Definitions

The parietal lobe is where peripheral

sensory information registers in the
cerebral cortex. Functions at this cortical
area include both perception and
interpretation of sensory information. With
parietal lobe lesions, the ability to interpret
peripheral sensory information is most
likely to be affected, although the primary
sensory modality itself may also be
impaired. Knowing this will help us to
better understand and differentiate the
sensory deficits caused by lesions at the
cortical level from those caused by
peripheral lesions.
Anatomy
The parietal lobe extends from the central sulcus anteriorly to the imaginary parietal-
occipital fissure posteriorly, above the temporal lobe. There is a parietal lobe in each
hemisphere, and one is not completely a mirror image of the other, especially at the
functional level. Over the convexity, each lobe shows three parts: the post central
gyrus, the superior parietal lobule and the inferior parietal lobule. The inferior
lobule includes theangular and the supramarginal gyri. From the medial aspect, the
parietal lobe contains the post-central gyrus part of the paracentral lobule, part of
the cingulate gyrus, and the precuneus.
Physiology
The dominant lobe is particularly important for perception, interpretation of sensory information,
and the formation of the idea of a complex meaningful motor responses to the stimuli (whereas the
frontal lobes are important for the execution of the act.). Particularly, the supramarginal gyrus and
the angular gyrus of the dominant inferior lobe are concerned with language, mathematical
operations, and body image. The non-dominant lobe is especially important for visual-spatial
functions.
Localization
Location of the Lesion Impairments
Post-Central Gyrus , Dominant or Non-
Dominant
(the post central gyrus is also known as the
Anterior Parietal Lobe)

1. Postural sensation (proprioception)
2. Appreciation of passive movement (kinesthesis)
3. Tactile sensation
4. Two point discrimination
5. Agraphism
6. Astereognosis
7. Sensory +/- visual inattention
8. High sensory thresholds
Superior Parietal Lobule, Dominant or Non-
Dominant
1. Balint Syndrome cannot reach for objects (optic ataxia)
2. trouble with spatial processing
3. poor visual guidance of hands, fingers, eyes, and limbs, head
(hard time catching a ball)
4. poor tactile recognition
5. poor knowing of limb position
6. hard time directing movement in space (trouble flying a kite)
7. hard time distinguishing left from right
Inferior parietal lobule, Dominant or Non-
dominant
1. Sensory extinction
2. Astereoagnosia
3. Dysgraphaesthesia
Dominant inferior parietal lobule
1. Acalculia
2. Agraphia
3. L-R confusion
4. Finger agnosia
5. Conductive aphasia, Wernicke's receptive dysphasia
6. Alexia/Dyslexia
7. Gerstmann's syndrome
Non-dominant inferior parietal lobule
1. Geographical agnosia
2. Phonagnosia
3. Amusia
4. Constructional apraxia
5. Asomatognosia
6. Anosognosia
7. Spatial neglect
8. Neglect of contralateral limb
9. Disappreciation of three dimensional sense
10. Dressing apraxia
11. anosagnosia (denial of illness)
Optic radiation deep in either parietal lobe
1. Contralateral homonymous inferior quadrantanopia

Definitions
amusia - inability to recognize and process music.
anosagnosia (denial of illness)
anosdiaphoria (indifference to illness)
asomatognosia (loss of knowledge or sense of ones own body usually right side
problem)
astereognosia (cant tell what things are by feeling them)
asymbolia for pain (absence of normal reaction to pain)
autotopagnosia (inability to localize or name body parts usually on the left side)
dysgraphaesthesia - inability to recognize letters or numbers written on the hand.
phonagnosia - inability to recognize familiar voices
receptive aphasia Patient cannot understand the spoken or written word. This condition is
suggested when the patient is unable to follow commands or questions. Speech is usually fluent
but disorganized. The Wernickies area is likely affected
.
Examinations
Acalculia Ask the patient to perform simple calculations with pen and paper. Serial 7s is to
take 7 from 100, then 7 from the answer and so forth.
Agraphia Ask the patient to write; inability is called agraphia.
Alexia - Ask the patient to read; inability is called alexia. Lesions in the Angular gyrus of the
inferior parietal lobe can cause these inabilities.
Anosognosia lack of awareness of disease, particularly of hemiplegia.
Asomatognosia Patient is unable to recognize parts of his or her body.
Astereognosia - Inability to identify objects by palpation. Test can be letting the patient hold an
object in the hand, e.g. a paper clip or a coin, without showing it to him/her and asking the patient
to identify it, or to discriminate between different textures by touch..
Conductive aphasia Patients performance on naming objects and repeating statements is
poor. But their speech is usually fluent and comprehension is intact therefore can follow verbal or
written commands. These patients also have impaired reading and writing. The pathway between
the Wernickes and the Brocas area is affected.
Conduction aphasia - Asked to write to dictation and to repeat words or phrases patient does
poorly; does better when confronted with objects to name and when writing spontaneous
message
Constructional apraxia inability to draw shapes or to construct figures/patterns or to copy
designs such as interlocking pentagons.
Dressing apraxia inability to dress. Tested by taking the patients pyjama top or cardigan,
turning it inside out and asking him or her to put it back on.
Finger agnosia - Ask the patient to name his or her fingers and/or examiner's fingers; inability to
do so is called finger agnosia.
Geographic agnosia - Ask patient to locate cities on a map
Ideomotor apraxia - Ask patient to do things such as salute, hammer a nail, kick something,
whistle, brush teeth, etc
L-R confusion Test for left-right confusion is to ask the patient to show his or her right and then
left hand. If this is correctly performed, then further ask the patient to touch his or her left ear with
the right hand and vice versa. Inability to do this is called left-right disorientation if the right hand
is affected.
Sensory extinction test When one side is tested at a time, sensation is normal, but when both
sides are tested simultaneously the sensation is appreciated only on the normal side. The lesion is
contralateral to the side with sensory extinction.
Spatial neglect Mainly occurs with patients having lesion in the non-dominant parietal lobe;
also occurs with dominant lesions but is less common. This is tested by asking the patient to fill
in the numbers on an empty clock face or to draw a bicycle. Presented with a pair of gloves the
patient may forget to put on the one on the neglected side. .
Visual test Note: the optic tracts run through the parietal lobes to get to the occipital
lobes. Parietal lobe lesion will give lower quadrant homonymous hemianopia. (Temporal lobe
lesion will give upper quadrant homonymous hemianopia; occipital lobe lesion will give
homonymous hemianopia.)

Syndromes
Angular gyrus - If dominant side: can copy writing but not write from dictation; poor spelling;
naming still usually possible; word blindness so unable to read out loud or to follow written
commands
Gerstmanns syndrome Dominant inferior parietal lobe dysfunction, specifically involving the
angular gyrus. Patient presents with acalculia, left-right confusion, agraphia, and finger agnosia.
Balint's Syndrome - Bilateral parietal dysfunction causing inability to voluntarily control the gaze
(ocular apraxia), inability to integrate components of a visual scene (simultanagnosia), and the
inability to accurately reach for an object with visual guidance (optic ataxia).
Links
Neuropsychology and behavioural neuroscience (Memphis)
Rice University: parietal lobe and language processing
Psychjam: psychiatric view of parietal lobe
Moo LR, Slotnick SD, Tesoro MA, Zee DS, Hart J. Interlocking finger test: a bedside screen for
parietal lobe dysfunction. Journal of Neurology, Neurosurgery & Psychiatry 2003; 74(4): 530-
532 [A Quick Screening for Parietal Lobe Dysfunction...Asks patient to mimic four interlocking
finger figures for parietal lobe dysfunction test.]