libihero

10+ Year Member
7+ Year Member
Sep 19, 2008
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So if I go into the patients room and ask her to stick out her tongue she will. If I ask her after that to raise her arm, she sticks out her tongue. If I ask her to close her eyes she sticks out her tongue.

Now if I go out of the room and come in a minute later and ask her to raise her arm she does. If I then ak her to stick out her tongue she raises her arm. If i ask her to close her eyes she raises her arm.

Essentially she follows the first command and repeats it for every following command. Is there a name for this and is the cause known? She is a senior who had a CVA and new onset seizures
 
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libihero

10+ Year Member
7+ Year Member
Sep 19, 2008
37
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Status
Medical Student
Awesome! That is exactly what I was looking for, thanks :)
 

Vader

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Jun 4, 2001
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Perseveration usually relates to damage to the frontal lobes, particularly dorsolateral prefrontal areas/circuits. It is thought to be related to the frontal lobes' role in shifting attentional set. Perseveration is seen in a variety of disorders that affect the frontal lobes (both neurologic and psychiatric). The Wisconsin Card sort task is one of the more famous tasks that can reveal a more subtle deficit, but at the bedside you can use the Trails portion of the MOCA. Obviously for this patient, the degree of perseveration is high which would likely make normal function with the world very difficult. On exam, she likely would also have frontal release signs that you could look for (i.e. grasp, snout, rooting, palmomental, etc) and severe impairment of working memory. If the stroke was not in the frontal lobes and there is question of seizures, it is possible this phenomenon may be ictal/post-ictal in nature, rather than static from a stroke, and in that case would be interesting to see if she improves with anti-epileptic drug therapy.