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Higher Cortical Functions

1. The document outlines the assessment of higher cortical functions including consciousness, orientation, memory, speech, reading, writing, repetition, naming, and gait. 2. Key aspects of speech assessment include comprehension, fluency, repetition, and different types of aphasia or dysphasia that can result from damage to brain areas like Broca's and Wernicke's areas. 3. Gait is assessed through tasks like walking, tandem walking, walking on toes/heels, and Romberg's test to identify issues like ataxia, foot drop, or other abnormalities.

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25 views8 pages

Higher Cortical Functions

1. The document outlines the assessment of higher cortical functions including consciousness, orientation, memory, speech, reading, writing, repetition, naming, and gait. 2. Key aspects of speech assessment include comprehension, fluency, repetition, and different types of aphasia or dysphasia that can result from damage to brain areas like Broca's and Wernicke's areas. 3. Gait is assessed through tasks like walking, tandem walking, walking on toes/heels, and Romberg's test to identify issues like ataxia, foot drop, or other abnormalities.

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Ammar Alnajjar

Higher Cortical Functions


1- Consciousness 2- Orientation 3- Memory 4- Speech 5- Gait

1- Consciousness Level: response to external & internal stimuli


A- Conscious →respond spontaneously
B- Drowsy → respond to verbal stimuli (‫)هذا اذا نعوفه ينام‬
C- Stupor → respond to painful stimuli
D- Coma → no response

2- Orientation: awareness of time, place, person Ask direct questions


if he doesn’t know ask indirect
questions

3- Memory: ‫ أشياء و اكله عيدها‬3 ‫انطي‬ ‫كشمولة‬.‫د‬


a- Registration (3 numbers)
a- Immediate → < 5 min‫راسا‬
b- Early memory (7 numbers)
b- Short term → > 5 min ‫أيام) وره خمس دقايق‬/‫(ساعات‬ c- Intermediate memory (5-3 min)
c- Long term → month/years ‫اسئل شغالت قديمة كلش‬ d- Late memory

Patient with Dementia → lose short term memory first


‫الن معظم الخلل يصير بالمنطقة المسؤولة عن الذاكرة القصيرة‬
Hippocampus in temporal lobe

4- Speech: ‫ شنو لغته؟ سمعه زين؟ التعليم؟ يمناوي لو يسراوي؟‬,‫الزم نتأكد من المريض‬

Notes
1- Auditory area (cortex) → receiving input from the ears in temporal lobe
2- Wernicke’s area → responsible for comprehension of speech (sensory part) ‫ يفسر الحجي‬in temporal lobe.
3- arcuate fasciculus → connect Wernicke’s to Broca’s
4- Broca’s area → responsible for production of speech (motor part) ‫ تحول الكالم‬in frontal lobe of the dominant hemisphere

- Aphasia is an inability to comprehend or formulate language


- Dysphasia is impairment of the power of expression by speech, writing, or signs, or impairment of the power of
comprehension of spoken or written language.

- Dysarthria is a motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or
weakened.

- anomia is a type of aphasia characterized by problems recalling words, names, and numbers
- Agnosia is an inability to recognize and identify objects or persons.

- Dysphonia → disorders of the voice


- Aphonia → the inability to produce voiced sound

1- Comprehension: ‫فهم اللغة‬


Wernicke’s area → sensory part of speech

‫ من احجي وياه الزم يكون مفتهم و أحاول اغطي حلكي من احجي بااليد‬,‫يحجي بطالقة و مفتهم‬
– ‫ أوامر‬3 ‫ما اغطي حلكي او اوكف وره المريض و انطي‬

2- Fluency: ‫جريان الكالم‬


Broca’s area → motor part of speech

- ‫( اخلي يحجي و يسولف‬fluent)

Damage to the Wernicke’s area: ‫حجي مخربط ما بي أي معنى‬


Wernicke’s dysphasia (superior temporal gyrus *inferior branch of MCA)
- salad of words
- meaningless
- neologisms (invented words)

Damage to the broca’s area (Inferior frontal gyrus *superior branch of MCA)
- Broca's dysphasia → partial loss of the ability to produce language
(spoken, manual, or written
‫ قليل يحجي بس يفهم األوامر‬effortful speech

Global aphasia → no comprehension or fluency (both areas effected) stroke (Complete MCA

3- Reading: ‫ اقره جملة‬do it not read it


4- Writing: ‫اذا ميعرف يكتب خليرسم‬

- agraphia → inability to write, as a language disorder resulting from brain


damage.
- Dyslexia → ‫ميكدر يقره‬
5- Repetition: ‫عبارة يعيدها وراية مباشرة‬

Conduction aphasia is the inability to repeat words or phrases.

6- Naming: common object


a- ‫شنو اسم هذا الشي‬
‫اذا ميعرف‬
anomia is a type of aphasia characterized by problems recalling words,
names, and numbers (angular gyrus lesion)

b- ‫شنو نسوي بي‬


‫اذامعرف‬
Agnosia is an inability to recognize and identify objects
a- Visual agnosia
b- Auditory agnosia
c- Tactile agnosia

Q/Causes of aphasia & dysphasia?


