ANATOM

Y
 Boundaries
1. Anterior -Central sulcus & its imaginary
2. continuation over inner paracentral lobule
medially
3. Posterior- parieto occipital sulcus on mesial
4. aspect & its continuation (imaginary) to join
pre-occipital notch inferolaterally
5. Lower- Sylvian fissure & its imaginary extension
backwards
FUNCTIONS
SUPERIOR PARIETAL LOBULE AND AREA 7

Information processed in primary and

association areas is transmitted to area 7,
where polymodel association takes place.
Area 7 is the highest level of somasthetic
integration. (also have connections with all
lobes).
3 D analysis of body space interactions (body
schema) Visual spatial properties
Visual attention
PRIMARY SOMASTHETIC AREA

Body image representation

• Afferents - VP nucleus of thalamus
• Efferents - to SPL (area 5)
- some to opp. Somatosensory cortex
via corpus callosum.

SOMASTHETIC ASSOCIATION AREA

Body in space
Tactile discrimination
Areas 5 and 7

have connections with premotor and motor

cortex - so, lesions I/t disturbances in
voluntary movement.
also have connections with cingulate gyrus
and prefrontal cortex . Therefore they mediate
influence of emotion, attention and
motivation on behavior - produced by
somatosensory & visual stimuli.
INFERIOR PARIETAL LOBULE

Last to mature anatomically and functionally.

So, the functions are late, to develop b/w 5 and 8 yrs
age. (reading , calculations )
Angular gyrus & Supra-marginal gyrus
they have interconnections with visual, auditory,
somasthetic, supr. colliculus, LGB and other lobes.
CLINICAL EFFECTS OF
PARIETAL LOBE LESIONS
1. CORTICAL SENSORY
SYNDROMES
2.ASOMATAGNOSIAS
3.APRAXIAS
4.VISUAL DISORDER
5.AUDITORY NEGLECT
CORTICAL SENSORY SYNDROMES

Cortical defect is essentially one of sensory

discrimination i.e impaired ability to integrate and
localize stimuli.
1.Loss of position sense and passive
movement.
2.Topagnosia - loss of localization of tactile,
thermal and noxious stimuli.
3. Astereognosis.
4. Agraphesthesia.
5. Loss of 'two point' discrimination.
This type of sensory defect is sometimes
referred to as "cortical", although it can be
produced as well by lesions of the subcortical
connections.

The perception of pain, touch, pressure,

vibratory stimuli, and thermal stimuli is
relatively intact in parietal lobe lesions.

Pseudothalamic pain syndrome : burning or

constrictive pain, identical to the thalamic pain
syndrome, resulted from vascular lesions
D. Double simultaneous stimulation:
• Pin prick used (both must be equally sharp).
• Eyes to be closed
Pt is told to expect sensation either one side or both sides.
After stimuli, ask to indicate site of stimulus and their
nature.
● Sensory extinction
● Sensory inattention
● Sensory suppression
● Sensory eclipse
● Tactile inattention
● Perceptual rivalry
POSITIVE test - stimuli on involved half is ignored or
● CORTICAL SENSORY SYNDROMES
● ASOMATAGNOSIAS
● APRAXIAS
● VISUAL DISORDERS
● AUDITORY NEGLECT
Tests for cortical
sensations
• Basic sensations must be intact.
A. Two point
discrimination :
Calipers or compass
used.
Sites - palms (8-15 mm), dorsum (2-
3cm),shins(3-4cm)
● * Ask pt. to close eyes - respond as 'one' or
B. Graphesthesia :
done with pencil or swab stick. sites - palms,
fingers and face.
● Digits like 1-9, or shapes/symbols
used.
● Stand beside the pt and face the area to be
tested (so that he will be familiar).
 C. Stereognosis :
● no preliminary visual demo
given.
● ex: key, pen or coin
● • abnormal side done first and then
normal
side.
 Asomatagnosias

● The termasomatognosia denotes the inability to recognize part

of one’s body

● Visual and tactile sensory information is synthesized

during development into a body Schema.
(perception of one's body and the relations of bodily parts to
one another)
 ANOSAGNOSIA: Unilateral asomatagnosia, Anton-Babinski
syndrome (Denial of illness)

•Denial is more implict than explict, in many pts. (i.e they may not
actively deny that they are ill) And some may act as if nothing were
the matter.
• 7 times more frequent with Rt. sided lesions than left.
•Ass. with blunted emotionality - pts look dull, inattentive and apathetic.
And also confused.
•Ass. with hallucinations of movement and allocheiria (one sided stimuli
are felt on other side)
HEMI NEGLECT: Neglect on one side of body in dressing
and grooming.

● Shave only one side or use only one sleeve of shirt.

● •Deviation of head and eyes to side of lesion
● Torsion of body to the side of lesion.
● V Fail to use one side of body, even though paralysis is not
present
● •Finds impossible to wear eye glasses.
● •Sensory extinction - is subtle form of neglect.
 Right Parietal lobe lesion

Two drawings that were made by a patient with spatial neglect. The
patient was asked to copy the two models (clock, house). In each
case, the copies exclude important elements that appeared on the left
side of the model, indicating that the patient was unable to process.
 GERSTMANN SYNDROME

•An example of bilateral asomatognosia and is dueto a left dominant

parietal lesion.

1. Finger agnosia
2. Right-left confusion
3. Acalculia
4. Dysgraphia
•May be ass. with dyslexia or homonymous hemianopia /
quadrantanopia.

*Lesion - left inferior parietal lobule (angular gyrus).

 Tests for calculations

*Components - Rote tables (add, multiply, etc) Recognition of

signs (+ , -, *)
Basic arithmetic(carrying, borrowing)

Spatial alignment of written calculations

• Verbal rote examples: what is 4 plus 6 ?
• Verbal complex examples: what is 21 * 5?
• Written complex examples:

• Pt with rt. hemisphere lesion & left neglect.

