PARIETAL LOBE

ANATOMY AND FUNCTIONAL CORRELATION

Presented by

Abdul Qavi
 INTRODUCTION

 The parietal cortex is considered as one of the most complex region

of human brain which is responsible for the integration of various
stimuli .

 Have undergone a major expansion in the course of human

evolution, largely in the inferior parietal region

 Receives, correlates, analyze primary sensory information to

interpret stimulus and aid in discrimination and recognition.
Lobe of the hand
 Defining the lobes

central (rolandic)
frontal lobe sulcus

parietal lobe

occipital
lobe

temporal lobe sylvyan (lateral) sulcus

BOUNDARIES OF THE PARIETAL LOBE
BOUNDARIES OF THE PARIETAL
LOBE

– Anterior border - Central Fissure

– Ventral border - Sylvian Fissure
– Dorsally by the cingulate gyrus
– Posterior border - Parieto-occipital sulcus
SULCI AND GYRI ON THE SUPERO LATERAL
SURFACE

medial
superolateral
 SULCI AND GYRI ON THE VARIOUS SURFACE OF
PARIETAL LOBE
SUPERO LATERAL SURACE
• Post central gyrus( area 1,2,3)
• Superior parietal lobule (area 5,7)
• Inferior parietal lobule
• Supra marginal gyrus - lies around the upturned end of sylvian
fissure.
• Angular gyrus – lies around the upturned end of superior temporal
gyrus.
MEDIAL SURFACE
• Supra splenial sulcus – separate the precuneus from cingulate gyrus
• Precuneus - lies between parieto occipital sulcus and paracentral
lobule
• Isthmus – Separates the splenium of corpus callosum from calcarine
sulcus
 Parietal lobe sulci and gyri
 Post central sulcus – posterior
boundary of somatosensory
cortex.
 Intraparietal sulcus behind
post central sulcus which
divides the parietal lobe into
sup. & inf. Parietal lobule
 Posterior end of sylvian
fissure curves upwards to
terminates into inf.parietal
lobule – surrounding cortex
supramarginal gyrus[SMG 40] Parietal lobe
Parietal lobe sulci and gyri
• Posterior end of sup. Temporal
sulcus – angular gyrus[AG 39]
• SMG & AG =Ecker’s inf Parietal
Lobule
• Ecker’s IPL & post. Third of first
temporal gyrus constitute the
wernicke’language area
• 3,1,2-primary sensory areas
• 5- somatosensory association
area
• 7-somatosensory or
somatosensory/visual
 Parietal Topography

•Postcentral Gyrus (1,2,3)

•Superior Parietal Lobule (5 ,

7)

•Supramarginal Gyrus (40)

•Angular Gyrus ( 39)

Subdivisions of the Parietal Lobes
Functional zones

Anterior zone -1,2,3,

•Somatosensory cortex

Posterior zone -remaining areas

•Posterior parietal cortex

von Economo:

Posterior parietal areas

•PE (5)
•PF(7b)
•PG -Polymodal and asymmetric
larger in right hemisphere
 Subdivisions of the Parietal Lobes
• Visual processing areas
– Intraparietal sulcus (cIPS)
• Control of saccadic eye movements
– Saccade - involuntary abrupt and rapid small movements
made by the eyes when changing the fixation point
• Visual control of grasping
– Parietal reach regions (PRR)
• Visually guided grasping movements
 Connections of the Parietal Lobes

Somatosensory strip
To area PE -Tactile recognition
To motor regions -sensory information about limb position and
movement
•Area PE is somatosensory
–Inputs from the somatosensory strip
–Outputs to primary motor cortex, supplementary motor
cortex, premotor regions, and area PF
•Area PF
Input from somatosensory, primary motor cortex, premotor
cortex, and small visual input through area PG
•Area PG
–Receives complex connections including visual, somesthetic,
proprioceptive, auditory, vestibular, oculomotor, and cingulate
connections
–Parieto-temporo-occipital crossroads
–Part of the Dorsal Stream
•Close relation between the posterior parietal connections and
the prefrontal
Connections of the Parietal Lobes
 A Theory of Parietal Lobe Function
• Anterior zones - process somatic sensations
and perceptions
• Posterior zones - integrate information from
vision with somatosensory information for
movement
• Spatial Map in the Brain?
 NEURO-IMAGING

