The Brain & Stroke

Frontal Lobe Function Planning & organisation Fine motor sequencing Impulse control Auditory sequencing Problem solving Abstract thought Reflexes Attention & concentration Verbal fluency Semantic fluency Other = insight, judgement, personality, initiative, motivation, drive, empathy Test Clock face Luria test Tap opposite (1 vs 2) Copy tapping sequence Novel scenario Proverbs Glabellar tap, rooting, grasp Serial 7s, no. – letters Words w/ F,A,S Category eg. Name all fruit

Parietal Lobe Functions – Visuospatial orientation – Object recognition – Ability to read, write & understand numbers – Speech – Manipulating objects

Temporal Lobe Functions – Memory – Auditory perception

Occipital Lobe Vision

Brain Regions Wernicke’s area = superior temporal gyrus Broca’s area = inferior frontal gyrus Primary motor cortex = precentral gyrus (ie. Just anterior to central sulcus) Primary somatosensory cortex = post-central gyrus

Vascular Territories

Questions – Which Lobe? A 67 year old man who is unable to dress himself following haemorrhagic stroke, despite intact sensory and motor function. – Parietal (dressing apraxia) Following an ischaemic stroke, a 74 year old woman has difficulty communicating, using only short words and sentences. She is able to carry out commands normally. – Frontal (Broca’s dysphasia) Following an open head injury, a 34 year old man repeatedly takes off his clothes and is sexually inappropriate toward the ward staff. – Frontal (need to also exclude delirium) A 21 year old woman who presents with recurrent experiences of unusual smells followed by impaired consciousness, motionless staring and lip smacking. – Temporal (temporal lobe epilepsy)

Questions – Which Lobe? A 75y.o lady keeps tripping over objects. She claims she doesn’t even notice them! You notice that she has no problems identifying her cat which is lying down close to her, on her right. – Parietal (Lower quadrantinopia)