A patient is asked to prepare a sandwich in order to test her ability to perform a sequence of acts. This test is aimed at demonstrating which of the following?
A. Ideational apraxia is an inability to correctly sequence a series of goal-directed acts in spite of the ability to execute the instructions when broken down into single acts. Asking the patient to demonstrate how to prepare a sandwich for lunch is a good test of ideational apraxia because it tests for a sequence of acts. Ideational apraxia is most often associated with dementia. Patients with conceptual apraxia suffer from difficulty in understanding the concept of using tools. Hence they will fail in tests for ideomotor apraxia. Unlike patients with conceptual apraxia, those with ideomotor apraxia have preserved concepts of using tools, but they cannot perform the action when required. Patients with limb-kinetic apraxia demonstrate a loss of dexterity and ability to make finely graded, precise, independent finger movements. They will not be able to employ pincer grasp to pick up a penny. They will also have trouble rotating a coin between the thumb, middle finger, and little finger. Limb-kinetic apraxia most often occurs in the limb contralateral to a hemispheric lesion.
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Syndrome of isolated loss of auditory comprehension and repetition, without any abnormality of speech, naming, reading, or writing is suggestive of which of the following?
A. Pure word deafness is a syndrome of isolated loss of auditory comprehension and repetition, without any abnormality of speech, naming, reading, or writing. Pure word deafness is caused by bilateral or sometimes unilateral lesion, isolating Wernicke’s area from the input of both Heschl’s gyri. Wernicke’s aphasia presents with logorrhoea, neologisms, and paragrammatism. Most patients have no elementary motor or sensory deficits. It may be associated with right homonymous hemianopia or upper quandrantanopia. The language disturbances seen in Wernicke’s aphasia may be difficult to distinguish from those of schizophrenia. People with Broca’s aphasia show agrammatism. Reading is often impaired in Broca’s aphasia despite preserved auditory comprehension. It is associated with right hemiparesis, hemisensory loss, and apraxia of the non-paralysed left limbs. Patients with motor aphasia have higher risk of depression. In transcortical aphasia the features of Broca’s and Wernicke’s aphasias are combined but with intact repetition. Lesions producing transcortical aphasia disrupt connections from other cortical centres into the language circuit. Anomic aphasia refers to an aphasic syndrome wherein naming is the principal deficit. Anomic aphasia is related to dominant angular gyrus lesion and may be accompanied by dominant parietal lesions.
A well-educated solicitor develops a sudden cerebrovascular defi cit which results in loss of ability to read or write, though he is able to speak reasonably well. The dysfunction produced by the ischaemia is called:
A. Alexia is the acquired inability to read. Alexia with agraphia is seen in angular gyrus lesions and is associated with Gerstmann syndrome. Alexia with agraphia is seen in insufficiency of vascular supply to territories of angular branch of middle cerebral artery. Patients with alexia without agraphia can write reasonably but cannot read written language. Left posterior cerebral artery insufficiency is associated with alexia without agraphia. This leads to infarction of the medial occipital lobe, the splenium of the corpus callosum, and often extending to the medial temporal lobe. Comprehension is preserved in conduction aphasia. In global aphasia, speech production will be impaired. Conduction aphasia is a result of a lesion in the arcuate fasciculus. Writing and spontaneous reading (not repetition) is preserved in isolated conduction aphasia.
Which of the following is NOT a feature of upper motor neurone lesion?
E. Muscle atrophy, fasciculations, absent refl exes, and hypotonia are features suggestive of lower motor neurone lesion. Features suggestive of upper motor neurone lesion include absence of fasciculations, hypertonia, minimal wasting of muscles, and exaggerated deep tendon refl exes. Corticobulbar and corticospinal tracts are the major upper motor neurone tracts while all peripheral and cranial nerves with motor components perform lower motor neurone function.
A 65-year-old patient has been drinking nearly 80 units of alcohol a week for the last 13 years. He has numerous physical complications of alcohol use including cirrhosis and cerebellar degeneration.
Which of the following is NOT a feature of cerebellar dysfunction?
A. Cerebellar limb ataxia is characterized by dysmetria (past pointing), intention tremor, dysdiadochokinesia, and excessive rebound of outstretched arms against a resistance that is suddenly removed. It is also associated with hypotonia and pendular deep tendon refl exes. Asymmetric cerebellar pathology can cause lateralized imbalance with nystagmus, which is present even when eyes are open. This is not Romberg’s sign. Romberg’s sign refers to prominent postural instability in patients with dorsal spinal column damage when attempting to stand with eyes shut.
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