PARIETAL LOBE
Dr Kshamaa H G
Dept of psychiatry
13 -2 - 2015
Introduction
• Parietal lobe predominantly concerned
with processing somesthetic, kinesthetic
and propioceptive information
• Critchley’s – Silent area of brain
• Integration of various sensory modalities
ANATOMY
SOMTOSENSORY CORTEX
CONNECTIONS
• Reciprocal commisural connection with
contralateral homunculus
• Reciprocal connections with thalamus and
claustrum
• Afferents from basal nucleus of mynert,
locus cereleus, midbrain raphe
• Efferents – corticostriatal fibres to
putamen
corticopontine and
SECONDARY SOMATOSENSORY AREA
• Topographic representation – head
anterior – sacral region posterior
• CONNECTIONS –
1. Primary somatosensory cortex
2. Ventral Posterior nucleus,
posterior group of nucleus
3. dorsal column nucleus
4. contralateral SSA
SUPERIOR & INFERIOR PARIETAL
LOBULE
• Superior parietal lobule - Area 5, 7a, 7b
▫ Also known as heteromodal cortex. It
integrates somatic, sensory, visual and
auditory stimulus – perception of self
• Inferior parietal lobule – area 30 and area 40
▫ Has supramarginal gyrus, angular gyrus,
arcus parieto-occipitalis
•Somatosensory area
•Lateral posterior nucleus
•Central lateral nucleus of •Contralateral area 5
intralaminar group except for distal limb
AREA 5
•Area 7
•Corticospinal tract •Premotor and
supplementary motor
cortex
•Post. Cingulate gyrus
•Insular granular cortex
•Occipital and
•Post cingulate gyrus
temporal lobe
•Insula
•Temporal cortex
•Area 5
•SSC AREA 7A
•Prefrontal and lat
AREA 7B
part of premotor
cortex
•Contralateral 7a and •Medial pulvinar
7b nucleus
•Intralaminar
paracentral area
Functions
• Anterior parietal cortex –
▫ tactile sensations
• Secondary sensory cortex –
▫ 2 – point discrimination,
▫ joint position,
▫ stereognosis, graphaesthesia
• Superior prietal lobe –
▫ Spatial orientation
▫ Constuctional ability
• Inferior parietal lobe-
▫ Language – gramatical and syntactical aspect
▫ Arithmetic calculations
Lobe function tests
• Visual-motor integration
• Geographic disorientation
• Calculations
Visual motor integration
Drawings to command
Block designs
• Geographic disorientation
▫ Localizing places on a map
▫ Ability to orient self in hospital
▫Calculations:
• Verbal rote examples:
▫Addition: (4 + 6)
▫Subtraction: (8 – 5)
▫Multiplication: (2 × 8)
▫Division: (56 ÷ 8)
• Verbal complex examples:
▫Addition: (14 + 17)
▫Subtraction: (43
– 38)
▫Multiplication: (21 × 5)
▫Division: (128 ÷ 8)
• Written complex examples:
▫ Addition: 108
+79
▫ Subtraction: 605
- 86
▫ Multiplication: 108
×36
▫ Division: 559
÷ 43
Parietal lobe lesions
• The varied features of parietal lobe
lesions can be mainly classified into
▫ Apraxia
▫ Agnosia
▫ Right - left disorientation
▫ Hemispatial neglect
▫ Visual disorientation and disorders of spatial
(topographic) localization
▫ Dyscalculia
Apraxia
• complex motor deficit that cannot be
attributed to pyramidal, extrapyramidal,
cerebellar, or sensory dysfunction and
that does not arise from the patient's
failure to understand the nature of the
task
▫ Ideomotor apraxia
▫ Ideational apraxia
▫ Dressing apraxia
▫ Constructional apraxia
• Ideomotor Apraxia: inability to correctly
imitate hand gestures and voluntarily mime tool
use
▫ Blow out a match.
▫ Drink through a straw.
▫ Lick crumbs off your lips.
▫ Comb your hair.
▫ Flip a coin.
• Ideational Apraxia: loss of ability to conceptualize, plan,
and execute the complex sequence of motor actions
involving the use of tools or objects in everyday life
▫ Letter-envelope-stamp
▫ Candle-holder-match
▫ Toothpaste-toothbrush
• Dressing apraxia –
▫ A patient with this condition is unable to align the body
axis with the axis of the garment and can be seen
struggling to wear it
Agnosia
• Inability to process sensory information
▫ Asomatognosia
▫ Simultanagnosia
▫ Finger Agnosia
▫ Astereognosis
▫ Visual Agnosia
▫ Agnosia for pictures
▫ Color agnosia
• Asomatognosia : denotes the inability to recognize part of
one’s body.
