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Cerebrovascular disease
Anterior cerebral artery
Supplies medial surface of the brain
B/L ACA infarct causes quadriparesis legs worse than arms, and
akinetic mutism
Tumours
Olfactory groove meningioma
Anosmia
Loss of inhibition
Headaches
Memory impairment
Visual symptoms
Metastatic brain tumours
Trauma
Other causes
Hydrocephalus
NPH
Tourette syndrome
Infections
HIV
Abscesses
Tuberculoma
Neurocysticercosis
Precentral gyrus
Monoparesis
Hemiparesis
Seizures
Focal
GTCS
Brocas area
Motor dysphasia/aphasia if in the dominant hemisphere
Prefrontal area
Personality change
Disinhibition
Inappropriate jocularity
Loss of initiative and concern
Akinetic mutism
General retardation
Grasp
Pout
Palmar-mental
Brisk jaw jerk
Contralateral DTR changes
Unsteady gait upright posture with short stride, hesitant, widened
base gait
Ignition apraxia
Poor balance
Paratonia
Paracentral lobule
Incontinence of urine or faeces cortical disinhibition
Orbital surface
Anosmia unilateral or bilateral
Physical examination
Frontal lobe specific cognitive screening
Frontal assessment Battery (FAB)
Montreal Cognitive Assessment (MoCA)
Go/No-Go task
Test of echopraxia
Ask patient to hold up 1 finger if the examiner holds up 2
fingers and 2 fingers if the examiner holds up 1
10 trials should be done
Failure to respond correctly suggests lack of normal
response inhibition
Antisaccade task
Ask patient to move eyes opposite to the direction of the
stimulus
Failure to do so reflects dysfunction of the prefrontal
cortex
Trail-Making Test
Part A connect 25 numbered circles
Part B connect numbers and letters in alternating
progression
Applause test
Brocas aphasia
Apraxia
Left premotor and supplemental motor cortices
Buccofacial apraxia cannot perform movements with the mouth
or lips, and is localized near Brocas area
Callosal apraxia unilateral apraxia ACA stroke
Contd
Neglect
Patients may neglect to draw one side of a drawing or to read
words on one side of a page Neglect dyslexia
Motor neglect
Sensory neglect
Anosognosia (denial of illness)
Contd
Utilization behavior
Using, touching or playing with an object that is inappropriate to
the scenario
E.g. A patient taking a physicians stethoscope and listening to his
heart sounds while the physician is talking to him
Other signs
Lack of originality
Inability to plan, initiate, organize or form and maintain
personal relationships
Thes patients lack insight and are dependent on
caregivers despite normal intellect
Witzelsucht addiction to joking patients tell
inappropriate jokes or pointless stories in socially
inappropriate situations
Thank You