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Within the brain, no other territory surpasses the parietal lobes in the rich variety of clinical phenomena exposed under conditions of disease Our current understanding of the effects of parietal lobe disease contrasts sharply with that of the late nineteenth century, when these lobes, in the classic textbooks of Oppenheim and Gowers, were considered to be silent areas However, the clinical manifestations of parietal lobe disease may be subtle, requiring special techniques for their elicitation; even more dif cult is the interpretation of these abnormalities of function in terms of a coherent and plausible physiology and psychology Close to the core of the complex behavioral features that arise from lesions of the parietal lobes is the problem of agnosia Allusion has already been made to agnosia in the discussion of lesions of the temporal lobes that affect language, and similar ndings occur with lesions of the occipital lobe as discussed further on In those contexts, the term refers to a loss of recognition of an entity that cannot be attributed to a defect in the primary sensory modality As a result of the extension of the term agnosia to a loss of more complex integrated functions as described below, a number of intriguing de cits arise These syndromes expose properties of the parietal lobe that have implications regarding a map of the body schema and of external topographic space, of the ability to calculate, to differentiate left from right, to write words, and other problems discussed below The fact that apraxia, an inability to carry out a commanded task despite the retention of motor and sensory

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than one contact at a time; the disregard of stimuli on the affected side when the healthy side is stimulated simultaneously (tactile inattention or extinction); the tendency of super cial pain sensations to outlast the stimulus and to be hyperpathic; and the occurrence of hallucinations of touch Of these, the testing of sensory extinction by the presentation of two tactile stimuli simultaneously on both sides of the body has become a component of the routine neurologic examination for parietal lesions With anterior parietal lobe lesions there is often an associated mild hemiparesis, since this portion of the parietal lobe contributes a considerable number of bers to the corticospinal tract Or, more often, there is only a poverty of movement or a weak effort of the opposite side in the absence of somatic neglect The affected limbs, if involved with this apparent weakness, tend to remain hypotonic and the musculature may undergo atrophy of a degree not explained by inactivity alone In some cases, as noted below, there is clumsiness in reaching for and grasping an object under visual guidance (optic ataxia), and exceptionally, at some phase in recovery from the hemisensory de cit, there is incoordination of movement and intention tremor of the contralateral arm and leg, simulating a cerebellar de cit (pseudocerebellar syndrome) While relatively rare, it is authenticated by our own case observations With parietal lesions, the arm and hand may sometimes be held in a xed dystonic posture The Asomatognosias The term asomatognosia denotes the inability to recognize part of one s body The idea that visual and tactile sensory information is synthesized during development into a body schema or image (perception of one s body and the relations of bodily parts to one another) was rst clearly formulated by Pick and elaborated by Brain Long before their time, however, it was suggested that such information was the basis of our emerging awareness of ourselves as persons, and philosophers had assumed that this comes about by the constant interplay between percepts of ourselves and of the surrounding world The formation of the body schema is thought to be based on the constant in ux and storage of sensations from our bodies as we move about; hence, motor activity is important in its development Always, however, a sense of extrapersonal space is central to this activity, and this depends upon visual and labyrinthine stimulation The mechanisms upon which these perceptions depend are best appreciated by studying their derangements in the course of neurologic disease of the parietal lobes Anosognosia (Unilateral Asomatognosia; Anton-Babinski Syndrome) and Hemispatial Neglect The observation that a patient with a dense hemiplegia, usually of the left side, may be indifferent to the paralysis or unaware of it was rst made by Anton; later, Babinski named this disorder anosognosia It may express itself in several ways: The patient may act as if nothing were the matter If asked to raise the paralyzed arm, he may raise the intact one or do nothing at all If asked whether the paralyzed arm has been moved, the patient may say yes If the fact that the arm has not been moved is pointed out, the patient may admit that the arm is slightly weak If told it is paralyzed, the patient may deny that this is so or offer an excuse: My shoulder hurts If asked why the paralysis went unnoticed, the response may be, I m not a doctor Some patients report that they feel as though their left side had disappeared, and when shown the paralyzed arm, they may deny it is theirs and assert that it belongs to someone else or even take hold of it and ing it aside This mental derangement, which Hughlings Jackson referred to as a kind of imbecility, obviously includes a.

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CIO, COO, CFO, and so forth We need to realize that the normal amount of time that each of these different levels of people have during the day to review and assimilate the information from these dashboards is anywhere from about two to three minutes for a C-level professional to about five to