U NIVERSITY OF N ORTHERN P HILIPPINES MED2C

M E D I S I N A 2 0 2 1
CENTRAL SULCUS of Rolando
SUBJECT : NEUROLOGY -separates the frontal lobe and the rest of
TUTOR : DR. ELTON ONG the cerebrum

Head Notes: FOUR LOBES of the CEREBRUM

 TITLE/EMPHASIZED  Occipital :visual - sensory
 AUDIO(Verbatim/Non Verbatim)  Temporal :hearing -sensory
 NOTES/RECALLS  Parietal :touch -sensory
 Frontal :motor
THE NEUROLOGICAL EXAMINATION
PREFRONTAL CORTEX in
-the most anterior portion of frontal lobe
which is responsible for the higher cortical
functions or executive functions or higher cognitive
functions.

SAGITTAL CUT OF THE BRAIN Level of Consciousness

• Awake and alert (conscious)
THE NEUROLOGICAL EXAM • Agitated, delirium
• Lethargic
• MENTAL STATUS – Arousable with
• CRANIAL NERVES • Voice (drowsy)
• MOTOR EXAM • Gentle stimulation (obtunded)
- OBSERVE, TONE, STRENGTH, • Painful/vigorous (stupor)
Abnormal movements • Comatose
• CEREBELLAR/ • USE GLASGOW COMA SCALE
• GAIT, stance posture
• REFLEXES Consciousness: awake and alert (midbrain and
• SENSATION upper portion of pons); reticular formation -> ARAS
• MENINGEAL SIGNS (Ascending Reticilar Activating System)-> cerebrum
(awareness)
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 U NIVERSITY OF N ORTHERN P HILIPPINES
M E D I S I N A
Abnormal flexion/ Decorticate:
- UL flexed; LL extended
 Presence of lesion above the
brainstem
 Intact brainstem
Abnormal extension/ Decerebrate:
-all extremities extended
 Brainstem is affected
 Nothing much can be done to
save the patient
MENTAL STATUS
 CONCENTRATION
-ability to focus in a particular task
– Serial 7’s or 3’s
– “WORLD” backwards
– Months of the Year Backwards
– Try to quantify degree of impairment
A and O and Concentration need to be intact for
other aspects of the Mental Status Exam to have
localizing value!
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MED2C
2 0 2 1
 MEMORY
 Immediate- test attention, memory,
and concentration
- REALLY A MEASURE OF ATTENTION
RATHER THAN MEMORY
- 3 OBJECTS AT 0/3/5 MINUTES
 Short Term
 Remote/Long Term
- HISTORICAL EVENTS
- PERSONAL EVENTS
• Amnesia vs dementia
• Anterograde vs retrograde amnesia
Amnesia (pure memory loss)
 Anterograde-unable to learn NEW things
 Retrograde- cannot recall PAST events
Dementia
- memory loss with the involvement of
the higher brain/ cortical functions; more
severe
 Alzheimer’s disease
- most common cause of Dementia
 Confabulation
- making up of stories due to
embarrassment done by memory
loss.
 Aprasia
- a type of dementia
- inability to carry out complex act;
generally normal
 ORIENTATION
 Person
-Not Who They Are But Who You Are
 Place
 Time
 U NIVERSITY OF N ORTHERN P HILIPPINES MED2C
M E D I S I N A 2 0 2 1
• Patient is awake but cannot understand and
 LANGUAGE speak/ talk
 Fluency 4. Conduction aphasia (arcuate fasiculus)
 Naming • Inability to repeat
 Repetition 5. Anomia
 Comprehension • Patient has a problem in naming things
 Reading And Writing
WERNICKE BROCA GLOBAL
 Wernicke’s, Broca’s, Conduction,
Global, Anomia Fluency + - -

Dominance: where the language center is located Naming - - -

 Left side: objective thinking Repetition - - -
 Right side: skills and talents
Right handed: left hemisphere (99. 95%) Comprehension - + -
Left handed: left hemisphere (>70%) Reading and writing

Coherent APHASIA vs DYSARTHRIA vs DYSPHONIA

- able to form a thought, process thought
and express it
- coherent: INTACT Broca’s, Wernicke’s, And
Arcuate Fasiculus
WERNICKE’S AREA
- superior part of the temporal lobe
- Sensory center of language;
understanding area
BROCA’S AREA
- inferior part of the frontal lobe
- Verbal output
ARCUATE FASICULUS
- connects the Wernicke’s area to the
broca’s area; transfer information.
LATERAL SULCUS (Fissure of Sylvius)
- separates the temporal and frontal lobes
1. Wernicke’s/ Sensory/ Receptive Aphasia
• Cannot understand but can speak/ talk
2. Broca’s/ Motor/ Expressive Aphasia
• Can understand but can’t speak/ talk
3. Global aphasia (both)
Aphasia: cannot understand or express
Dysarthria: inability to pronounce the words
appropriately; slurring of speech and stuttering
Dysphonia: hoarseness; a problem in voice
production
OTHER COGNITIVE FUNCTIONS/
EXECUTIVE FUNCTIONS
 CALCULATION
 ABSTRACTION
- look beyond what he/she sees
 INTERPRET PROVERBS
 SIMILARITIES/DIFFERENCES
 JUDGEMENT
- How the patient is going to perform/ act
toward a certain situation
 PERSONALITY/BEHAVIOR (Mood vs Affect)
 Mood: cannot be seen; internal
 Affect: outward manifestation of
mood
 INSIGHT- awareness of his/ her disease
TRANSCRIBERS: NADINE,C LAIRE, SYLVIANE

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