Higher Centres Examination

Lying or sitting

1. General inspection

  • Obvious cranial nerve or limb lesions
  • Ask patient about right- or left-handedness, level of education
  • Shake hands

2. Orientation

  • Time
  • Place
  • Person

3. Speech

  • Orientation
    • Full name?
    • Date?
  • Name objects (nominal dysphasia)
  • Free speech
    • Describe my tie?
  • Phonation
    • “Big cough for me”
    • “say eeeee”
  • Articulation
    • “say peter piper refers Perth”
    • “say la-la-la-la”

4. Parietal lobes

  • Dominant (Gerstmann’s syndrome)
    • Acalculia (mental arithmetic)
    • Agraphia (write)
    • Leftright disorientation
    • Finger agnosia (name fingers)
  • Non-dominant
    • Dressing apraxia
  • Both
    • Sensory inattention
    • Visual inattention
    • Cortical sensory loss (loss of graphaesthesia, two-point discrimination, joint position sense and stereognosis)
    • Constructional apraxia

5.Memory (temporal lobe)

  • Short term (e.g. names of flowers)
  • Long term

6. Frontal lobe

  • Reflexes—grasp—pout—palmar mental
  • Proverb interpretation
  • Smell
  • Fundi
  • Gait

7. Other

  • Visual fields
  • Bruits
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