behavioral observations
• +/- of classic behavioral changes indicative of
organic dysfunction
• Possibility of both adjustment and functional
psychiatric disorder
• Establish patients pre morbid behavior and
level of functioning
• Patients general medical status

5. History out line
• Description of present illness
• Other organic behavioral symptoms
unusual or bizarre behavior
poor social judgment
attention & concentration problems
language problems
reading ,writing, calculation difficulty
memory difficulty
geographic orientation
• Psychiatric symptoms(hallucinations, delusion, depression, anxiety)
• Past history (neurological, psychiatric , medical, drug & alcohol abuse , head
trauma, seizures , CNS infections, )
• Birth and development history
• Educational &vocational history
• Family history

6. Physical appearance
• General appearance
A)descriptive data (age, ht, wt)
B)general impression of appearance
(appearance for chronologic age, posture, facial
expression, eye contact)
• Personal
cleanliness(hair, nails, teeth, beard, indications of
unilateral neglect)
• Habits of dress
• Motor activity

7. Mood&emotional status
• Mood
normal for situation
sadness
elation
apathy & lack of concern
fluctuations in mood
• Emotional status
cooperation with examiner
depression
anxiety
suspiciousness
anger
reality testing (delusions, hallucinations)
indications of non psychotic emotional symptoms(phobia, mania, obsessiveness )
abnormalities of language & speech

8. Delirium(acute confusional state)
• Confusion-mental &behavioral state of reduced
comprehension , coherence and capacity to reason
• Delirium – a state of confusion accompanied by
agitation, tremor, hallucination and illusion
-clouding of consciousness
-inattention
-confabulation
- in coherent speech
-acute symptoms

11. Frontal lobe syndrome
• Apathy
• Euphoria
• Short lived irritability
• Social inappropriateness

12. Frontal lobe tests
• Visual pattern completion test

14. Frontal lobe tests
Motor pattern tests
• Fist-palm-side test
• Fist –ring test
• Reciprocal coordination test

15. Pseudo dementia&dementia

16. Level of consciousness
• Alertness
• Lethargy
• Obtundation
• Stupor or semicoma
• coma

18. attention
• Observation
• History
• Digit repetition
• Sustained attention(A random letter test)
• Unilateral inattention

19. language
• Dysarthria
• Apraxia
• Aphasia
• Alexia
• agraphia

20. Anatomy of aphasia
Conduction
Transcortical-
motor
Anomic
Broca’s
Global
Wernicke’s
Transcortical-
sensory
20

21. Broca’s Famous Patient
21

22. Evaluation of language
• Handedness
• Observing spontaneous speech
• Verbal fluency
animal naming
FAS test
• Comprehension
yes or no questions
pointing commands
• Repetition
• Naming and word finding
• Reading
• writing

23. Aphasic syndromes

24. memory
• Immediate
digit repetition
• Recent
orientation to place, person and time
• Remote
personal information
• New learning ability
4 unrelated words recalled after 5,10,30 mts
• Verbal story for recall
• Visual memory for hidden objects
• Paired associate learning

25. Constructional ability,reproduction
drawings

26. Construction ability
• Drawing to commands
• Draw a clock face with all numbers
• Set clock for a time

27. Neglect
27

28. Higher cognitive functions
• Fund of information
• Calculations
verbal rote examples
verbal complex examples
written complex examples
• Proverb interpretation
• Similarities
• Insight and judgement

29. Related cognitive functions
• Ideomotor apraxia
• Ideational apraxia
• Right –left disorientation
• Finger agnosia
• Visual agnosia
• Prosopognosia
• simultagnosia
• Asteriognosis
• Geographic disorientation

30. Lobar function tests
• Frontal lobe tests
insight
judgement
proverb interpretation
fund of information
similarities
visual pattern completion tests
alternating motor pattern tests
digit repetition test
A random letter test

31. • Parietal lobe tests
ideomotor apraxia
ideational apraxia
dressing apraxia
calculation
RT-LT disorientation
finger agnosia
stereognosis
construction apraxia

32. • Temporal lobe tests
verbal memory
visual memory
paired associate learning

33. • Occipital lobe tests
visual agnosia
prosopognosia
simultagnosia