Q10: June 2020 PLAB 1 Exam Style Question.
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A 67-year-old woman presents to her general practitioner with complaints of progressive memory issues, difficulties with spatial orientation, and frequent collisions with furniture and objects around her house. She also reports episodes where she has difficulty recognizing familiar objects by touch. When asked to draw a clock face during the mini-mental state examination, she omits all the numbers and hands on the left side of the clock face. Additionally, she seems unaware of these deficits. Based on her symptoms and the neuropsychological findings, which part of the brain is most likely affected?
A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D. Occipital lobe
E. Cerebellum
Correct Answer: B. Parietal lobe
Explanation
Diagnosis:
The most likely diagnosis in this case is a lesion in the parietal lobe. The patient's symptoms are highly suggestive of hemineglect or neglect syndrome, which is a neurological disorder that affects attention and awareness of one side of space, usually the left side. Her difficulty with spatial orientation, tactile recognition, and especially her inability to draw the left side of the clock face are classic presentations.
Why Parietal Lobe (Option B)?
Hemineglect is a hallmark symptom of parietal lobe lesions. Features in parietal lobe lesions include:
- Hemisensory loss
- Sensory inattention
- Impaired 2-point discrimination
- Astereognosis (inability to recognize objects by touch)
- Gerstmann’s syndrome (finger agnosia, agraphia, acalculia, and left-right disorientation)
Why Not Other Options?
A. Frontal lobe: Lesions here usually cause issues with motor control, personality changes, and difficulties with speech planning and coherence. Hemiparesis can also be a feature.
B. Temporal lobe: Lesions in the temporal lobe typically present with symptoms such as dysphasia, contralateral homonymous hemianopia, and amnesia.
C. Occipital lobe: Lesions here primarily affect visual processing, leading to symptoms like contralateral visual field defects, polyopia, and palinopsia.
D. Cerebellum: A cerebellar lesion would cause symptoms such as ataxia, dysdiadochokinesia, intention tremor, nystagmus, slurred speech, and hypotonia. The mnemonic DANISH can help remember these features: Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia.
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Reference:
The BMJ Best Practice provides an overview of the symptoms, diagnosis, and treatment of hemineglect, including a summary, epidemiology, etiology, case history, approach, investigations, screening, treatment algorithm, emerging prevention, patient discussions, monitoring, complications, prognosis, guidelines, images and videos, and references.
The Practical Neurology provides a comprehensive overview of the clinical assessment of parietal lobe function, including its anatomy, physiology, history taking, examination techniques, and common syndromes. It also includes images of typical cases and differential diagnoses.
The Geeky Medics provides a detailed guide on the visual pathway and visual field defects, including the anatomy of the optic nerve and visual pathways, the types of visual field defects and their causes, the clinical features and diagnosis of visual field defects, and the management of visual field defects. It also includes diagrams and videos to illustrate the concepts.
The Verywell Health provides an article that explains what a parietal lobe stroke is, what causes it, how it affects the brain and body functions, how it is diagnosed and treated, and what the possible complications and outcomes are. It also includes pictures of the condition and some tips for prevention.
