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61 Cards in this Set

  • Front
  • Back
Language promlems with Aphasia
-have diff. pathophysiologic impairment
-often evolve form 1 syndrome to another
Concept stating that both hemispheres contribute in varying degreesdepending on the lang. function
-challenged by neroimaging studies
Cerebral dominance
Handedness in relation to brain dominance
70% of time: Lhanded have L dominance
20-30%: lang. dominance is witched to the R side (strong family history)
*always ask about handed history
-supported by clinicopathologocal correlations
-80% of Aphasia syndromes roughly conform to this scheme
-Theory rejects 1:1 correspondance between specific linguistic structural elements and focal segments of the brain
Localizationist-Connectionist model
Fluent Ahpasia:
Transcortical sensory (TSA)
Non-fluent Aphasia:
Transcortical motor (TMA)
-lrg. lesion in L lateral frontal, pre-rolandic suprasylvian region
-usually extends into pre-ventricular white matter deep to ____ area
-supplied by superior division of MCA
Broca's Aphasia
Damage to Broca's area:
Non-sufficient or necesesary to get Broca's Aphasia
-lesion is not confined, shows damage to basal ganglia and insula
-only Broca's lesion leads to sounding like Apraxia and prosody prob.
Supplies traditional zone of language
Middle Cerebral Atery (MCA)
-small anterior lesion
-may affect the supplemental motor cortex
-usually L frontal lobe anterior or superior to Broca's
-white matter underneath supplemental motor area
-seen w/ TBI
-Broca's area is spared
supplied by Anterior cerbral artery (ACA) or anterior most branches of MCA
*not seen often
Transcortical Sensory Aphasia
-lrg lesion
-involves L fronto-parietal-temporal zone of lang. from Brocas to Weirnickes to angular gyrus to deep sunadjacnet white matter
-supplied by both divisions of MCA
-Affects Temporal, Frontal, Pareital
Global aphasia
Milder version of Global
Mixed Aphasia
-prod. by lesions in posterior third of superior temporal gyrus
-supplied by inferior division of the MCA
Weirnicke's Aphasia
2 variations of Weirnickes:
1. primarily temporal lesion- produces a word-deaf variant in which reading is preserved. Can't understand auditory info as easily as text
2. More posterior lesion- more difficulty w/ written text over isolated words (more parietal)
-lesion in supramarginal gyrus and underlying white matter connecting Werinickes to Brocas
-alos by a combo lesion affecting L primary aud. cortex, insula and underlying white matter
-will be posterior
Conduction Aphasia
-lesion in Angular gyrus
-high functioning type of Aphasia
-some evolve to this typeduring recovery
Anomic Aphasia
**All aphasias have a word-finding or anomic component
-involves basal ganglia, especially the head of the caudate nucleus and/or adjacent regions of the internal capsule
Subcortical Aphasia
R and L carotids
R and L vertebral
Vascular supply to the cerebral hemispheres
runs in the anterior aspect of the neck
-divide into external and internal branches
Carotid arteries
Internal carotid artery
supplies much of forebrain and bifurcates into the anterior/middle cerebral arteries
Anterior and middle cerebral arteries
supplies the anterior and lateral surface of the cerebral hemisphere
-run to cranium through foramen magnum
-L and R unite to form basilar artery
-proceeds along pons and divides into posterior cerebral arteries
-imp. for brain stem, occipital area and inferior and medial aspects of the hemisphere
Vertebral arteries
Fluency of patient
look at ability to retrieve words and phrase length:
9+ words-fluent
6-8 words- borderline
0-5 words- non-fluent
*avg. of 3 longest utternaces
Aud. comp. of patient
Ability to understand verbal speech:
-words-actions, body parts, colors
-yes/no quest.
-paragraph length
Repetition of patient
-single words
-function words vs. content
Broca's symptoms:
-better comprehension than expression
-agrammatic: nouns only w/ no functor words
- some overlearned expressions
-spatial-temporal discoordination:can't get articulators tp proper area to create word
Transcortical Motor symptoms:
-impaired initiation of verbal output
-short phrase length, frag. speech
-good aud. comp
-no artic. effort
-not as severe as Broca's
Global symtoms:
-profound dis. across lang. modalities
-want evolution
Weirnicke's symptoms:
-speech output better than aud. comp
-neurologic paraphasia: jargon
-sound errors
-wrong words
2 versions:
1. understand written words over aud. info
2. opposite
Transcortical symptoms:
-poor aud. comp.
