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Disorder of Frontal lobes

The Frontal lobes divided into:
  1. Motor-premotor: The precentral cortex or primary motor cortex is concerned with the planning, initiation and control of physical movement.
  2. Dorsolateral prefrontal: concerned with planning, strategy formation, and other executive functions.
  3. Medial prefrontal: A kinetic mutism to mild lack of motivation.
    Frontal abulic syndrome
    1. Loss of initiative, creativity and curiosity
    2. Pervasive emotional apathy and blandness
    3. Akinetic mutism
  4. Orbitofrontal: is concerned with response inhibition, impulse control, and social behaviour.
    Clinical Features of lesion in orbitofrontale lobe (Disinhibition syndrome):
    1. Mental flexibility impairment
    2. Foresight impairment
    3. Judgment impairment
    4. Impairs the ability to inhibit inappropriate responses (Disinhibition)
    5. Frontal disinhibition syndrome, patient become socially disinhibited and show severe impairments of judgments, insight and foresight.
    6. Fatuous euphoria
Foster Kennedy syndrome: 
It is caused due to tumor of frontal lobe and gives rise to ipsilateral optic atrophy and contralateral papilledema.
Dementia Vs. Pseudodementia
Dementia Pseudodementia (Depressive)
Patient rarely com-plains of the cognitive Impairment Patient usually always complains about the impairment
Patient emphasizes Achievements Patient emphasizes disability
Patient appears unconcerned Patient communicates distress
Usually labile affect Severe depression
Patient makes mis takes ‘Don’t know’ answers are frequent on examination
Recent memory impairment found on examination     Recent memory rarely found on examination
Confabulation may be Present Confabulation very rare
Consistently poor performance on similar tests Marked variability in performance on similar tests
History of depression Past history of manic/ depressive episodes may be present uncommon include
Most common cause of pseudodementia is Depression

Predictors of bad prognosis following heal injury include
  1. Glasgow Coma Scale score <9
  2. Prolonged duration of coma
  3. Post traumatic amnesia (best predictor)
  4. True seizures that can mimic pseudoseizures are:
  5. Frontal lobe tumors
  6. Absence seizures
  7. Temporal lobe tumors
  8. Complex partial seizures
Table - Causes of Secondary Mood Disorders
Drug Intoxication
   Alcohol or sedative-hypnotics
   Metoclopramide, H2-receptor blockers
   Antihypertensives (especially centrally acting agents, e.g., methyldopa, clonidine, reserpine)
   Sex steroids (e.g., oral contraceptives, anabolic steroids)

Drug Withdrawal
   Nicotine, caffeine, alcohol or sedative-hypnotics, cocaine, amphetamines

   Primary cerebral, Systemic neoplasm

   Cerebral contusion, Subdural hematoma

   Cerebral (e.g., meningitis, encephalitis, HIV, syphilis)
   Systemic (e.g., sepsis, urinary tract infection, pneumonia)

Cardiac and Vascular
   Cerebrovascular (e.g., infarcts, hemorrhage, vasculitis)
   Cardiovascular (e.g., low-output states, congestive heart failure, shock)

Physiological or Metabolic
Hypoxemia, electrolyte disturbances, renal or hepatic failure, hypo- or hyperglycemia, postictal states

 Thyroid or glucocorticoid disturbances

 Vitamin B12, folate deficiency

 Multiple sclerosis

 Parkinson's disease, Huntington's disease

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