1. Dominant hemisphere2. Non dominant hemisphere3. Frontal lobe4. Occipital lobe5. Bedside neurocognitive assesment

1. Focal lesion = focal defect2. False localization3. Disconnection syndromes4. Hemispheric specialization :• Handness• Lateralization onset

• Broca’s ( Fluency )• Prefrontal and supplementary motor ( syntax )• Werneck’s ( comprehension )• Tempoparietal ( lexicon )• Angular gyrus ( reading )• Arcuite fasiculus ( werneck’s broca’s )• Carpus callosum ( Lt Rt = emotional )• Subcortical ( thalamus / BG )

• Most commonly MCA ( S.Division ) infarct• ↓ fluency • ↓ syntax• ↓ prosody• ↓ repitition• ↓ naming• Reading / writting : effortful / agrammer• Comprehension intact • Associated with dysarthia & faciobrachial hemiparesis +/-

depression with apraxia

• Most commonly MCA ( I.Division ) infarct• ↓ comprehension• Lexical : meaningless / paraphasia & neologism• ↓ repitition• ↓ naming• normal fluency • normal prosody & syntax• Comprehension intact • Read / write : effortful / agrammer• Associated with homonous hemianopia +/- agitation & paranoid with apraxia

• Recovery pattern :• Global broca’s or wernick’s transcortical

motor or sensory anomic

1. Gertsmann syndrome

2. Apraxia

3. High order deafness : • Cortical deafness• Non verbal auditory agnosia

4. Alexia & Agraphia :• Most commonly associated with aphasia• Alexia with agraphia ( angular gyrus lesion )• Agraphia without aphasia ( inferior parietal lobule lesion• Alexia vs dyslexia

5. Disconnectoin syndromes• Conduction aphasia• Alexia without agraphia• Pure word deafness• Agraphia of the lt dominant hand

• Hemineglect syndromes : Anosognosia & asomatognosi

• Vasiopatial orientaion : integrate multiple sensory input processed in non dominant dorsal parieto-occipital-temporal area ( where center )

• General attention : cortical & subcortical• Rt. Hemisphere : Lt. Attention & Rt. Attention >>> Lt.

Hemisphere .

I. Sensory • Tactile > visual > auditory neglection• Sensory Extinction• Allesthesia• Hemianopia vs visual neglectionII. Motor • Motor extinction• Allokinesia• Spatial akinesia• Encephalic pt tactile response

III. Combination sensory & motor testing :• Pen & paper tests : line bisection test / cancellation tasks• Drawing clock face

IV. Conceptual :• Anosognosia• Asomatognosia• AnosodiaphoriaV. Other manifistations :• Psychiatric manifestations • Bilateral ptosis• Receptive & expressive aprosody • Rare syndromes : Capgras / Fregoli / Reduplicative paramnesia

• Dysfunction ( 5 P’s )• PPersonality dysfunctions• PParaparesis• PParatonia• PPositive primitve reflexes• Gait APPraxia• DDx :• Diffuse : Hydrocephalus, Binswinger ,Toxic, Anoxia• Local : Tumar, ACA-MCA Watershed, A.comm

aneurym/compression• Mimikers : PD, Depression, Catatonia

I. 1ry visual cortex• Hallucination/ migrain aura• Anton’s syndrome • Normal fundus , no RAPDII. I. occipito-temporal syndromes ( what ? )• Proposognosia• Achromatopsia• Color agnosia• Metamophopsia• PalinopsiaIII. L. parieto-occipital Syndromes ( Where ? )• Balint Syndrome : ( simultanognosia / optic ataxia / ocular apraxia )• Cerebral akinetopsia

• Alertness• Orientation• Attention and concentration• Memory• Frontal exécutive fonctions• Dominant hemisphere functions• Non dominant hemishere functions• MMSE

• 45 years old lady K/C/O secondary progressive MS• Admitted with involuntary movement • Past Hx• Started relapsing remitting multiple neurological symptoms since 2002 • Diagnosed as PPMS & Started on INF B injection but was not compliant • Since 2008 disease started to be more progressive , became epileptic • Started on novantron but again didn’t complete the coarse• Gradualy became demented• MRI Brain requested

• Hereditary spastic paraparesis• Leukodystrophies• Mitochondrial syndromes• CADASIL