Professional Documents
Culture Documents
E. Fund of
information
F. Insight, judgment,
and planning
G. Calculation
SENSORIUM
Outline of mental status examination
General behavior and
appearance
Stream of Talk
Content of thought
Intellectual Capacity
Sensorium
Is the Pt normal,
hyperactive, agitated,
quiet, immobile? Is the Pt
neat or slovenly? Does the
Pt dress in accordance
with age, peers, sex and
background?
Does the Pt converse
normally? Is the speech
rapid, incessant, under
great pressure, or is it slow
and lacking in
spontaneity? Is the Pt
discursive and unable to
reach the conversational
goal?
Is the Pt euphoric,
agitated, inappropriately
gay, giggling or silent,
weeping and angry? Does
the mood swing in a
direction appropriate to
the subject matter of the
conversation? Is the Pt
emotionally labile?
Does the Pt have illusions,
hallucinations or delusions
and misinterpretations? Is
the Pt preoccupied with
bodily complaints, fears of
cancer or heart disease, or
other phobias? Does the
Pt suffer delusions of
persecution and
surveillance by malicious
persons or forces?
Is the Pt bright, average,
dull, or obviously
demented or mentally
retarded?
A. Consciousness
B. Attention span
C. Orientation for
time, place, and
person
D. Memory, recent
and remote
Concept of Sensorium
A mechanism integrates all of the senses, all of the
memories, all the hopes and desires, into a stream of
consciousness.
Locus of Sensorial Mechanism
Hippocrates brain as the site of the sensorium
Aristotle sensorium in the heart (is the first of all parts
to be formed)
Charaka The heart is the seat of consciousness
Herophilus Sensoriom in the Calamus Scriptorius of
the Fourth Ventricle
- Shifted the cite to cerebellum, and suggested
that the superior intelligence of human kind
resulted from the richness of the cerebral
cortical convolutions
Galen supported the doctrines of Herophilus,
Erasitratus and Hippocrates
Interpretational definition of the sensorium commune
Sensorium commune the mechanism for consciously
perceiving ongoing events, relating them to the past
and to future goals and responding with behavior
appropriate to ones role in life
The sensorium then:
- Receives the ongoing afferent information and
relates it to memory traces of past events and
to future possibilities
- Invests the stream of thought with emotion,
significance, and priority
- Programs behavior appropriate to ones role
and station
- The whole process constitutes perception,
integration, and execution. As such, the
sensorium has no localized residence but
represents the integration of all neural activity
within the brain
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
4. Memory
a. Note how well the Pt recalls and relates the
events of the medical history
b. Inquire: Does your memory work all right?
Do you have trouble with your memory? If
you suspect memory disturbances:
Suppose we try out your memory? Provide
Pt with nonsense items that have no special
relationship (53 Broadway, orange and
table) At the end of the NE, ask the Pt to
recite them
c. Determine whether the Pt differs in the
ability to recall recent or remote events.
Can the Pt give his date of birth, but not the
present day, month, and year?
Recent memory suffers most in aging or
brain diseases:
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
-
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
Exclamatory Speech serves to communicate the
emotional states of the instant, rather than ideas
- OUCH!
Prepositions/Representations simple declaration;
states something for analysis that was, is or could be; a
preeminently willful, planned and often crafty
- Fire engines ought to be red
Clinical Testing for Aphasia
1. Detecting early aphasia during the interview
2. Formal aphasia screening test
To test the Pts ability to read, write, name
things, repeat words and sentences and copy
them to dictation, and to follow written and
verbal commands
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
2. Lesion site
Region around the posterior end of the sylvian
fissure at the parieto-occipito-temporal confluence
Lesion affects the aphasic zone more posteriorly
and temporally than in nonfluent aphasia
It disconnects the auditory cortex in the superior
temporal gyrus from the rest of the posterior
parasylvian area, the word association area
Dyslexia, or visual word agnosia
1. Clinical Features
a. Pure agnosia for the meaning of written words,
inspite of adequate intelligence and exposure to
conventional methods of instruction
b. Cannot name colors
c. Give paragraphs to read and ask the Pt to
explain the material
2. Lesion site
Posterior end of the aphasic zone. It damages word
association cortex of the occipital lobe or
disconnects it from afferents that arrive via corpus
callosum, or from the lingual and fusiform gyri.