NORMAL CORTICAL ANATOMY

• The Central Sulcus

• Sagittal
• Axial
• Coronal

NP/MGH
The Central Sulcus

NP/MGH
 The Central Sulcus (CS)*
• superior frontal sulcus - pre CS sign
• sigmoidal Hook sign
• pars bracket sign
• Bifid post-CS sign
• thin postcentral gyrus sign
• intraparital sulcus - post-CS
• midline sulcus sign

*Naidich & Brightbill. Int J Neurorad 1996;2:313-338

NP/MGH
 The Central Sulcus (CS)
• Superior frontal sulcus - preCS sign
– the posterior end of the superior frontal sulcus joins
the precentral sulcus in 85%
Superior frontal gyrus

Superior frontal sulcus

Superior frontal
sulcus

Precentral
sulcus

Precentral
sulcus

NP/MGH
Precentral gyrus Precentral gyrus Central sulcus
 The Central Sulcus (CS)
Precentral gyrus
• pars bracket sign
– The paired pars Superior frontal
sulcus
marginalis form a
“bracket” to each
side of the Precentral
sulcus
interhemispheric
fissure at or behind
the central sulcus
(96%). Central sulcus

Pars bracket Paracentral lobule

NP/MGH
 The Central Sulcus (CS)
Sigmoid “Hook”

– hooklike configuration
of the posterior
surface of the Precentral
sulcus
precentral gyrus
– the “hook”
corresponds to the
motor hand area.
– The “hook” is well
seen on CT (89%)
and MRI (98%).

NP/MGH Central sulcus

 The Central Sulcus (CS)
• Bifid post-CS sign
– the post-CS is bifid (85%).
– The bifid post-CS encloses the lateral end of the pars
marginalis (88%).

Precentral
sulcus

Central sulcus

Precentral gyrus
Postcentral
sulcus
NP/MGH
Pars bracket
Central sulcus Central sulcus Central sulcus

Postcentral Postcentral
Postcentral sulcus
sulcus sulcus

Pars bracket Pars bracket

NP/MGH
The Central Sulcus (CS)
Precentral gyrus

Thin post-CG sign

– the postcentral gyrus is

thinner than the precentral
gyrus (98%).

Postcentral gyrus

NP/MGH
 The Central Sulcus (CS)
Intraparietal Sulcus (IPS) and the post-CS

– in axial MRI, the IPS intersects the post-CS (99%).

Postcentral
sulcus

IPS

IPS

NP/MGH
Pars bracket Pars bracket
 IP
S IP IP
S S
Postcentral
sulcus
Postcentral Postcentral
sulcus sulcus

NP/MGH
 The Central Sulcus (CS)

SFS-preCS sign

Hook sign
Thin postcentral
gyrus sign

Bifid post-CS
sign IPS - postCS sign
Pars bracket sign
NP/MGH
Axial
Neuroanatomy

NP/MGH
 Fusiform gyrus

Superior Temporal gyrus

Middle Temporal gyrus

Inferior Temporal gyrus

NP/MGH
 Superior frontal gyrus Middle frontal gyrus

Inferior frontal gyrus,

pars orbitalis

Lateral fissure

Inferior frontal gyrus,

pars opercularis

Inferior parietal gyrus Insula

Lateral fissure
Cingulate gyrus
Superior temporal gyrus
Parieto-occipital fissure
Superior temporal sulcus

Middle temporal gyrus Calcarine sulcus

Middle occipital gyrus Cuneus

Superior occipital gyrus
Intra-occipital sulcus NP/MGH
 Superior frontal gyrus
Middle frontal gyrus

