The clinical sign of finger–nose ataxia is seen in lesions of which of the following structures?
D. Inferior olivary lesions lead to appendicular ataxia which can be tested using the finger– nose test. The inferior olivary nucleus serves motor coordination via projecting climbing fibres to the cerebellum. Isolated lesions of superior colliculus result in defective visual saccades. Subtle auditory defects are noted in similar lesions of the inferior colliculus. Pyramidal decussation carries corticospinal fibres; damage to the corticospinal fibres rostral to (above) the pyramidal decussation results in contralateral motor deficits, while lesions below the decussation result in ipsilateral deficits. Thalamic damage often results in sensory deficit syndromes.
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A patient is observed to be repeating the phrases or words spoken by the examiner.
Which of the following can cause this phenomenon?
E. Echolalia is the phenomenon where the patient repeats words or phrases said by the examiner; palilalia is the phenomenon where the patient repeats words or phrases that he has uttered himself. In patients who develop both phenomena, echolalia precedes the onset of palilalia. Common causes of echolalia include the transcortical aphasias and disorders that affect the basal ganglia–frontal circuit. Echolalia could be due to a frontal executive deficit, leading to failure of environmental autonomy and resulting in echoing of perceived environmental stimuli. Palilalia should be distinguished from stuttering and logoclonia (repetition of the fi nal syllable of spoken words). Echolalia may be observed as part of speech disturbances in catatonic states.
Neuropsychiatric Interview (NPI) is often employed in patients with dementia or cognitive deterioration to detect psychiatric and behavioural problems.
Which of the following is not tested by the NPI?
E. Orientation is a measure of cognitive function. NPI is used for the assessment of thought disturbance, perceptual disturbances, affect, abulia, agitation/aggression, disinhibition, appetite disturbance, sleeping pattern, and aberrant motor activity in patients with dementia/cognitive deficits. It does not test cognitive functions such as memory or orientation.
Regarding handedness, which of these statements is true?
D. Hemispheric dominance is clinically inferred by handedness. It is a peripheral indicator of cerebral hemispheric language lateralization. Handedness is now considered to exist as a continuum, from extreme unilateral hand dominance on one end to ambidexterity on the other. In this respect, the Edinburgh Handedness Inventory is a semiquantitative measurement of handedness. It is thought that at least 90% of the human population is right-handed. Of these, 95% are left-hemisphere dominant. Approximately 10% of the human population is left-handed and of these at least 60% are left-hemisphere dominant. Left-handers are more likely to have bilateral language representation.
A patient with a history of traumatic brain injury undergoes neuropsychological testing. In part A of the test he is asked to connect numbered circles on a paper as fast as he can in correct order, using a pen. In part B of the same test the same task is repeated but numbers and alphabets occur in alternate sequences.
Which of the following statements is correct with regard to this test?
D. This test is called the trail making test. It is not only a test of attention, but it also tests visuomotor tracking and cognitive flexibility (part B). Trail making test A requires the subject to connect numbered dots. Trail making test B requires the subject to connect alternating alphabets and numbers. This tests the ability to shift mental sets and hence to some extent corresponds to executive functioning. This has been shown to be sensitive to change in patients with progressive cognitive decline (e.g. dementia). Patients with traumatic brain injury perform slower on trail making tests.
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