•Pt with rt. parietal hematoma - showing poor alignment and

calculation errors.
•Lt parietal lesions - inability to understand and carry out
numericals.
Severe acalculia = Anarithmetria.

•Rt parietal lesions - inability to align numbers and to do complex

computations ( borrowing, carrying, etc).
But, pt can do problems in his head.
 Tests for right - left confusion
Identification on self
ex: show your left foot.
• Crossed commands on self
ex: with your right hand touch your left ear
• Identification on examiner
ex: point my right elbow
• Crossed commands on examiner
ex: with your left hand point my right foot.
 Tests for finger agnosia
Inability to name, point or recognize fingers
on oneself or others.
1. Non verbal finger recognition:
with pt eyes closed, touch one of his fingers. Ask
him to touch the same finger of examiner, with
eyes open.
2.Identifying named fingers on examiner's hand:
examiner places hand in some irregular
position and asks pt -" point to my middle finger"
3.Verbal identification (naming) of fingers :
either examiner's or pt's hand kept in an irregular
position. Examiner points to a finger and
asks him - "name this finger?"
● CORTICAL SENSORY SYNDROMES
• ASOMATAGNOSIAS
• APRAXIAS
• VISUAL DISORDERS
• AUDITORY NEGLECT
 APRAXIA AND PARIETAL LOBE
An inability to carry out a commanded task despite the retention
of motor and sensory function
• Sensory guidance of movement is lost
• Defect - unable to show, but uses the object.
- unable to do whole task, but does individual tasks.
•Failure to conceive or formulate an action, either spontaneously or
on command.
•Sensory areas 5 and 7 in dominant parietal lobe, supplementary and
premotor cortex of both cerebral hemispheres and their integral
connections - are involved to accomplish these actions.
1. Ideomotor apraxia *
2. Ideational apraxia *
3. Buccofacial apraxia *
4. Constructional apraxia
5. Dressing apraxia
 IDEOMOTOR APRAXIA ("how to do")

Most common type of apraxia

i. Buccofacial apraxia (blowing a match)

ii. Limb apraxia (flip a coin, comb hair )
iii. Whole body apraxia (stand like boxer )

• Commands to be alternated b/w right and left

limbs.
 IDEATIONAL APRAXIA ("what to do")

• Disturbance of complex motor planning of a higher order .

• Pt able to do individual tasks, but cannot integrate them as
a whole.
.'Conceptual apraxia' - there is apparent inability to recognise
the use of objects (object agnosia).
ex: pt attempts to light a candle by striking it on matchbox
Praxis testing done in an order)
1. Observe the actions - shaving ,dressing, eating.
2. Carry out familiar acts - blow a kiss, wave gudbye.
3. Imitate the examiner ('do this after me')
4.How to use objects (pantomime) simple acts -
hammer nail, comb hair .
complex acts - light and smoke cigar;
open soda bottle, pour in glass and drink.
5. Demonstrate use of actual items
CONSTRUCTIONAL APRAXIA • Constructional
ability/praxis = visuoconstructive
ability - high level non verbal cognitive function.
[ ] • Perceptual motor ability involving
integration of occipito - parieto - frontal
connections.
• Non dominant parietal lobe is imp. for this.
•Area 17 -> IPL (kinesthetic analysis of visual
patterns done here)
->Premotor area
•Connections with frontal and occipital lobes provide
necessary proprioceptive and visual information - for
movement of body and manipulation of objects
or constructional activities. Parietal lobes are principle
areas of visual -
motor integration.
Tests of constructional
•
ability
Reproduction drawings
: given in order of
complexity
Tests for visual disorders
• Visual field testing

• Visual neglect :
- casual observation of pt's
behaviour.
- drawings made by the pt.

Visual inattention

•Topographagnosia: tests for

geographic disorientation.
Tests for geographic disorientation
•Geographic orientation is function of
parietal lobe and its multimodal association
area.
•Combination of processes - spatial orientation,
right-left orientation ,visua
perception
and its memory.
1. History from relatives:
Does he becomes lost in work? Does he have difficulty in
orienting to new
environment?
2.Localizing places in maps: Adequate literacy level and
historical knowledge
is necessary.
ex: to locate cities or states on maps.

3. Ability to orient self in hospital:

By observing the pt's capacity to find
their bed, ward and bathroom.
• CORTICAL SENSORY SYNDROMES

•ASOMATAGNOSIAS

•APRAXIAS

• VISUAL DISORDERS

•AUDITORY NEGLECT
AUDITORY NEGLECT

•This defect in appreciation of the left side of the environment is

less apparent than is visual neglect.

•Many patients with acute right parietal lesions are initially

unresponsive to voices or noises on the left side.
• Main lesion usually lies in the right superior lobule.
SUMMARY
EITHER PARIETAL LOBES (Rt. or Lt.)

1. Loss of cortical sensations.

2. Mild hemiparesis, hypotonia and hemiatrophy.
3. Hemianopia / quadrantanopia .
4. Visual inattention.
5. Abolition of optokinetic nystagmus.
6. Hemineglect ( more with Rt. parietal lobe
lesions ).
 DOMINANT PARIETAL LOBE

Additional phenomenon include,

1. Disorders of language ( anomia, aphasia, alexia,
agraphia).
2. Gerstmann syndrome
3. Tactile agnosia (bimanual astereognosis)
4. Bilateral ideomotor and ideational apraxia.
NON DOMINANT PARIETAL LOBE

Additional phenomenon include,

1. Visuospatial disorders
2. Topographic memory loss
3. Anosagnosia
4. Dressing and constructional apraxias.
Thank you