Inferior frontal gyrus

Central sulcus Postcentral gyrus

Lateral fissure Inferior parietal gyrus

Superior temporal gyrus Lateral fissure

Superior temporal sulcus

Middle occipital gyrus

Intra-occipital sulcus Parieto-occipital sulcus

Superior occipital gyrus
NP/MGH
 Superior frontal gyrus

Middle frontal gyrus

Superior frontal sulcus

Inferior frontal gyrus

Centrum semiovale

Central sulcus
Central sulcus

Postcentral sulcus
Postcentral sulcus

Supramarginal gyrus
Intraparietal sulcus

Angular gyrus

Parietooccipital sulcus Superior parietal gyrus

NP/MGH
Precuneus
 Superior frontal gyrus

Superior frontal sulcus

Middle frontal gyrus

Precentral sulcus

Central sulcus
Precuneus
Postcentral sulcus

Paracentral lobule

Superior parietal gyrus

Intraparietal sulcus
Pars marginalis

NP/MGH
Coronal
Neuroanatomy

NP/MGH
Interhemispheric Fissure
Superior Frontal gyrus
Inferior Frontal gyrus

Middle Frontal gyrus

Inferior Frontal gyrus

Gyrus rectus
Medial Orbital gyrus

Olfactory bulb

NP/MGH
 Superior Frontal
Superior Frontal sulcus gyrus Cingulate sulcus

Middle Frontal gyrus

Precentral
sulcus

Precentral gyrus

Sylvian Fissure

Superior Temporal
gyrus
Superior Temporal Sulcus

Middle Temporal gyrus

Amygdala
NP/MGH Inferior Temporal gyrus
Anterior commissure
 Postcentral gyrus Paracentral lobule Intraparietal sulcus
Intraparietal sulcus Central Sulcus Cingulate gyrus

Supramarginal gyrus

Superior Temporal gyrus

Middle Temporal
gyrus

Inferior Temporal gyrus

Fusiform gyrus
Collateral sulcus
NP/MGH
Parahippocampal gyrus
 Paracentral lobule
Central sulcus

Superior Temporal gyrus

Middle Temporal gyrus

Inferior temporal gyrus

Fusiform gyrus NP/MGH

 Superior parietal lobule
precuneus

Cingulate gyrus Inferior parietal lobule

Lingual
gyrus
Middle occipital gyrus
Calcarine
sulcus

Collateral sulcus

Fusiform gyrus Inferior occipital

gyrus

Lingual gyrus
NP/MGH Tentorium cerebelli
Sagittal
Neuroanatomy

NP/MGH
Superior frontal gyrus Cingulate sulcus
Marginal ramus of
Cingulate sulcus
Cingulate gyrus Paracentral lobule

precuneus

Parietooccipital sulcus

Cuneus

Calcarine sulcus

Lingual gyrus

Subcallosal gyrus
NP/MGH
Gyrus rectus Fastigium, fourth ventricle
 Precentral
sulcus Central sulcus
Superior frontal gyrus
Marginal ramus of
Corona radiata Cingulate sulcus

Superior parietal lobule

Precuneus

Parietooccipital sulcus

Calcarine sulcus

Lingual gyrus Inferior occipital gyrus

NP/MGH
 Central sulcus

uperior Temporal gyrus

Middle Temporal gyrus

Inferior Temporal gyrus

NP/MGH
 Superior frontal gyrus Cingulate sulcus Precentral gyrus
Marginal ramus of
Central sulcus Cingulate sulcus
Cingulate gyrus

Superior parietal lobule

Precuneus

Parietooccipital sulcus

Cuneus

Calcarine sulcus

Frontomarginal gyrus
Lingual gyrus
Caudothallamic groove
NP/MGH
Gyrus rectus
 Precentral sulcus

Superior frontal sulcus

Central sulcus
Postcentral sulcus
Lateral fissure,
Inferior frontal gyrus, posterior segment
pars triangularis

Inferior frontal gyrus, Angular gyrus

pars orbitalis

Superior Temporal gyrus

Superior Temporal sulcus Middle occipital gyrus
Middle Temporal gyrus
Inferior Temporal gyrus Anterior occipital sulcus

