Brandeis Human Neuropsychology Exam 2 (Class Notes)

Front 1

Language & brain damage

Back 1

One of the consequences of brain damage is a problem with language

Front 2

Where is language is in the brain for most people?
(left and right-handed)

Back 2

Left Hemisphere

Front 3

Sources of Cell Loss

Back 3

• Penetrating missile injury to the brain
• Closed head injury
• Anoxia
• Hypoxia
• Stroke

Front 4

Penetrating Missile Injury to the Brain

Back 4

• Could be a bullet to the brain
• Could be a telephone pole, a steering wheel of a car, a piece of a fence
• Any object that penetrates your brain
• Is surprisingly not a very good source of research material because the injury is very rarely focal
• If penetrates the skull, the shattered pieces of bone will go into the brain and cause a lot of damage, which is surprisingly difficult to localize
• Avoid getting this injury, if at all possible

Front 5

Closed Head Injury

Back 5

• Car accident, driving on the road at 60 mph and hit a brick wall, head hits the windsheild, and skull goes from 60 pmh – 0 mph in a matter of one second, but the brain keep moving and crashes into the skull
• The Coo is the “blow” and a Contracoo “counterblow” (French)
• Think of a bell ringing, brain bounces, and hits the skull on the other side of the skull
• Sometimes the counterblow does more damage
• Being hit on the head with a club, a baseball bat, being near an explosion
• Closed Head Injury aka Traumatic Brain Injury (TBI)
• can cause psychological injuries which are very similar to PTSD
• TBI is in the news today because of the increases of survived brain injury coming out of Iraq
• With body armor, soldiers are surviving more injuries, but are still losing their arms and legs

Front 6

Anoxia

Back 6

• Deprevation of oxygen to the brain
• an – oxia = no oxygen

Front 7

Hypoxia

Back 7

• reduced oxygen to the brain (less bad)
• if oxygen level drops to below 40%, can recover
• if oxygen level drops to below 20% for more than 10 minutes, there will be permanent cell damage
• can get hints of it in high altitudes = dizzy and lose consciousness
• airplaine: adjusts cabin pressure to above ground level = may feel dizzy, minor hypoxia

Front 8

Stroke

Back 8

• CT or MRI can help us see exactly where the damage is
• “a generic term for cut-off of blood to the brain”
• CVA (Cerebro-vascular accident)
• and “brain attack”

Front 9

Degrees of stroke

Back 9

• sometimes can effect entire brain = will probably not survive
• massive strokes = damage or bleeding affects large parts of the brain
• strokes are the 3rd most common cause of death (after heart attacks and cancer)
• today, about 80-90% of stroke cases do survive
• of those who survive, about 70-80% are left with permanent neurological changes that affect their daily lives
• focal lesion = a stroke that causes localized damage
• lecunar stokes = tiny little strokes, very difficult to see on an x-ray image, looks almost like a shadow. If enough of these little strokes happen, however, they can summate into a very large amount of damage

Front 10

Blocking versus Bleeding Strokes (2 Types)

Back 10

• Blocking (87% of all strokes)
• Bleeding (13% of all strokes)

Front 11

Bleeding Strokes aka Hemorrhagic Strokes

Back 11

•Greek: "blood" + "bursts forth"
•Aneurysm
•Hematoma
•Intracerebral hemorrhage
•Subarachnoid hemorrhage

Front 12

Aneurysm

Back 12

•Bleeding Stroke aka Hemorrhagic Stroke
•when a weak spot in the wall of a cerebral blood vessel 'balloons' and breaks, flooding the surrounding brain tissue with blood

Front 13

Hematoma

Back 13

•Bleeding Stroke aka Hemorrhagic Stroke
•the name for the large accumulation of the blood at the site of the aneurysm

Front 14

Intracerebral hemorrhage

Back 14

•Bleeding Stroke aka Hemorrhagic Stroke
•vessel bursts within the brain

Front 15

Subarachnoid hemorrhage

Back 15

•Bleeding Stroke aka Hemorrhagic Stroke
•burst of blood vessel on surface of the brain flooding the subarachnoid space; increases pressure on the brain

Front 16

Blocking Strokes

Back 16

• Ischemia
• Infarction
• Thrombosis
• Atherosclerosis
• Cerebral Embolism

Front 17

Ischemia

Back 17

•Blocking Stroke
•loss of blood supply

Front 18

Infarction

Back 18

•Blocking Stroke
•an ischemic stroke that causes necrosis (cell death)

Front 19

Thrombosis

Back 19

•Blocking Stroke
•blockage of a cerebral artery (or narrowing = "stenosis") caused by a clot ("thrombus") forming inside an artery

Front 20

Atherosclerosis

Back 20

•Blocking Stroke
•narrowing of an artery by build-up of fatty plaques on an artery wall ("atherosclerotic plaque"). (Clots can also build up around these deposits, further constricting the artery.)