▫ Anosognosia (Unilateral Asomatognosia; Anton-Babinski
Syndrome): The patient may fail to shave one side of the
face, apply lipstick or comb the hair only on one side, or
find it impossible to put on eyeglasses, insert dentures, or
put on a shirt or gown when one sleeve has been turned
inside out
• simultanagnosia : inability to integrate visual information in
the center of gaze with more peripheral information. The
patient gets stuck on the detail that falls in the center of gaze
without attempting to scan the visual environment for
• Finger Agnosia: is the loss in the ability “to
distinguish, name, or recognize the fingers”
not only with the patient’s own fingers, but
also the fingers of others, and drawing and
other representations of fingers
• Astereognosis: inability to identify an object
by active touch of the hands without other
sensory input.
▫ Coins, key, pen, watch, stone, cube
• Visual Agnosia: impairment in recognition of
visually presented objects
▫ Key , watch, pen, book, coin, wallet
• Agnosia for pictures
▫ Circle, square, star, triangle, key, wall clock,
spoon, bottle, cow, horse
• Color agnosia
▫ Red, blue, green, yellow, white, brown
▫ Name the color of objects
Grass, ripe tomato, milk, crow, parrot, sky, sand
Hemispatial neglect
• characterised by reduced awareness of
stimuli on one side of space, even though
there may be no sensory loss
▫ simultaneous bilateral stimulation
examiner provides either unilateral or
simultaneous bilateral stimulation in the
visual, auditory, and tactile modalities. After
right hemisphere injury, patients who have no
difficulty detecting unilateral stimuli on
either side experience the bilaterally
presented stimulus as coming only from the
▫ visual target cancellation
• Copy the drawings
• Right-Left Disorientation:
▫ Identification on self:
Show me your right foot
Show me your left hand
▫ Crossed commands on self:
With your right hand touch your left shoulder
With your left hand touch your right ear
▫ Identification on examiner:
Point to my left knee
Point to my right elbow
▫ Crossed commands on examiner:
With your right hand point to my left eye
LESIONS OF PARIETAL LOBE
I. Effects of unilateral disease of the parietal lobe, right
or
left
A. Corticosensory syndrome and sensory extinction
(or total hemianesthesia with large acute lesions of
white
matter)
B. Mild hemiparesis (variable), unilateral muscular
atrophy in children, hypotonia, poverty of
movement, hemiataxia(occasional)
D. Abolition of optokinetic nystagmus with
target moving toward side of the lesion
E. Neglect of the opposite side of external
space (far more prominent with lesions of
the right parietal)
II. Effects of unilateral disease of the
dominant parietal lobe additional
phenomena include
A. Disorders of language (especially alexia)
B. Gerstmann syndrome (dysgraphia,
dyscalculia, finger agnosia, right-left
confusion)
C. Tactile agnosia (bimanual astereognosis)
D. Bilateral ideomotor and ideational apraxia
III. Effects of unilateral disease of the
nondominant parietal lobe
A. Visuospatial disorders
B. Topographic memory loss
C. Anosognosia, dressing and constructional
apraxias (most frequently in nondominant
side)
D. Confusion
E. Tendency to keep the eyes closed, resist lid
opening, and blepharospasm
IV. Effects of bilateral disease of the
parietal lobes
A. Visual spatial imperception, spatial
disorientation
B. complete or partial Balint syndrome:
Simultanagnosia, Dressing Apraxia, and
Construction Apraxia
• Tumors of parietal lobe
▫ Tactile or kinesthetic hallucinations
▫ Tactile perseveration
▫ Depression
▫ Spasmoidic feeling of someone standing
closely
▫ Absence or displacement of part of body
▫ Transformation of limb to mechanical object
▫ Phantom appearance of 3rd limb
• Parietal lobe epilepsy
▫ Incidence <5%
▫ MCC – tumors
▫ Somatosensory auras in 80% (contralateral)
Paraesthesias – tingling, numbness, prickling
Spreads in jacksonian manner
May be associated by tonic clonic movements
▫ Medial paracentral lobule – u/l genital sensations
▫ Posterior parietal –
Distortion of body image
Illusion that parts of body are moving or have changed
postures
Ictal ideomotor apraxia
parietal lobe
• schizophrenic delusions and hallucinations stem
from aberrant perceptual experiences
• Temporoparietal junction region over-activation
might underlie schizophrenic hallucinations
• right inferior parietal activity was related to an
active delusional state in a magneto
encephalography (MEG) study
References
• Gray’s anatomy; 39th edition
• Adam and Victors neurology; 8th edition
• Lishmans’s organic psychiatry; 4th edition
• Kaplan and Saddocks comprehensive textbook of psychiatry; 9 th
edition
• Neuropsychology, neuropsychiatry and behavioral neurology;
Rhawn Joseph
• Hippocampal temporal-parietal junction interaction in the
production of psychotic symptoms: a frame work for
understanding the schizophrenic syndrome; cynthia G. Wible ;
Frontiers in Human Neuroscience; June 2012; 6 ;180
THANK YOU
