Lesson 4: HIGHER PSYCHICAL FUNCTIONS.

QUESTIONS

1. Describe the cortex centre of the speech function. Give the definition of the expressive and impressive speech.
2. Give the definition of different central speech disorders.
3. Where is the motor speech centre located?
4. Where is the sensory speech center located?
5. What names do the different speech centers have?
6. Describe the methods of the examination of speech disturbances.
7. What signs develop after damage of the motor speech centre?
8. Give the definition of the motor aphasia.
9. What signs develop after damage of the sensory speech centre?
10. Give the definition of the sensory aphasia.
11. What does the conductive aphasia mean?
12. Where is the pathological process in conductive type of aphasia located?
13. What does the Brocas aphasia mean?
14. What does the Wernices aphasia mean?
15. Describe different types of apraxies.
16. Describe different types of agnosies.
17. Where is the cortex centre of the gnosis located? Describe the visual and auditory types of agnosies.
18. Describe the methods of examination of different types of apraxies.
19. Give the definition of praxis.
20. What lobe of the brain is dominant in righthanded people?
21. What complex of sign will develop after damage into the left frontal lobe?
22. What kinds of the paresis of the gaze will be after damage into frontal lobe develops?
23. Give the definition of the psychical disorder, which will develop after damage into the frontal lobe?
24. What complex of signs will develop after damage into the left temporal lobe?
25. Describe the special signs of the temporal epilepsy.
26. Describe the clinical picture that will develop after damage of the parietal lobe.
27. Give the description on the damage in occipital lobe.
28. Give the localization of the damage process in presentation of the astereognosis.
29. What complex of signs is develops after damage on the border between parietal, temporal and occipital lobes?

Task 1.

A 59 y/o right-handed man was brought to the emergency room because of sudden onset of disturbance of speech. On examination, he spoke spontaneously and excessively but conveyed little meaning. He used paraphrasias and neologisms. He could carry out only simple instructions. Naming, repetition, and reading were all impaired.

● Define "aphasia", "apraxia", "agnosia", "alexia", "agraphia".

● Describe Broca's vs. Wernicke's aphasia & usual lesion site.

● Give a description and pathophysiological explanation of a "disconnection syndrome".

Lesson 5 : VASCULAR DISEASE . STROKE. INFARCTION OF THE

BRAIN. TIA. Cerebral infarctions.

QUESTIONS

1. Give some conditions which predispose to intracranial hemorrhage (in order

of frequency).

2. Where does hypertensive intraparenchymal hemorrhage usually occur?

3. How does cerebellar hemorrhage develop & why is an early diagnosis important?

4. Where are Berry aneurysms commonly located?

5. List the signs of AVM before and after the rupture.

6. What are the clinic manifestations of subarachnoid hemorrhage?

7. What studies can be done to clarify the diagnosis of SAH?

8. What is the differential diagnosis of SAH?

9. Give secondary complications of SAH.

10. Give several brief recommendations for a management of the

patient with subarachnoid hemorrhage.

Task № 1.

А 55 year old male patient , after waking up, suddenly observed the weakness in the right extremities and speech disturbances.

Objectively: conciseness is clear, the skin has a pallor color, pulse- arrhythmic, the heart tones are deaf, AP – 160\100 mm Hg .

In neurological state: active movements in the right extremities are limited, more – in the arm. Muscle tones and tendon reflexes are increased on the right side. The muscle strength in the right extremities is 3 balls. The right angle of the mouth is lowered. Deviation of the tongue in the right side is present. Hemyhyposthesia on the right side is present, more – in the arm.

1. Where is the pathological object localized?

2. Make a clinical diagnosis.

3. Call necessary neurophysiologic investigation methods.

4. Prescribe a treatment.

Task № 2.

А 52 years old male patient applies to the clinic with a complaint of the pain in the heart region , dull , asphyxia during the night. Somatic state is severe. The skin has a pallor color and the cyanosis is present on the lips moistly. In the lungs – the breathing is weak. The heart borders are widened on the left side. The heart tones are deaf. Pulse- 120 beat per min. AP – 150\80 mm Hg. Liver size is increased by 5 cm lower the rips border. On the 5-th day in the clinic, in patient suddenly developed a short lost of conciseness ( 5 min.) and hemiplegia on the right side.

Objectively: conciseness is clear, motor aphasia, the patient may carry out elementary instructions. The right angle of the mouth is lowered. There is deviation of the tongue in the right side. The active movements in the right extremities are lost; tendon reflexes are increased on the right side. Hemyhyposthesia – on the right side. Meningeal signs are absent. Pulse- 100 beat per min. AP – 120\90 mm Hg.

In ophtalmoscopy- atherosclerotic retinopathy.

1. Where is the pathological object localized?

2. Make a clinical diagnosis.

3. Call necessary neurophysiologic investigation methods.

4. Prescribe a treatment.

Task № 3.

A 56 year old female patient has been transported to the clinic by the emergency ambulance. The patient has mitral valvular heart disease since 17 , rheumatic origin. Today, in the midday, he has developed the plegia on the right side and the speech was distorted, without loss of conciseness

On admission -objectively: lost of the ability to comprehension of the addressed speech, bath he can, t answer the questions, may only pronounce a sound”a“. The right angle of the mouth is lowered. There is a deviation of the tongue on the right side. The active movements in the right arm are lost. Arterial pressure is 120\80 mm Hg .

1. Where is the pathological object localized?

2. Make a clinical diagnosis.

3. Call necessary neurophysiologic investigation methods.

4. Prescribe a treatment.

Task № 4.

A 63 year old male patient has been suffering from arterial hypertonia and atherosclerosis for many years, he was treated an emergency. He was admitted after the acute developed speech disturbances and weakness in the right extremities. It is known, that 3 weeks ago, after the bath with hot steam, he developed nausea, dizziness, weakness in the right arm , disturbances of speech( it was complete pronounce the words) . In the next 10 days the signs gradually regressed. Now, the patient is in clear conciseness, contact is disturbed after the speech disorders: the instructions are carried out correctly. Hemiplegia is on the right side, central paresis of the 7 and 12 pairs of the brain nerves takes place.

1. Where is the pathological object localized?

2. Make a clinical diagnosis.

3. Call necessary neurophysiologic investigation methods.

4. Prescribe a treatment.