-use nondescript words i.e. thing
-frequ. semantic paraphrasic errors
-*good repitition skills (due to outside of lang. zone)
Conduction symptoms
-repetition worse than spontaneous speech
-normal phrase length
tries to self-correct
-good aud. comp.
Anomic symtpoms:
Really only word finding problems
Subcortical aphasia types:
1.Thalamic lesion
2. Anterior Capsular/Putaminal or Basal Ganglia lesion
3. Posterior Basal Ganglia lesion
Subcortical Thalamus lesion symptoms:
-variable phrase length
-good repetition
-low volume
-grammatically correct syntax
-word-finding prob.
Subcortical Anterior Capsular/Putaminal or Basal Ganglia lesion symptoms:
-variable phrase length
-good aud. comp and repetition
-low volume
imprecise artic.
-phomenic and semantic errors
Subcortical posterior basal ganglia lesion symtpoms:
-variable phrase length
-poor aud. comp and repetition
-good artic.
-low volume
Forms by Anterior Comm. Artery (AcomA)
-links 2 AcomA
Circle of Willis
Ability of collateral arteries to take over and supply an adequate blood supply to the affected area
Collateral Circulation
-largely supplied by the MCA
-if lesion is outside of this area the patient can repeat
Zone of language
Excision within the artery
-excise the carotid artery and remove clots from obstructing the artery and flow to the brain
-Computerized axial tomography
complete or partial artery occlusion. Cells begin to die and infarct devlops with necrosis and loss of tissue bulk
-most common ischemic stroke
-arteriosclerosis: proliferation of smooth muscle calles of arterial wall and expansion and deposition of lipid w/in associated connected tissue
-narrowing of an artery
-narrowing of an artery
->70%= change in distal blood flow andincreased risk of stroke
Breaking off of a clot into the bloodtream which can occlude a distal artery for an reason
Rupture of blood vessel w/in intercranium
-occurs in:
1. brain
2. subaracnoid
3. subdural space
Hemmorrhagic stroke
Brief focal cerebral event where symptoms develop rapidly and last < 24hrs.
Transient Ischemic Attack(TIA)
Every language act involves networks of neurons widely distributed in brain functioning in series and parallel
Accepted classical theory
Confrontational naming tests:
word length
semantic classification
frequency of occurance
phonation complexity
emotional valence
*Boston naming test
Discourse testing
descriptive:naming about... procedural: Tell me about...
Generative naming testing
word fluency
ability to subclassify
use of working memory
i.e. name animlas or things beginning with "a"
Fluency testing
-reponse to open-ended ?s
-desciption of a pictured scene
-repsonse to emotional or historic event
Aud. comp testing
*ability to understand verbal speech
-words: actions,objects, body parts, colors
-commands: single and multi-step
-yes/no quest
-paragraph level material
repetition testing
-single words
-word frequ, length, phonological complexity, semantic category, etc.
-functor vs. content words
-bleeding that originates in subcortical grey matter (thalamus or putamen)
-usually massive rupturing into ventricular system and affects conciousness
-survivors result in dense hemiplegia and subcortical aphasia
Intercerbral hemmorhage from CVA
-less than 2 cm. in area from occulsion of small artery due to changes in these arteries caused by increased blood pressure
-often bilateral and deep in frontal lobe, periventricular white or subcortical grey matter
-symptom of Aphasia
Lacunar Infarct
*may not be bad enought to go to hospital
heart attacks and stroke
25% of CVA patients with artherscleriosis have had previous heart attacks
Diabetes and stroke patients
diabetes exacerbates clogging of arteries (artherscl.)
Insult to the brain, not of the degenerative or congenitial nature, but caused by an external force, that may produce a diminished pr altered state of conciousness
Twisting or shearing of axons due to the twisting of the brain
Diffuse Axonal Injury
Brain hit on impact and then boucong backwards and hit on the opposite side as well
"coup" and "contracoup"