Neuropsychological Syndromes

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In neurology , neuropsychological syndromes are combinations of symptoms in which disorders of alertness , attention , language , complex courses of action , perception and memory are detected.

alertness

The vigilance can disorders according to the site of injury and the extent of impairment of consciousness are divided into three groups: major damage to brain damage, brain damage, and means Bulbärhirn- (brainstem). By definition, vigilance disorders are cerebral syndromes.

Types of vigilance disorders
localization Breathing type Pulse and blood pressure posture Spontaneous motor skills
  • normal
  • elevated
  • humiliated
  • limp
  • Arm flexion, leg extension
  • limp
  • Automatisms and myoclonia
  • Rolling movements, "stretching cramps"
  • no

As can be seen from the table, useful conclusions can be drawn about the location of the damage from observation of the patient alone. In order to assess vigilance disorders, it is helpful to create a clinical observation protocol after securing the vital functions, in which the parameters: posture, spontaneous motor skills, pupil status, ocular motor skills and breathing type are documented, since such syndromes show a time-variable course.

Attention deficit

Attention disorders after brain damage can affect different aspects (reaction speed and quality of reaction). A distinction is made between alertness ( alertness ), selective attention (in the sense of concentration), divided attention (simultaneous attention to stimuli from two sensory channels; multitasking ), spatial attention ( neglect ) and sustained attention ( alertness , vigilance ).

Attention processes are controlled in a network-like manner by different brain regions.

Aphasia

In the German-speaking world, aphasia is usually divided into four sub-forms. They are generally characterized by a loss or by deficits in the area of ​​the previously fully acquired language. Speech production, auditory language comprehension, reading-sense comprehension and written language can be affected to different degrees independently of one another. Different diseases of the brain (strokes, cerebral hemorrhages, traumatic brain injuries, etc.) can lead to aphasia.

In terms of severity, a distinction is made between amnestic aphasia with a minor disorder (the key symptom being word finding disorders) and global aphasia with severe impairment of speech production and comprehension.

A distinction is then made between two specific aphasia syndromes, which often appear as vascular syndromes that are comparatively well defined. Ischemia in the supply area of ​​the arteria praerolandica on the left leads to damage in the area of Brodmann area  44 with the consequence of motor Broca's aphasia (reduced spontaneous speech, often largely preserved speech understanding).

Ischemia in the left posterior temporal artery supply area leads to damage in the area of ​​the superior temporal gyrus resulting in sensory Wernicke aphasia (lively, faulty spontaneous speech with paraphasias and severe impairment in speech comprehension).

In the Anglo-American area, the distinction between fluent and nonfluent forms of aphasia is common.

The aphasia therapy should start as soon as possible after the damage and be carried out with high frequency. Disorder-specific and communication-promoting approaches are distinguished. Additional external aids (letter boards, voice computers, etc.) may also be required to support communication.

Dyexecutive disorders

The dysexecutive syndrome is a disorder that includes the most diverse aspects of disruptions in action planning and action control. Historically, executive disorders have primarily been associated with damage to the frontal lobe. But they are also caused by damage to other brain regions ( parietal lobes , cerebellum, etc.).

Apraxia

The apraxias are disruptions in the course of action. There are three forms. In ideomotor apraxia , the ability to plan an action as a whole is retained, but the execution of individual movements within the overall action is disturbed. The Wernicke area , the primary motor cortex ( Brodmann area  4) and the premotor cortex (Brodmann area 6) come into question as the lesion site . In ideatory apraxia , individual movements are possible, but the ability to plan as a whole is disturbed. The damaged area is the temporoparietal region. In constructive apraxia , the ability to perform actions is disturbed (drawing).

Agnosias

As agnosia , refers to a series of neuropsychological syndromes in which the recognition is disturbed even though the primary sensory organs are intact. Agnosias in the narrower sense, such as isolated visual agnosia , are very rare because they require limited damage to the visual cortex on both sides (as in a basilar head aneurysm ). As agnosias in the broader sense (without a clear relationship to a sensory modality) we know:

  • the spatial agnosias
  • the prosopagnosia (disorders of facial recognition)
  • the autotopagnosia (disorientation in one's own body) and
  • the anosognosia (failure to recognize one's own neurological deficit).

It is not uncommon to find neglect of the perception of the damaged side of the body in patients with primary ischemic cerebral infarction and hemiplegia. This disorder is a special form of anosognosia and is called neglect .

Amnesias

The fifth area of ​​neuropsychological syndromes is memory disorders. There are three types of amnesia in neurology.

So-called traumatic amnesias occur as a result of accidents or injuries to the head. They can occur retrograde (memory gap before the damaging event), congrad (memory gap for the duration of the impaired consciousness after the event) or anterograde (memory impairment after the event).

In neurology, the amnesiac syndrome is a synonym for the Korsakoff syndrome , a memory disorder that occurs primarily as a result of alcoholism, but is also observed after brain trauma, poisoning or infections. The patients show a disturbance of the memory and an antero- and retrograde disturbance of the long-term memory . The tendency of patients to fill the gaps in their memory with inventions ( confabulation ) is considered characteristic of Korsakoff syndrome . Korsakoff syndrome can be temporary. The corpora mamillaria are considered the damage site.

A special form of memory disorder is transient global amnesia . It is a rare clinical picture with a temporary complete loss of memory with mostly retrograde amnesia . The condition occurs suddenly, usually without any external cause, and can last for a few hours to days. There are recurrent courses with an increased risk of ischemic cerebral infarction in the flow area of ​​the basilar artery.

literature

  • Heinz-Walter Delank: Neurology. Ferdinand Enke Verlag, Stuttgart 1994, ISBN 3-432-89917-3 .

Movies

Head lights (1998): German documentary film in which various neuropsychological disorders are presented using patient examples (available e.g. on YouTube).