Inferior occipital gyrus

NP/MGH
BLOOD SUPPLY
BLOOD SUPPLY
 Functional areas
Primary somatosensory area
Location : Post central gyrus(ant parietal lobule) on lateral surface and
dorsal aspect of paracentral lobule on medial serface. Broadman area (3
,1, 2)
Representation : contralatral half of body inverted
Function: initial reception center for afferent impulses, especially for
tactile, pressure, and position sensations. necessary for discriminating
finer, more critical grades of sensation and for recognizing intensity.
Afferent connections: VP nucleaus of thalamus

Outputs: primary motor cortex, contralateral S1,association

somatosensory cortex(area 5 & 7), thalamus

Deficit: Postural sensation (proprioception), passive movement

(kinesthesis), Tactile sensation, Two point discrimination,
Astereognosis,High sensory thresholds
 Somatosensory Homunculus
Body presentation
 Secondary Somatosensory area

Location : superior lip of lateral fissure (parietal operculam)

Representation :contralateral side dominant, Bilateral representation

Afferent: Intralaminar nuclei and posterior group of nuclei of thalamus

Function: not well described, ? Involved in less discriminative aspects of

sensation.

Lesions: none ascribed, rarely inability to appreciate pain(asymbolia)

 Somato-sensory association area:
Location : superior parietal lobule. broadmann’s area(5,7)
Function : interpretation; similarities and differences, spatial
relationships and 2D qualities, variations in form and weight, and
localization of sensation
• Area 5-, Manipulation of objects Tool use/body image

• Area 7- Integration of visual and somato-sensory stimuli, Hand-eye

coordination, reaching and grasping,,

• Afferent: primary somato-sensory area

• Deficit : Impair gnostic (knowing, recognition) aspects of sensation ,
stereognosis, graphesthesia, two-point discrimination, and tactile
localization , poor hand eye coordination,
(appreciation of primary sensations remains, but assoc. functions
impaired)
 Inferior parietal lobule
• Location: supramarginal gyrus (40) and angular gyrus (39)

• Function:.
 Left hemisphere – language ,maths, reading, writing, understanding
of symbols.
 Right hemisphere—visuo-spatial orientation.

• Lesions
Aphasia, agnosia, and apraxia and visuspatial defects

• A deeply placed parietal lesion may cause either an inferior

quadrantic or hemianopic visual field defect
Clinical assesment and testing
 Post-Central Gyrus,Dominant or Non-Dominant

1. Impaired Postural sensation (proprioception), passive movement

(kinesthesis).

2. Astereognosis

3. Impaired Two point discrimination

4. Agraphesthesia

5. Weight discrimination
 Astereognosis (tactile agnosia)

 Inability to discriminate size and shape of objects and identify them

by touch alone.

Tests

 Patient identifies by touch such common objects as a coin,

paperclip, pencil, or key (each hand tested separately)

 Patient judges the relative size of a series of coins

 Patient judges the texture of a series of objects, such as cloth,

wire, sandpaper
Astereognosis
 Graphesthesia
 Ability to recognise letters or numbers written on skin with
pencil,or dull pin
 Testing is often done over the finger pads, palms, or dorsum of the
feet
 Letters or numbers about 1 cm in height are written on the finger
pads, larger elsewhere
 clear figures as 8, 4 5 used first, more difficult 6, 9 ,3 can be used as
finer tests
 Tactile movement sense, directional cutaneous kinesthesia- Ability
to tell the direction of movement of a light scratch stimulus drawn
for 2 cm to 3 cm across the skin which may be a sensitive indicator of
function of the posterior columns and primary somatosensory cortex

 Loss of graphesthesia or the sense of tactile movement with intact

peripheral sensation implies a cortical lesion, particularly when the
loss is unilateral.
 Two point discrimination
 Ability to differentiate, eyes closed, cutaneous stimulation by one
point from stimulation by two points.
Instruments: two-point discriminator, electrocardiogram
calipers,compass, paper clip bent into “v,” adjusting the two points
to different distances.
Method
 Either one-point or two-point stimuli are delivered randomly, and
the minimal distance that can be discerned as two points is
determined.
 The result is taken as the minimum distance between two points
that can be consistently felt separately.
 Normal 2-point discrimination - 1 mm (tip of the tongue), 2 mm to 3
mm ( lips), 2 mm to 4 mm ( fingertips), 4 mm to 6 mm (dorsum of
the fingers), 8 mm to 12 mm( palm), 20 mm to 30 mm( back of the
hand), and 30 mm to 40 mm ( dorsum of the foot).

