Cerebral Syndromes

Effects of fontal lobe lesions

SiteSymptoms/signs
Unilateral Contralateral spastic hemplegia
Contralateral gaze paresis
Apathy and loss of initiative
Elevation of mood, increased talkativeness, joke inappropriately (witzelsucht), lack of tact, difficulty in adaptation
Left: Broca's aphasia with agraphia, with or without apraxia of the lips and tongue; Sympathetic apraxia of left hand
Prefrontal: grasp and suck reflexes
Orbitofrontal: anosmia
Bilateral Bilateral hemiparesis
Spastic bulbar (pseudobulbar) palsy
Decomposition of gait and sphincter incontinence
Prefrontal: abulia or akinetic mutism, lack of ability to sustain attention and solve complex problems, rigidity of thinking, bland affect, social ineptitude, behavioral disinhibition, inabilty to anticipate, labile mood, and varying combiations of grasping, sucking, obligate imitative movements, utilization behavior
adapted from Adams and Victor's Principles of Neurology, 10e

Effects of temporal lobe lesions

Site Symptoms/signs
Unilateral, dominant Homonymous contralateral upper quadrantanopia
Wernicke's aphasia (word deafness; auditory verbal agnosia)
Dysnomia or amnesic aphasia
Amusia (some types)
Visual agnosia
Occasionally, amnesic (Korsakoff) syndrome
Unilateral, nondominant Homonymous upper quadrantanopia
Inability to judge spatial relationships in some cases
Impairment in tests of visually presented nonverbal material
Agnosia for sounds and some qualities of music
Unilateral, either side Auditory, visual, olfactory, and gustatory hallucinations
"Dreamy" states with seizure (focal temporal lobe seizure)
Emotional and behavioral changes
Delirium-confusional states (usually nondominant)
Disturbances of time perception
Bilateral Korsakoff amnesic defect (hippocampal formations)
Apathy and placidity
Klüver-Bucy syndrome: compulsion to attend to all visual stimuli, hyperorality, hypersexuality, blunted emotional reactivity
adapted from Adams and Victor's Principles of Neurology, 10e

Effects of parietal lobe lesions

Site Symptoms/signs
Unilateral Corticosensory syndrome and sensory extinction (or total hemianesthesia if large white matter lesions)
Mild hemiparesis or poverty of movement (variable), hemiataxia (seen only occasionally)
Homonymous hemianopia or inferior quadrantanopia (incongruent or congruent) or visual inattention
Abolition of optokinetic nystagmus with target moving toward side of the lesion
Neglect of the opposite side of external space (more prominent with right parietal lobe lesions)
Dominant (left) Disorders of language (especially alexia)
Gerstmann syndrome (dysgraphia, dyscalculia, finger agnosia, right–left confusion)
Tactile agnosia (bimanual astereognosis) 
Bilateral ideomotor and ideational apraxia
Nondominant (right) Visuospatial disorders
Topographic memory loss
Anosognosia, dressing, and constructional apraxias (more frequent and severe with nondominant lobe lesions)
Confusion
Tendency to keep the eyes closed, resist lid opening, and blepharospasm
Bilateral Balint syndrome: visual-spatial imperception (simultagnosia), optic apraxia (difficulty directing gaze), and optic ataxia (difficulty reaching for objects)
adapted from Adams and Victor's Principles of Neurology, 10e

Effects of occipital lobe lesions

Site Symptoms/signs
Unilateral Contralateral (congruent) homonymous hemianopia, which may be central (splitting the macula) or peripheral; also homonymous hemiachromatopsia
Elementary (unformed) hallucinations—usually with irritative lesions
Left Alexia without agraphia if deep white matter and splenium of corpus callosum involved
Visual object agnosia
Right Visual illusions (metamorphopsias) and hallucinations (more frequent with right-sided lesions) if more extensive lesions.
Loss of topographic memory and visual orientation
Bilateral Cortical blindness bilateral hemianopias
Anton syndrome (visual anosognosia, denial of cortical blindness)
Loss of perception of color (achromatopsia)
Prosopagnosia (impaired face recognition, bilateral temporooccipital including fusiform gyrus)
Balint syndrome (bilateral dorsal parietooccipital)
adapted from Adams and Victor's Principles of Neurology, 10e

