Neurosurgery notes/Anatomy/Cortex/Frontal lobe/Frontal lobe examination

Frontal lobe examination

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Frontal lobe

Frontal lobe syndrome

  • Remember as eiffel tower
  • mnemonic: EEFFILLL
  • E-emotional instability
  • E-euphoria
  • F-flight of ideas
  • F-functional abnormality (hyperphagia etc)
  • I-impaired memory
  • L-lack of attention & concentration
  • L-lack of initiative & decrease intellect
  • L-loss of moral & social sense
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Inspection

  • Appearance
    • Abulia
    • Unkempt
    • Inappropriate
    • Verbal dysdecorum
  • Posture/gait—decorticate, 'magnetic'
    • Seen in NPH too
  • Presence/absence of urinary catheter
  • SCARS!

Motor

  • Pyramidal weakness

Frontal eye fields

  • Saccadic eye movements - horizontal
  • Posterior middle frontal gyrus lesion

Speech

  • Broca's aphasia
    • Verbal fluency
      • Come out with as many words starting with a letter within 1 min

Primitive reflexes

  • Moro
  • Palmo-mental
    • The palmomental reflex, an involuntary contraction of the mentalis muscle of the chin caused by stimulation of the thenar eminence, can be tested easily and rapidly
  • Glabellar tap

Anosmia

  • Ask the patient to block one nostril at a time, close their eyes, and present a familiar, non-irritant scent (such as coffee, vanilla, or citrus peel) close to the open nostril.
  • The patient should try to identify or describe the scent.
  • Repeat for the other nostril to compare bilateral function.
  • Do not use irritants like alcohol or ammonia, which may stimulate the trigeminal nerve and give a false impression of olfactory function

Neuropsychological tests—echopraxia,

  • Perseveration
    • Stroop test:
      • Read out a list of coloured words: Green Blue
      • A test of restraint
    • Luria test
        • This tests motor sequencing. Tell the patient you are going to show him a series of hand movements. Without verbal prompting show a sequence of fist, edge, palm, and repeat five times. Ask the patient to do the same.
        • The patient may demonstrate perseveration with repetition of the same movement or be quite unable to do the sequence in order
        LURIA'S TEST FIST EDGE (Bird's Eye View) PALM (Bird's Eye View) 4
  • Conceptualization
    • In what way area a banana and orange different
  • Working memory
    • Telephone number memorization

Urodynamic testing

  • Urine urgency