 The findings on the two sides of the body must always be compared.
 Superior Parietal Lobule,Dominant or Non-Dominant

 cannot reach for objects (optic ataxia) -Balint syndrome

 Poor visual guidance of hands, fingers, eyes, and limbs, head (hard
time catching a ball)

 Hard time directing movement in space (trouble flying a kite)

 Hard time distinguishing left from right

 Dominant inferior parietal lobule

1. Acalculia
2. Agraphia Gerstmann’s syndrome
3. Left-right confusion
4. Finger agnosia
5. Conductive aphasia
6. Alexia
7. Ideomotor apraxia
 Ideomotor apraxia:
 failure to perform previously learned motor acts accurately.
 Results from left hemisphere lesion
 Usually affects both sides, may be worse on right side
 Can affect the face (buccofacial) and/or the limbs

Tests
Carrying out motor acts to command:
 Buccofacial (blow out a match, protrude tongue, drink through a
straw)

 Limb (salute, use a toothbrush, flip a coin, hammer a nail, comb

hair,,snap fingers, kick a ball, crush out a cigarette)

 Whole body commands(stand like a boxer, swing a baseball bat)

 Ideomotor apraxia:

1. wernicke area

2. Arcuate fasciculus

3. Lt premotor area

4. Lt motor cortex

5. Corpus callosum

6. Rt premotor area

7. Rt motor cortex
 Ideational apraxia:
 Able to carryout individual components of a complex motor act but
can not perform the entire sequence properly leading to a goal.
 Results from left hemisphere lesion ( temporo-parietal)
 also seen in generalised cognitive impairment.

Tests
Carrying out complex motor acts to command:
 Opening tooth paste, taking tooth brush from holder, and placing
toothpaste on brush.

 How to mail a letter

 How to drive a car.
 Conduction aphasia
 Results from left hemisphere supramarginal gyrus lesion if the
underlying arcuate fasciculus is cut
 Fluent speech with word finding pauses
 Severely defective repetition
 Paraphasia in repetition and in spontaneous speech
 Normal comprehension and reading
 Impaired writing, spontaneous and to dictation, errors in
spelling, word choice,
 Naming may be mildly impaired
Tests
 Repetition of words, phrases, & sentences
 Write to dictation (letters, words, sentences)
 Ask patient to write sentences describing a Job, the weather, or
a picture
 Confrontation naming of objects, clothing, body parts, parts of
objects, colors
 Finger agnosia:
 Inability to recognize, name, and point to individual
fingers on self and others
 Usually associated with lesion of dominant hemisphere
 Lt handed pts may have finger agnosia with lesions of
either hemisphere
 Limited clinical utility for localisation
Tests
• Non verbal finger recognition: pt eyes closed, touch pt finger,
then ask pt to point same finger on examiner hand
• Identification of named fingers on examiner’s hand: examiner’s
hand placed in various positions. Ask pt “point to my middle
finger”
• Verbal identification (naming) of finger on self and examiner:
hand placed in various positions, ask pt “what is the name of this
finger”
 Right-left disorientation

 Inability to distinguish right from left on self or env.