A/problem in the speech center in cortex (Wernicke’s, Broca’s, Transcortical)

Dysphonia: problem in the phonation


vocal cord‫ لحد ال‬brain ‫يعني خلل من ال‬
:‫مثال‬
1- Laryngitis ‫صوته مبحوح‬
2- Stroke in speech center
3- ‫ ممكن‬cranial nerves

Dysarthria: problem in articulation


lips & mouth ‫ الى حد ال‬brain ‫يعني من ال‬
:‫مثال‬
1- Myasthenia gravis
2- Problem in brainstem
3- Facial palsy
Types of Dysarthria

1- Spastic (hot potato speech)


a- If lesion in one cortex → speech not effected
b- If lesion in both → Bilateral UMNL (pseudobulbar)

2- Scanning speech: is a type of ataxic dysarthria in which spoken words are broken up into separate
syllables, often separated by a noticeable pause, and spoken with varying force.
a- Cerebellum lesion (specific)

3- Slurred speech (Non specific)

4- Nasal speech (bulblar) LMNL

5- Slow monotonous speech: Parkinson’s & depression


6- Gait ‫اذا متمدد يكوم يكعد‬
1- Walk forward, turn & return back to me (10m) )‫ (ثابتة لو يترنح‬:‫نشوف الكعدة مالته‬
Note: truncal ataxia ‫يترنح‬
a- Time taken to complete first 10m ‫نخلي يكوم يوكف (زين لو فاتح رجليه من‬
b- Stride length )‫يوكف‬
wide based gait ‫اذا فاتح رجليه‬
c- Arm swing → no arm swing → extra-pyramidal tract
cerebellar lesion ‫او‬
lesion (Parkinson’s disease)
d- Steadiness Parkinson’s disease
e- Turning → ‫→ اذا ميكدر يدور بسرعة‬
f- Any limbing
Cerebellar lesion

2- Tandem gait (Heel to toe walking) Cerebellar lesion → ipsilateral gait ataxia
This gait is useful for emphasizing
Damage to vermis (median segment of cerebellum) →ataxia
gait ataxia but it can not enable
on both sides (truncal ataxia)
me to differentiate between
cerebellar or sensory ataxia.

3- Walk on tip of toes


Useful in emphasizing simple lordosis (increased anterior curvature of spinal cord)
Seen in achondroplasia & peripheral neuropathy

4- Walk on Heels In foot drop the patient slaps his


Useful in emphasizing mild foot drop → mild motor foot on the ground as he walks so
that the gait in foot drop is called
peripheral neuropathy
slapping gait
Poliomyelitis → unilateral foot drop

5- Romberg’s test If unsteadiness is noticed before


closing the eyes → Cerebellar ataxia
a- Stand up straight
b- Feet close together
c- Arms straight forward & fingers separated If unsteadiness is noticed after
d- Keep this position few seconds then close his eyes closing the eyes → Sensory ataxia
(impaired proprioceptive or what is
called joint receptors)
6- Gower’s test Normally → stand up easily
a- Squat with the hands behind the head
Proximal myopathy → can’t, climb up using
b- Ask him to stand up nearby objects

DDx of proximal myopathy is wide, including:


a- Duchenne muscular dystrophy
b- steroid (drug-induced)
c- autoimmune polymyopathy
d- osteomalacia

Gait Abnormality

1- Hemiplegic Gait (Circumductive gait/spasticity)

a- Flexion of hand
b- Extension of the lower limb

Causes: after stroke (due to corticospinal lesion)

‫ حيصير‬upper ‫ بال‬pyramidal tract lesion‫الن عادة بال‬


flexor stronger than extensor‫ال‬
extensor stronger than flexor‫ ال‬lower ‫اما بال‬

2- Shuffling Gait

a- Small short steps


b- Loss of arm swing

Causes:
a- Parkinson’s disease
b- Extrapyramidal lesion

‫ ينحني ليكدام‬rigid‫ تكون‬trunk ‫هذا ينحني ليكدام الن عضلة ال‬


‫ يكوم يمشي اسرع حتى ليوكع و يوزع الشغل‬gravity ‫ويه‬

Small steps then large & fast steps

In parkinson’s → rigidity in proximal muscles


other than distal
3- Wide Based Gait Cerebellar ataxia:
‫ يمشي خطوات جبيرة‬.‫ما يكدر يسد رجله‬ a- Wide based gait
b- Ataxic gait

Causes: (lesion in the cerebellum) (broad stand, they can’t stand


a- Bilateral cerebellar hemisphere normally, tend to fall)
b- Vermis of the cerebellum is involved (Truncal ataxia) ‫ و همين‬ipsilateral

4- Ataxic Gait
‫يترنح ويه المشي على جهة‬

Causes:
Cerebellum lesion (unilateral)

‫ و يكون الترنح على الجهة المضروبة‬ipsilateral

5- Waddling Gait (Myopathic gait)

‫يمشي مثل البطة‬


‫المريض يميل الن العضلة القريبة ضعيفة‬
‫فيحاول يخلي القوة على العضلة األعلى‬
‫فيميل من جهة بعدين يميل على الجهة‬
‫الثانية‬

Causes:
a- Pregnant
b- Proximal weakness
(hypothyroidism, osteoporosis,
osteomalacia)
6- Stomping Gait (foot drop) → sensory ataxia
‫يطب رجله بالكاع‬

Causes:
a- distal nerve injury
b- Loss of position & vibration
sensation → peripheral
neuropathy, B12 Deficiency

7- Steppage Gait (Neuropathic gait)


They can’t dorsiflex because their foot is very relaxed

Causes:

a- Peroneal muscle atrophy or peroneal nerve injury, as with a


spinal problem (such as spinal stenosis or herniated disc

b- Charcot mary tooth disease

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