Always perform formal visual field testing.
Parietal Lobe
Reception and analysis of sensory information
- Sensory and visual inattention – inattention of contralateral side when both sides tested simultaneously
- Astereognosis – cannot name an object placed in the hand of a patient with their eyes closed
- Agraphism – inability to appreciate a number drawn on palm of contralateral hand to side of lesion
Dominant parietal lobe: Gerstmann syndrome – ALF
- A: Aphasia, Agraphia, Alexia + acalculia
- L: L-R disorientation
- F: Finger Agnosia
Non-dominant parietal lobe:
- dressing apraxia
- + constructional apraxia – inability to draw simple shapes
- spatial neglect
Temporal Lobe
Short- and long-term memory
- Immediate Recall: give a 4-5 digit number and ask to recall it backwards
- Short-term Memory: give the patient your name, address, and the name of three flowers and ask them to recall them immediately and then again 5 minutes later
- Long-term Memory: e.g. What year did WW2 end?
Think: confabulation? Ask the patient if they have met you before.
Frontal Lobe
- Primitive reflexes:
- Grasp Reflex: run fingers across patient’s palm, between their index finger and thumb – impaired contralateral to side of lesion
- Pout and Snout reflex: stroke or tap with tendon hammer over (above) the upper lip – bilateral lesion
- Interpret proverb: patient instead gives a concrete explanation
- Gait Apraxia – marked unsteadiness in walking, feet “glued” to the floor → wide-based shuffling gait (but if you ask the patient to “practice” walking whilst supine, they can mimic walking well)
- Urinary incontinence
- Test for Anosmia
- Fundoscopic examination
- Foster-Kennedy syndrome: frontal lobe space-occupying lesion
- optic atrophy – ipsilateral compression of optic nerve
- papilloedema – contralateral, due to raised intracranial pressure
- Foster-Kennedy syndrome: frontal lobe space-occupying lesion
Parietal Lobe Signs – General Practice Notebook