 More common with left hemisphere lesion
 Normal population (9%males, 17% females ) can have difficulty in rt
- lt testing

Tests
• Identification on self(show me your rt foot),
• Crossed commands on self(With your rt hand touch your lt shoulder)
• Identification on examiner(point to my lt elbow)
• Crossed command on examiner(with ur rt hand point to my lt eye)
 Acalculia
 Loss of ability to understand & order numbers
 More severe with left hemisphere lesion
 Also note errors in borrowing, alignment , error to particular
calculation,
Tests
Verbal examples(addition, subtraction, multiplication, and division)
Eg. 4+6, 8-5, 9*7, 9 /3

Verbal complex problems (allow 20 sec for response)

Eg. 14+17, 43-38, 21*5, 128/8

Written complex problems(allow 30 sec for response)

108 605 108 559
+79 -86 *36 /43
 Calculation errors
Rt hemispheric lesion with lt neglect

Rt parietal bleed , poor alignment, calculation errors

Alzeimers ds, rote multiplication good but

basic arithmatic disturbed
 Agraphia
 Diagnosed when pt demonstrate basic language errors, gross
spelling errors, or use of paragraphias (word or syllable
substitution)
Test
First, ask patient to write letters and numbers to dictation.
Second , ask the pt write names of common objects or body parts
Third , if pt can successfully write single words , ask them to write
sentence describing his job , whether, or picture from magazine

Alexia
Results from damage to the angular gyrus itself and renders the
patient unable to understand the written words and write.
Pt are not appreciably aphasic but anomia may be present
 Non-dominant inferior parietal lobule
1. Constructional apraxia
2. Dressing apraxia
3. Contralateral Neglect
4. Topographic disorientation
5. Phonagnosia-
6. Amusia .
7. Somatoperceptual disorders(Asomatognosia,
Anosagnosia)
8. Sensory extinction or inattention
 Constructional apraxia
 Inability to draw or construct 2 or 3D figures or shapes in presence
of normal strength, coordination, sensation , comprehension.
 More common and severe with right non dominant parietal lesion
than left.
Tests
 Reproduction drawings (both 2D and 3D drawings as vertical
diamond, 2D cross, 3D block, 3D pipe, triangle within triangle are
used). Scoring done from poor (0) to excellent (3)

 Drawings to command(clock with numbers and hands, daisy in

flowerpot, house with 2 sides and roof).
 Constructional apraxia
Scoring Interpretation Vertical diamond

Poor (0) Non recognizable,gross distortion

Fair(1) Mod distorted or rotated 2D and

loss 3Dimensionality

Good(2) Minimal distortion

Excellent(3) Perfect or near perfect

Rating 0 is 100% probability and

Rating 1 is 80% prob of brain damage
 Constructional apraxia
Reproduction drawings
2D cross test 3 D cube test 3 D pipe test Triangle within triangle
 Constructional apraxia
Drawings to command

clock Flower pot House in perspective

 Constructional apraxia
Block designs Common errors

Rt lt rotation

Near far rotation

Figure ground or color

reversal
 Constructional apraxia

Interpretation
Specific errors pathognomic of
brain damage (non retarded,
age > 10 yrs)

1. Rotation by >45 degree

2. Perseveration or repitition of
figure
3. FragmentatIon of design
 Dressing apraxia
Unable to properly clothe
themselves

Most often leaves lt side partly

undressed

MC with Rt nondominant parietal

lesions

Associated with impaired tactile

and visuospatial coordination

Considered as part of neglect

syndrome
 Contralateral Neglect and denial
Neglect for visual, auditory, and
somesthetic stimulation on one side of the
body or space
Examples:
1.pt draw clock ,house flower with missing
lt side
2.If pt asked to read foot ball or ice cream
he will read “ ball” and“cream”
3.May shave only the right side of his face
4.May not use one side of body even if no
weakness

May be associated with denial disorder

1.Anosognosia-Unawareness or denial of
illness in presence of obvious disability
 Sensory extinction or inattention
Loss of the ability to perceive two simultaneous sensory stimuli

Double simultaneous light touch stimuli at homologous sites on the

two sides of the body
.
Extinction can also be done on one side. In general the more rostral
area is the dominant one; (the face hand test). It may be normal to
extinguish the hand stimulus.