Disconnection syndromes

  1. Occipital lobe
    1. Mesial
      1. Visual field defects
      2. Visual agnosia
      3. Visual hallucinations
      4. Alexia without agraphia
      5. Visual anosognosia; Anton syndrome (denial of blindness)
    2. Lateral
      1. Alexia with agraphia
      2. Impaired optokinetic nystagmus
      3. Impaired ipsilateral scanning
      4. Palinopsia
      5. Visual allesthesia
  2. Temporal lobe
    1. Inferomedial aspect (amygdala and hippocampus)
      1. Amnesia (impaired storage)
        1. Greater for verbal information with left involvement
        2. Greater for visuospatial material with right involvement
    2. Anterior tip (bilateral lesions)
      1. Kluver–Bucy syndrome
        1. Visual agnosia
        2. Oral-exploratory behaviour
        3. Tameness (amygdala)
        4. Hypersexuality
        5. Hypomotility
        6. Hypermetamorphosis
    3. Lateroinferior aspect
      1. Dominant hemisphere
        1. Transcortical sensory aphasia
        2. Word selection anomia
        3. Agitated delirium
      2. Nondominant hemisphere
        1. Impaired recognition of facial emotional expression
    4. Laterosuperior aspect
      1. Dominant hemisphere
        1. Pure word deafness
        2. Sensory aphasia
      2. Nondominant hemisphere
        1. Sensory amusia
        2. Sensory aprosodia
      3. Bilateral lesions
        1. Auditory agnosia
        2. Pure word deafness
      4. Contralateral superior quadrantanopia
    5. Nonlocalizing
      1. Auditory hallucinations
      2. Complex visual hallucinations
    6. With epileptogenic lesions (mainly inferomedial)
      1. Interictal manifestations (a–f below plus g or h)
        1. Deepening of emotions
        2. Tendency to transcendentalize minutia (cosmic vision)
        3. Concern with minor detail
          1. Hypergraphia
          2. Circumstantiality
        4. Paranoid ideation
        5. Hyposexuality
        6. Abnormal religiosity
        7. Left hemispheric foci
          1. Ideational aberration
          2. Paranoia
          3. Sense of personal destiny
        8. Right hemispheric foci
          1. Emotional disturbances (sadness, elation)
          2. Denial
      2. Ictal manifestations
        1. Hallucinations of smell and taste (amygdala)
        2. Visual delusions (déjà vu, jamais vu)
        3. Experiential delusions (déjà vecu, jamais vecu)
        4. Psychomotor seizures (temporal lobe variety of partial complex seizures)
  3. Parietal Lobe
    1. Postcentral gyrus
      1. Simple somatosensory disturbances
        1. Contralateral sensory loss (object recognition > position sense > touch > pain and temperature, vibration); tactile extinction
        2. Contralateral pain, paresthesias
    2. Mesial aspect (cuneus)
      1. Transcortical sensory aphasia? (dominant hemisphere)
      2. Attentional disorder
    3. Lateral aspect (superior and inferior parietal lobules)
      1. Dominant hemisphere
        1. Parietal apraxia (higher lesion)
        2. Finger agnosia
        3. Acalculia
        4. Right–left disorientation
        5. Literal alexia (supramarginal gyrus)
        6. Conduction aphasia
      2. Nondominant hemisphere
        1. Anosognosia
        2. Autotopagnosia
        3. Spatial disorientation
        4. Hemispatial neglect (sensory inattention)
        5. Constructional apraxia
        6. Dressing apraxia
        7. Loss of topographical memory
        8. Allesthesia
        9. Hemisomatognosia
        10. Asymbolia for pain
  4. Frontal Lobe
    1. Precentral gyrus (motor area 4)
      1. Face area (unilateral: transient: bilateral: lasting)
        1. Dysarthria
        2. Dysphagia
      2. Hand area
        1. Contralateral weakness, clumsiness, spasticity
      3. Leg area (paracentral lobule)
        1. Contralateral weakness
        2. Gait apraxia
        3. Urinary incontinence (lasting with bilateral lesions)
    2. Mesial aspect (F1, cingulate gyrus)
      1. Akinesia (bilateral akinetic mutism)
      2. Perseveration
      3. Hand and foot grasp
      4. “Salutatory” seizures (“fencer's posture”)
      5. Alien hand sign
      6. Transcortical motor aphasia (dominant hemisphere)
      7. Difficulty with initiating contralateral arm movements (may require initiation by examiner)
      8. Bilateral ideomotor apraxia (apraxia of sequential acts)
    3. Lateral aspect (premotor region)
      1. Middle frontal gyrus (F2)
        1. Impaired contralateral saccades
        2. Pure agraphia (dominant hemisphere)
        3. Contralateral weakness of shoulder (mainly abduction and elevation of arm) and hip muscles plus limb-kinetic apraxia
        4. Hemiakinesia (intentional neglect)
      2. F3
        1. Motor aphasia (dominant hemisphere)
        2. Motor aprosodia (nondominant hemisphere)
    4. Frontal pole, orbitofrontal area (prefrontal)
      1. Blunted affect (apathetic, indifferent)
      2. Impaired appreciation of social nuances
      3. Impaired goal-directed behavior
      4. Impotence
      5. Facetiousness (“witzelsucht” or moria)
      6. Environmental dependency syndrome
      7. Inability to plan and execute multistepped processes
      8. Abulia (poverty of thought, action, and emotion) with large midline or bilateral dorsofrontal lesions
  5. Callosal Lesions
    1. Lack of kinesthetic transfer
      1. Inability to mimic position of the contralateral hand
      2. Left hand apraxia
      3. Left hand agraphia
      4. Right hand constructional apraxia
      5. Intermanual conflict (alien left hand)
    2. Perplexity (and confabulation) trying to explain left-handed activity
    3. Double hemianopia
    4. Left hemiparalexia
adapted from Localization in Clinical Neurology, 7e.