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61 Cards in this Set
- Front
- Back
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Language promlems with Aphasia
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-complex
-have diff. pathophysiologic impairment -often evolve form 1 syndrome to another |
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Concept stating that both hemispheres contribute in varying degreesdepending on the lang. function
-challenged by neroimaging studies |
Cerebral dominance
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Handedness in relation to brain dominance
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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 |
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-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
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Fluent Ahpasia:
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Weirnicke's
Transcortical sensory (TSA) Conduction Anomic |
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Non-fluent Aphasia:
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Broca's
Transcortical motor (TMA) Global |
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-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
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Damage to Broca's area:
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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. |
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Supplies traditional zone of language
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Middle Cerebral Atery (MCA)
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-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 |
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-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
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Milder version of Global
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Mixed Aphasia
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-prod. by lesions in posterior third of superior temporal gyrus
-supplied by inferior division of the MCA |
Weirnicke's Aphasia
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2 variations of Weirnickes:
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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) |
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-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
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-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 |
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-involves basal ganglia, especially the head of the caudate nucleus and/or adjacent regions of the internal capsule
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Subcortical Aphasia
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R and L carotids
R and L vertebral |
Vascular supply to the cerebral hemispheres
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runs in the anterior aspect of the neck
-divide into external and internal branches |
Carotid arteries
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Internal carotid artery
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supplies much of forebrain and bifurcates into the anterior/middle cerebral arteries
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Anterior and middle cerebral arteries
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supplies the anterior and lateral surface of the cerebral hemisphere
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-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
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Fluency of patient
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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 |
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Aud. comp. of patient
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Ability to understand verbal speech:
-words-actions, body parts, colors -commands -yes/no quest. -paragraph length |
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Repetition of patient
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-single words
-phrases -sent. -function words vs. content |
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Broca's symptoms:
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-anomia
-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 |
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Transcortical Motor symptoms:
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-impaired initiation of verbal output
-anomia -short phrase length, frag. speech -good aud. comp -no artic. effort -not as severe as Broca's |
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Global symtoms:
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-profound dis. across lang. modalities
-want evolution |
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Weirnicke's symptoms:
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-speech output better than aud. comp
-neurologic paraphasia: jargon -sound errors -wrong words 2 versions: 1. understand written words over aud. info 2. opposite |
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Transcortical symptoms:
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-anomia
-poor aud. comp. -use nondescript words i.e. thing -frequ. semantic paraphrasic errors -*good repitition skills (due to outside of lang. zone) |
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Conduction symptoms
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-anomia
-repetition worse than spontaneous speech -normal phrase length tries to self-correct -good aud. comp. |
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Anomic symtpoms:
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Really only word finding problems
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Subcortical aphasia types:
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1.Thalamic lesion
2. Anterior Capsular/Putaminal or Basal Ganglia lesion 3. Posterior Basal Ganglia lesion |
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Subcortical Thalamus lesion symptoms:
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-anomia
-variable phrase length -good repetition -low volume -grammatically correct syntax -word-finding prob. |
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Subcortical Anterior Capsular/Putaminal or Basal Ganglia lesion symptoms:
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-anomia
-variable phrase length -good aud. comp and repetition -low volume imprecise artic. -phomenic and semantic errors |
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Subcortical posterior basal ganglia lesion symtpoms:
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-variable phrase length
-poor aud. comp and repetition -good artic. -low volume -paraphasias |
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Forms by Anterior Comm. Artery (AcomA)
-links 2 AcomA |
Circle of Willis
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Ability of collateral arteries to take over and supply an adequate blood supply to the affected area
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Collateral Circulation
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-largely supplied by the MCA
-if lesion is outside of this area the patient can repeat |
Zone of language
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Excision within the artery
-excise the carotid artery and remove clots from obstructing the artery and flow to the brain |
Endarterectomy
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-Computerized axial tomography
-PET -Static/functional |
Neuroimaging
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complete or partial artery occlusion. Cells begin to die and infarct devlops with necrosis and loss of tissue bulk
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Ischemic
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-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 |
Thrombosis
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-narrowing of an artery
->70%= change in distal blood flow andincreased risk of stroke |
Stenosis
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Breaking off of a clot into the bloodtream which can occlude a distal artery for an reason
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Embolism
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Rupture of blood vessel w/in intercranium
-occurs in: 1. brain 2. subaracnoid 3. subdural space |
Hemmorrhagic stroke
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Brief focal cerebral event where symptoms develop rapidly and last < 24hrs.
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Transient Ischemic Attack(TIA)
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Every language act involves networks of neurons widely distributed in brain functioning in series and parallel
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Accepted classical theory
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Confrontational naming tests:
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word length
semantic classification frequency of occurance phonation complexity emotional valence *Boston naming test |
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Discourse testing
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descriptive:naming about... procedural: Tell me about...
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Generative naming testing
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word fluency
ability to subclassify use of working memory i.e. name animlas or things beginning with "a" |
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Fluency testing
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-reponse to open-ended ?s
-desciption of a pictured scene -repsonse to emotional or historic event |
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Aud. comp testing
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*ability to understand verbal speech
-words: actions,objects, body parts, colors -commands: single and multi-step -yes/no quest -paragraph level material |
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repetition testing
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-single words
-phrases -sentences -word frequ, length, phonological complexity, semantic category, etc. -functor vs. content words |
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-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
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-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 |
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heart attacks and stroke
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25% of CVA patients with artherscleriosis have had previous heart attacks
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Diabetes and stroke patients
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diabetes exacerbates clogging of arteries (artherscl.)
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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
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TBI
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Twisting or shearing of axons due to the twisting of the brain
-non-penetrating |
Diffuse Axonal Injury
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Brain hit on impact and then boucong backwards and hit on the opposite side as well
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"coup" and "contracoup"
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