A 50 year old anatomist had constant headaches & increasing difficulty doing dissections. A seizure forced him to the hospital. When the doctor stood to his left side, he was unresponsive to questions but when the doctor stood to his right his responses were fluent but without emotional tone.
When dressing he slipped only his right arm into his shirt, ignoring his left arm.
Though visual fields were normal he did not recognize the simultaneous wiggling movements of the doctor's fingers in the left visual field.
He could feel touch and pressure of numbers traced on the left plan but could not recognize them (graphesthesia). Copying simply figures was inaccurate in that the left sides of objects were omitted.
Motor and sensory examination on the right was normal, there was only minor diminution of pain and discriminative touch on the left.
Minor diminution of sensation on the left suggests that sensory pathways to the primary sensory cortex were intact. Ignoring objects in his left extrapersonal space i.e., the doctor, wiggling fingers, drawn objects and personal space (left sleeve) and graphesthesia, is common with lesions of the right parietal lobe, especially in the area of supramarginal and angular gyri (areas 39 & 40).
The slow progression of symptoms followed by a seizure suggests a growing mass culminating in irritative phenomena. Radiologic evidence showed a right parietal lobe absess.
The slow progression of symptoms followed by a seizure suggests a growing mass culminating in irritative phenomena. Radiologic evidence showed a right parietal lobe absess.
Extended Explanation
There is an upper motor neuron syndrome involving the left face, arm and leg caused by injury at cortical levels, of cells of origin of the right corticospinal and related fiber tracts; fibers of this tract originate from both the frontal and parietal lobes.
Left sided graphesthesia, extinction, and ignoring the left visual field suggest that the lesion probably is in the right cortex.
Such sensory deficits i.e., acquisition and recognizing primary sensory data but with deficits in integrative functions as demonstrated by graphesthesia, extinction, tactile agnosia, etc., occurs with lesions of the parietal lobe, especially in the area of the supramarginal and angular gyri (areas 40 & 39).
Failure to pay attention to the left space as indicated by his drawings, impaired visual recognition, inattention to people and dressing apraxia is common with lesions of the right parietal lobe.
Left sided graphesthesia, extinction, and ignoring the left visual field suggest that the lesion probably is in the right cortex.
Such sensory deficits i.e., acquisition and recognizing primary sensory data but with deficits in integrative functions as demonstrated by graphesthesia, extinction, tactile agnosia, etc., occurs with lesions of the parietal lobe, especially in the area of the supramarginal and angular gyri (areas 40 & 39).
Failure to pay attention to the left space as indicated by his drawings, impaired visual recognition, inattention to people and dressing apraxia is common with lesions of the right parietal lobe.
The slow progression of symptoms followed by a seizure does not suggest a vascular event but rather a growing mass culminating in an irritative phenomenon.
