Makindo Medical Notes

🧠 Cognition

• See dedicated section: Mental State and Cognitive Assessment.
• Core domains include attention, memory, executive function, visuospatial ability, language, and praxis.
• Screening tools such as the MMSE or MoCA help detect global impairment; localisation requires more detailed testing.

🗣️ Dysphasia (Aphasia)

• Covered under Speech and Language Examination.
• Refers to a disorder of language comprehension or production due to dominant hemisphere lesions.

👐 Dyspraxia

• 🧩 Definition: Inability to perform a learned complex motor task despite normal strength, sensation, coordination, and understanding.
• 📍 Usually due to left parietal lobe dysfunction but also seen in dementias and diffuse cortical disease.
• 🧠 Examples of testing:
  • “Show me how you would comb your hair.”
  • “Strike a match, then blow it out.”
  • “Brush your teeth” or “Wave goodbye.”
  • Reproduce complex hand shapes such as interlocking fingers or ‘OK’ sign.
• 🏥 Clinically significant because these deficits impair activities of daily living (ADLs) — frequently identified by occupational therapists during functional assessments.

✍️ Dyslexia and Dysgraphia

• 📚 Dyslexia: Impaired reading or decoding of written words.
• 📝 Dysgraphia: Impaired writing and spelling despite preserved motor function.
• Both result from dominant parietal (angular gyrus) lesions and commonly accompany dysphasia/aphasia.
• They may coexist in degenerative syndromes such as primary progressive aphasia.

🧍 Apraxia

• Refers to inability to carry out specific skilled acts despite intact cognition, sensation, and power.
• Dressing Apraxia: Puts clothing on incorrectly (e.g. trousers on over the head).
• Ideomotor Apraxia: Cannot perform purposeful gestures (e.g. brushing hair) on command — due to dominant parietal injury.
• Functionally important because it directly impacts self-care and independence.

🕶️ Agnosia

• Inability to recognise or identify objects despite intact sensory function.
• Example: unable to identify a £1 coin or a key placed in the hand (astereognosis).
• Usually from a contralateral parietal lobe lesion — often right-sided for visuospatial agnosias.

🙈 Anosognosia

• Patient lacks awareness of their own neurological deficit.
• Common with right parietal or frontal strokes.
• Typical scenario: severe left hemiparesis but insists they can walk → high risk of falls.
• Clinically important because such patients may refuse treatment or be prematurely discharged if the deficit is not recognised.

👁️ Extinction Phenomenon

• When identical stimuli are presented bilaterally (visual or tactile), the patient only perceives the stimulus on the unaffected side.
• Suggests a contralateral parietal lobe deficit, classically the right parietal lobe → left sensory neglect.
• Bedside test: touch both hands simultaneously — patient reports feeling only one.

📘 Summary Table – Higher Cortical Deficits (Parietal Lobe)

📚 References

• Ropper & Samuels, Adams & Victor’s Principles of Neurology, 12th ed.
• Oxford Textbook of Clinical Neuropsychology (2023).
• NICE NG128: Stroke and TIA in Over 16s: Diagnosis and Initial Management.
• British Society of Rehabilitation Medicine: Neurorehabilitation Standards (2022).