Parietal lobe

Parietal lobe borders

• Anterior border: central fissure
• Ventral border: sylvian fissure
• Posterior border: parieto-occipital sulcus
Anterior
Posterior
Anterior SPL

IPL
Functional areas
Structural area Functional area Function
Anterior parietal Primary sensory (1, Sensation
2, 3)
Superior parietal Sensory association Cortical sensory,
lobule (5, 7) Asomatagnosia,
Apraxia, Neglect
SPL+IPL Dorsal stream visual Visuospatial
execution
Inferior parietal Dorsal stream Auditory agnosia
lobule auditory (temporo-
parietal)
Sensory speech Agraphia, alexia
areas (39, 40)
Parietal exam
Left (more verbal) Right (more visuospatial)
Sensation Right PP, LT, 2-point, temp, Left PP, LT, 2-point, temp, vibration
vibration
Agnosia R cortical sensation (tactile L cortical sensation (tactile
agnosia), Gerstmann (finger agnosia), Anosognosia
agnosia, L-R, acalculia, agraphia)
Neglect R visual, auditory, tactile L visual, auditory, tactile (MC?)
Apraxia Ideomotor, ideational Dressing, construction
Visuospatial Execution: copy cube, clock
drawing
Language and auditory agnosias Transcortical sensory, naming,
reading, writing
CN 2 – inferior quadrantanopia 2 – inferior quadrantanopia
Parietal lobe exam
• Intro
• Screen
• Observation
• LAABS
• Focused MSE
• Cortical sensory
• Asomatognosia
• Visual neglect and executive function
• Language and auditory agnosia
• Calculations
• Apraxia
Screen
• ID/first language/highest education/handedness
• Vision: include VF (comment on quadrantanopia), extinction
• Auditory: include extinction
• Motor: prox/distal, UL+LL, tactile extinction
• Comprehension
Observation
• What brings you in to the hospital
• What kind of problems are you having because of your injury – anosognosia
• How does that make you feel – anosodiaphoria

• Comment on:
• LOC
• Affect and mood: may be blunted, dull, apathetic with anosognosia
• Appearance: neglecting one side of body
• Behaviour
• Speech
Parietal lobe exam
• Sensation
• Agnosias
• Cortical sensation
• Asomatognosia - Left: Gerstmann
• Asomatognosia - Right: anosognosia, anosodiaphoria
• Apraxia:
• Left: IM/IA/conceptual
• Right: dressing/constructional
• Neglect (R parietal)
• Visuospatial
• Language
• Cranial nerves
Cortical sensation
• Agraphesthesia (bilat): write number/letter on dorsum of hand
• Astereognosia (bilat): key/pen/coin in abN hand first
• 2-point discrimination (left): palm, dorsum, shin
• Topagnosia (right): touch part of pt’s body and ask them to point to
where you touched
Asomatagnosia
Left Right
• Gerstmann’s: • Anosognosia: denial of illness
• L-R confusion • Anosodiaphoria: aware of deficit
• Finger agnosia but no emotional concern
• (Acalculia)
• (Agraphia)
Calculations
• Verbal – left
• Simple: 4+6
• Complex: 21*5
• Written – right
• Simple: 2+3
• Complex: 52-25: Includes spatial orientation,
alignment, borrowing numbers
Apraxia
Left Right
• Ideomotor • Dressing
• Ideational • Constructional
• Conceptual
Neglect (R>L)
• Extinction: visual, auditory,
tactile (tested)
• Paper tests:
• Line bisection
• Cancellation test
Neglect (R>L)
• Visual neglect • Visual neglect + execution
Visuospatial and visual disturbances
• Visuospatial execution – right (also frontal)
• Clock drawing, copying cube
• Topographagnosia – right
• Loss of spatial localization, gets lost in hospital, difficulty with N/S/E/W
• Visual agnosia – right (more occipital than parietal)
• Apperceptive: can’t name or use when shown object, but can name or use when tool is in hand
• Can’t recognize object, can’t describe scene, can’t copy
• Associative: can’t name but can use when shown object
• Can’t recognize object, can describe scene, can copy
• If you want to include visual disturbances here:
• Quadrantonopia
• Abolition of optokinetic nystagmus
Auditory agnosias
• Temporal-parietal
• Auditory agnosia – left
• Difficulty distinguishing speech and non-speech sounds
• Ex: can’t tell if sound of rain or sound of car
• Auditory verbal agnosia – left
• Pure word deafness
• Hearing intact, but can’t recognize spoken words as semantically meaningful
• Cortical deafness – left
• Doesn’t perceive auditory info but hearing intact
Language
• Alexia, agraphia – left
• Naming, fluency, comprehension, repetition
• Repetition – conduction aphasia
• Comprehension – transcortical sensory
Other motor things to consider
• Mild hemiparesis, hypotonia, hemiatrophy
• Fixed dystonic postures
• Coordination
• Optic ataxia
• Pseudocerebellar syndrome
Parietal syndromes
• Balint’s syndrome: (bilateral parieto-occipital lobes)
• Oculomotor apraxia: inability to voluntarily guide eye movements, especially
saccades (vertical preserved)
• Optic ataxia: inability to move hand to specific object using visual information
• Clumsiness reacihgn for objects
• Simultagnosia: inability to perceive more than one single object at a time
• Parietal ataxia:
• Pseudocerebellar syndrome: incoordination and intention tremor of
contralateral limb
• Sensory ataxia
Left vs right parietal
Left
• Cortical sensory: 2pt
• Gerstmann’s
• Apraxia: IM/IA/concept
• Language: alexia, agraphia
• (auditory agnosia)
Right
• Cortical sensory: topagnosia
• Anosognosia
• Neglect
• Apraxia: dressing, construction
• Visuospatial execution
• (visual agnosia)