Most commonly occurs with lesions of the inferior parietal lobule but
may also occur with lesions of the temporoparietaloccipital junction,
thalamus, and mesencephalic reticular formation .These areas have
shown activation in attentional tasks

Lesions causing hemispatial neglect are similar to those causing

inattention and extinction
Sensory extinction or inattention
 Topographic disorientation
Inability to find way to familiar environments, localize places on
maps, and find his way to new environment
Evaluation
History obtained from family-
1.Does pt lost at neighbourhood, or home?
2.Has pt lost travelling less frequent location?
3.Does pt have difficulty orienting new environment?
 Localizing places on maps
Ask pt to draw map of India, if pt can’t draw, doctor should draw
map
Ask pt to locate cities on map eg. Delhi, mumbai, calcutta
1.Are cities located in appropriate states, ?
2.Are cities located on one half of map(either east or west)?

Ability to orient self in hospital environment

ask nurses staff regarding pt capacity to find their bed, ward,
bathroom
 Clinical syndromes
Either hemisphere

1. Cortical -sensory syndrome & sensory extinction

2. Total hemi anesthesia may occur

3. Mild hemiparesis, unilateral muscular atrophy in children,

hypotonia, slowness of movements, hemiataxia,
pseudoathetosis of opposite side

4. Homonymous hemianopia, visual inattention , anosognosia,

hemineglect (with right>left lesion)

5. Abolition of optokinetic nystagmus with target moving towards

Right hemisphere Left Hemisphere
Topographic disorientation Gerstman’s syndrome
(Angular gyrus)
Visuospatial disorders Acalculia,
Finger agnosia,
Lt/rt disorientation,
Agraphia

Hemi inattention Tactile agnosia

(bimanual asteriognosis)

Anosognosia Bilateral Ideomotor & ideational

apraxia

Constructional apraxia, /dressing apraxia Disorder of language

especially alexia
 Take home message
 Both parietal lobes have equal processing capabilities for light touch,
tactile localization, 2-point discrimination, joint position sense, passive
movement sense, and stereognosis.

Language and sequential analysis ability are strongly lateralized to the

left inferior parietal lobe

Spatial abilities are strongly lateralized than language. Both parietal

lobes have substantial spatial abilities, with the right being superior

Lesions to the parietal lobe are seldom localized to one particular

quadrant (e.g. inferior, superior), or even restricted to the parietal lobe.

Even after assessment of clinical symptom and signs it is difficult to

ascertain all signs to particular area of the parietal lobe.
Questions and Answers
1- Which one is not a part of parietal lobe

a) Angular gyrus
b) Gyrus rectus
c) Supramarginal gyrus
d) Precuneus

Ans: b) Gyrus rectus

2- Supramarginal gyrus corresponds to
Brodmans area-

a) 39
b) 40
c) 44
d) 42

Ans: b) 40
3- Sigmoid Hook sign denotes-

a) Central sulcus
b) Precentral sulcus
c) Calcarine sulcus
d) Parieto-occipital sulcus

Ans: a) Central sulcus

4- All are functions of parietal lobe except-

a) Stereognosis
b) Proprioception
c) Two point discrimination
d) Prosody

Ans: d) Prosody
5- Inferior quadrantanopia occurs in lesion of-

a) Frontal lobe
b) Occipital lobe
c) Parietal lobe
d) Temporal lobe

Ans: c) Parietal lobe

6- Normal two point discrmination for the ‘tip of
tongue’ is-

a) 2-3 mm
b) 4-6 mm
c) 1 mm
d) 6-8 mm

Ans: a) 2-3 mm
7- Gerstman syndrome include all except-

a) Finger agnosia
b) Agraphia
c) Acalculia
d) Aphasia

Ans: d) Aphasia
8- Conduction aphasia occurs in lesion of-

a) Cuneus
b) Paracentral lobule
c) Angular gyrus
d) Arcuate facsiculus

Ans: d) Arcuate facsiculus

9- Which one is not seen in lesion of non-
dominant inferior parietal lobule lesion -

a) Ideomotor apraxia
b) Dressing apraxia
c) Constructional apraxia
d) Atopographia

Ans: a) Ideomotor apraxia

10- Unawareness or denial of illness (hemiplegia)
is called as-

a) Anosognosia
b) Asomatognosia
c) Anosodiaphoria
d) Autotopagnosia

Ans: a) Anosognosia