Mental status exam

lvl of alertness, attention, cooperation

tests: spell short word, repeat sting of integers, name all months (all forward and back)

LOC

impaired w/ brainstem reticular formation damage and in bilat lesions of thalami or cerebral hemisphere

orientation

test: ask for full name, location, date (A&Ox3)

recent memory

test: ask pt to recall 3 items or brief story after 3-5 mins delay

remote memory

test: ask about historical or verifiable personal events

recent memory

damage to limbic memory structures located in medial temporal lobes and medial diencephalon

anterograde amnesia

difficulty remembering new facts/events occurring after lesion onset

retrograde amnesia

impaired memory of events of a time period immediately before lesion onset, w/ relative sparing of earlier memories

calc, right/left confusion, finger agnosia, agraphia

4 parts of gerstmann’s syndrome

gerstmann’s syndrome

lesion of dominant parietal lobe

apraxia

inability to follow a motor command due to deficit in higher-order planning or conceptualization (not due to primary motor deficit or lang impairment)

apraxia

test: ask pt to complete complex tasks (pretend to comb hair, strike match/blow it out)

hemineglect

abnorm in attention to 1 side; not due to primary sensory/motor disturbance

sensory neglect

pt ignores visual, somatosensory, or auditory stim on affected side, despite intact primary sensation

extinction

double simultaneous stim

motor neglect

norm strength may be present, but pt often doesn’t move affected limb unless attention is strongly directed towards it

anosognosia

pt unaware of severe deficits on affected side

left side neglect

common in lesions of right (nondominant) parietal lobe

mild right side neglect

left parietal lesion

sequencing tasks and frontal release signs

frontal lobe patho/lesion

perseveration

difficulty changing from 1 action to next when asked to perform a repeated sequence of actions

luria manual sequencing task (for perseveration)

test: pt tap table w/ fist, open palm, side of open hand and then repeat as quick as possible

motor impersistence

form of distractibility which pt only briefly sustain a motor action in response to a command

auditory go-no-go test (for motor impersistence)

tests ability to suppress inappropriate behaviors; pt moves a finger in response to 1 tap on table but must keep it still for 2 taps

abnorm sensory phenomena

caused by focal lesions or seizures in visual somatosensory, or auditory cortex

thoughts disorder

caused by lesion in association cortex and limbic system

mood

imbalances in neurotransmitter systems