Lesions of dominant frontal love that may be
associated with Brocas aphasia
Auditory Agnosia
1. Clinical Features
- Fails to understand spoken words but can write
and speak
2. Lesion Site
Lesion destroys virtually all of the left
parasylvian cortex or its connections with
the caudate-putamen, or thalamus.
-Common infaction
Role of the right hemisphere in language
1. The right hemisphere can interpret words as
symbols for verbal communication only to a
limited extent, after the brain reaches
developmental maturity
2. The right hemisphere has to deliver the
language stimuli it receives to the left
hemisphere via corpus callosum for
interpretation and motor expression
3. The parasylvian zone of the right hemisphere
interprets and modulates the prosody of
emotional expression, the rhythm, melody and
inflections that add emotions to speech
4. Pts with lesions in the right parasylvian zone or
its subcortical connections cannot invest their
own speech with its emotional coloring nor
interpret the emotional connotation or gestures
of others
5. Pt whose speech lacks emotional inflection has
expressive aprosody
6. Pt who cannot differentiate the emotional
inflections of language spoken by others have
receptive aprosody or Global aprosody
Testing for right hemisphere aprosody
- The Ex listens for flat emotionless speech during
medical history
- Ex says a test phrase in different emotional
inflections and ask the Pt to interpret the
emotion conveyed.
The levels and types of speech disturbances
2. Lesions
- Lesion occupy posterior part of the superior
temporal gyrus next to the primary auditory
receptive area in the transverse gyri, in the floor
of the sylvian fissure
Global Aphasia
1. Clinical Features
Pt has severe expressive and receptive
dysphasia, virtually eliminating all receptive and
expressive communication by words.
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
-
Mutism or Aphonia
- Little or no speech
- Deaf mutism, elective mustism, hysterical
mutism, akinetic mutism, autism, and other
retardation syndromes, catatonia, depression,
postictal confusion, and the mutism or
bradylalalia after bilateral lesions of thalamus or
basal motor nuclei
Too much speech an increase in the amount and
rate of speech, of logorrhea, fluent aphasia,
cluttering, echolalia, and pressure of speech
Gerstmanns Syndrome
1. Clinical Features
Dysgraphia cannot copy
Dyscalculia
Finger agnosia
Right left disorientation
2. Lesion site
Left angular gyrus, at the
parietooccipitotemporal junction may cause the
4 core components, one or all of the
components can occur with lesions of more
distant sites
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
Table 11.2 Outline of sample questions to screen the Patients
Sensorium
Questions
Questions in Filipino
Area of
sensorium
tested
What is your name?
Ano po ang pangalan
Orientation
How old are you?
niyo?
to person,
When is your
Ilang taon na po kayo?
time and
birthday?
Kailan po ang inyong
place; recent
kaarawan?
and remote
memory;
What is your address?
Saan po kayo nakatira,
consciousnes
Are you staying there
dun po ba kayo
s of self and
now?
namamalagi?
environment
What kind of work do
you do?
Do you have a
family/wife/husband
or children?
What are their
names/occupations/ag
es/addresses?
Where are they now?
Do you happen to
know the time of the
day?
Have you been waiting
long to see me?
Mayroon po ba kayong
pamilya, asawa o mga
anak?
Ano ano po ang kanilang
mga pangalan at edad?
Saan po sila nakatira?
What is the
day/date/month/year
?
Orientation
to time,
recent
memory
Doctor/Patie
nt role
recognition,
insight as to
presence of
an illness or
need for
medical
attention and
judgment
Judgment
and
planning?
Recent
memory,
fund of
information,
etc)
Kamusta naman po ang
inyong memorya,
madalas po ba kayong
nakakalimot?
