Overview.
The parietal lobe is located behind the central sulcus, above the lateral fissure, and posteriorly connected to the occipital lobe. The postcentral gyrus receives deep and superficial sensory impulses from the contralateral body and is the cortical sensory center, the parietal lobule is the analytic area for solid sensation, the supramarginal gyrus is the use center, and the angular gyrus is the reading center in the dominant hemisphere. Parietal lobe syndrome is aphasia-missing use-missing reading syndrome, also known as Bianchi syndrome. It is most commonly seen in traumatic brain injury, parietal lobe tumor, middle cerebral artery lesion, and in brain tumors, the incidence of neuroglioma is about one times higher than that of meningioma.
Etiology
All parietal lobe and blood circulation disorders, tumors, and trauma can cause this syndrome, but occlusion of the parieto-occipital branch of the middle cerebral artery cortex is the most common. If the middle cerebral artery is extensively damaged, hemiplegia and other hemispheric symptoms may occur without parietal lobe syndrome.
Symptoms
Sensory aphasia (often with amnesic aphasia), isolated aphasia (structural, imaginative, and imaginative-motor aphasia), and dysgraphia and dyslexia are present. Contralateral hemiplegia, tactile agnosia of the corresponding hand and foot, temporary mild hemiparesis, ipsilateral hemianopsia, and agnosia are also common.
1. Parietal lobe damage in right-handed patients: manifested as inability to recognize the left hemisphere autologically and locally, inability to recognize space, inability to dress, inability to use structures, inability to read space, and inability to calculate.
2. Left parietal lobe damage in right-handed people: manifested by structural dyslexia, imaginative dyslexia, dysgraphia, dyslexia, etc.
Examination
1. General physical examination and neurological examination
General examination includes observation of consciousness, body temperature, pulse, blood pressure, respiration, etc., to know whether there are signs of serious infections, serious physical diseases and organic diseases such as craniocerebral trauma. Neurological examination should be emphasized to look for evidence of organic brain diseases.
2. Mental examination
Comprehensive mental examination, including appearance and behavior, speech and thinking, emotional state, perception, cognitive function, self-awareness and motor behavior.
3. Auxiliary examination
Routine laboratory tests such as blood routine, blood biochemistry, thyroid hormone, etc., and auxiliary tests such as electroencephalogram, brain CT, brain MRI, etc., to find out whether there are somatic diseases and organic brain lesions.
4. Psychological Assessment
Wechsler Adult Intelligence Assessment, Cognitive Function Assessment, Clinical Memory Assessment, etc.
Diagnosis
Diagnosis can be made on the basis of clinical manifestations and corresponding auxiliary examinations, such as brain CT scan, brain MRI examination, cerebral angiography. It shows typical symptoms of aphasia, dyslexia, dysgraphia and dyscognition. This sign is mostly sensory aphasia, and some patients also show it in the form of aphasic amnesia. The dysfunctions are not single motor dysfunctions, but can become manifest in the form of structural dysfunctions or conceptual dysfunctions.
Differential diagnosis
1. Cerebral infarction
This sign is seen in infarction of the parietal lobe of the main hemisphere, with occlusion of the parieto-occipital branch of the middle cerebral artery being the most common. This disease is mostly seen in elderly people over 60 years old, especially in patients with arteriosclerosis and hypertension; it mostly develops at rest, and the symptoms often worsen gradually in a few hours or a longer period of time, showing the type of progressive stroke; the consciousness remains awake, with aphasia but hemiparesis is not obvious; the cerebrospinal fluid is clear, and the pressure is not high.
2. Parietal lobe brain tumor
Before the manifestation of this syndrome, there is often a history of chronic headache, which is progressively aggravated. With the aggravation of tumor occupancy, nausea, vomiting, optic disc edema and other symptoms of increased cranial pressure may appear. It is not easy to distinguish the tumor from cerebral infarction in the early stage of the disease.CT shows the occupying lesion in the parietal lobe of the main hemisphere, which shows ring, patchy or nodular enhancement after enhancement. Other occupying lesions in the parietal lobe of the main hemisphere, such as meningioma, metastatic tumor, brain abscess, etc., may also present with this syndrome.
3. Gerstmann syndrome
Gerstmann’s syndrome is caused by lesions in the temporal lobe of the dominant hemisphere and is easily confused with this syndrome. This syndrome includes four symptoms: finger dyslexia, left-right dyslexia, dyscalculia and dysgraphia, as well as various psychiatric symptoms, aphasia, color dyslexia, visual disorientation, dyslexia, and structural dysfunction. It is rare for the syndrome to have a combination of all four symptoms.
Treatment
Treatment of the primary disease, symptomatic treatment, occupying lesions can be surgically treated if necessary.
Prognosis
Depending on the cause, the prognosis is generally good.