Magbigay ng pangalan,
kulay at address
attention
span
Calculation,
attention
span
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
Table 11-3 Instructions for use with stimuli of Fig 11-6 to test
for cerebral dysfunction
Patients Task
Examiners
Examiners
Instructions to
Instruction to
the patient
patient (in
Tagalog)
1. Copy
First, draw this on Paki guhi/gaya
Square/Parisu your paper (point po ito (point to
kat (A)
to square) I want
square, dont
you to do it
mention its
without lifting
name) Wag
your pencil from
niyo pong
the paper. Make
itataas ang
it about this same lapis. Gayahin
size
niyo po ang
saktong sukat.
2. Name
What is that
Ano po ang
SQUARE/PARI shape called?
tawag sa hugis
SUKAT
na ito?
3. Spell
Would you spell
Puwede nito
SQUARE/PARI that word for me? ho bang
SUKAT
banggitin ang
mga letrang
bumubuo sa
salita/ paki
spell po ang
salita?
4. Copy
Draw this on your Paki guhit din
CROSS/EKIS
paper. Go around po ito (point to
(B)
the outside like
B)
this until you get
back to where
you started.
5. Name
What is that
Ano po ang
CROSS/EKIS
shape called?
tawag sa hugis
na ito?
6. Spell CROSS
Would you spell
Pwede niyo ho
that word for me? bang i-spell
ang salitang
iyon?
7. Copy
Same with 1 and
TRIANGE/TAL 4 above
SULOK
8. Name
Same as above
TRIANGLE/TA
TSULOK
9. Spell
Same as above
TRIANGLE
10. Name
What is this?
Ano itong nasa
BABY/SANGG
larawan?
OL (D)
11. Write CLOCK
Now I am going to Magpapakita
(E)
show you another po ako ng
picture but dont
larawan pero
tell me the name
wag niyo pong
of it. Just write
sasabihin kung
18. Repeat
___________
______
19. Repeat
___________
_______
20. Write
SQUARE (K)
ano ito,
isusulat niyo
po.
Ano po ito?
Paki basa po
ito.
Paki basa rin
po ito.
Paki basa po
ito.
Nababasa niyo
po ba ito?
Magbabanggit
po ako ng
salita at
gayahin niyo
po pagkatapos
ko.
23. Repeat
explain HE
SHOUTED
THE
WARNING/SI
NIGAW NIYA
ANG BABALA
24. Write HE
SHOUTED
THE
Paki banggit
po ang
sasabihin kong
salita:
____________
__
Paki ulit po ang
salitang ito:
____________
_________
Huwag niyo
pong
babanggitin
ang nakasulat
dito, isulat
niyo pos a
inyong papel.
Paki basa po
ng malakas
itong
nakasulat
Paki ulit po ang
sasabihin ko:
SEVEN
Gayahin niyo
po ang
sasabihin ko at
ipaliwanag ang
ibig sabihin
nito.
Paki sulat po
yung aking
sinabi
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
WARNING/SI
NIGAW NIYA
ANG BABALA
25. Compute 8520 (M)
26. Compute 7 x
3
paper
What is this?
If you had one of
this in your hand,
how would you
use it?
I want you to
draw a picture
that looks like this
Would you read
this?
Now would you
do what I said?
Paki-calculate
po ito.
Paki sabi po
ang sagot
gamit ang inyo
lamang isip
Ano poi to?
Paano niyo po
ba ginagamit
ito?
Paki guhit po
ang larawang
ito
Paki basa po
ito
Paki hawakan
po ang inyong
kanang tenga
gamit ang
inyong
kaliwang
kamay
Paki hawakan
po ang inyong
kaliwang siko
gamit ang
inyong
kaliwang
kamay
CRUZ 1-B [THE PATIENTS MENTAL STATUS AND HIGHER CEREBRAL FUNCTIONS]
7 SIX 2 M G W
SQUARE
85-20=
SEVEN