Front 21

Cerebral Embolism

Back 21

•Blocking Stroke
•a clot that forms or breaks off from a deposit on a cell wall and "wanders" to the brain from another part of the body
•(may have a transient-schemic attack that fixes itself by getting pushed onwards by the build-up of blood in the vessel – like pushing raft downstream)
•Wingfield drawing: branching of vessels in the brain getting smaller, circular mass eventually getting stuck in a small vessel

Front 22

Size of Stroke

Back 22

• Massive
• Focal
• Lecunar
• T.I.A (transient-schemic attacks)

Front 23

Zangwill

Back 23

• Importance of the right hemisphere
• Did not overturn the classical doctrine
• Had a transient-schemic attack = words were slurred, he got dizzy (there was nothing that they could do back then)
• Today, one should call 911 for a transient-schemic attack
• Enough T.I.A.’s = dimentia

Front 24

Vascular Dementia

Back 24

• Vascular Dimentia (VaD)
• Can come about from multiple T.I.A’s

Front 25

Aspirin

Back 25

may be described to thin blood if someone has a blocking stroke

Front 26

Stroke; Inferences from Lesions

Back 26

•strengths and weakness for research
•recovery of function
•human cost

Front 27

Weaknesses for research

Back 27

• Broca implied something that would not be said today - Wingfield: “That area of the brain is very important for language. Language is not necessarily located there.”
• Brain is highly plasic, brain adjusts
• If brain loses a piece of tissue, the rest of the brain will try to readjust for the absence of that piece of brain (can be successful or unsuccessful)
• Can’t assume that you are looking at a normal brain b/c you are not

Front 28

Recovery of function

Back 28

• Take the form of the brain finding an alternative solution to the same problem
• Through recovery, person may begin to use work order
o E.g., if you say “put the book on the table.” and they do it correctly
o E.g., if you say “on the table, put the book.” they do it incorrectly
• “I was going to take a Train to NY, but it was too heavy.”
o Normal brain = understand it’s a joke
o Damage to right hemisphere = may understand as a result of timing, not because they can hear the pitch or the melody pattern (timing = L. hemis) (pitch – R. hemis)
• Researches generally wait months or even a year before doing research with stroke patients because at the beginning the brain is still swollen and healing

Front 29

Humant Cost

Back 29

• After some people get strokes, the incidence of divorce is very high
o It’s no longer the same person that they married
o In many cases, the stroke victim remarries a different kind of spouse
• After some people get strokes, the incidence of job change is high
• Large number of Americans living with stroke
• Cost of stroke to the U.S. is very high

Front 30

Stroke & Research

Back 30

• History of research on stroke has given us a baseline for modern reserch on strokes
• Is there a significant difference when doing an activity and not doing an activity in a particular brain area?
o fMRI or PET can show significant activity even when the amount of change is very small
o If MRI has shown us a lot, it is b/c it “stood on the shoulders of giants” aka early lesion work

Front 31

Brain Tumors

Back 31

• Also a source of focal brain lesions
• Compresses brain tissue = herniation
o Can interfere with brain function or destroy brain cells
o With good luck, they operate and remove the tumor and then the patient gets better (helps us learn more about the brain)
• Invades brain tissue
• Glioma (50% of brain tomors) = cancerous

Front 32

Apraxias, Agnosias, Aphasias

Back 32

• Some of the language-related problems following stroke
• All are disorders of symbolism, “A” and “dis” refer to “not” and are interchangeable
• Apraxias are difficulties “doing things”
• Agnosias are difficulties “understanding things”
• Aphasias are diffiuclties “with language”

Front 33

Ideomotor apraxia – “Use a key”

Back 33

• Damage usually to the left parietal, but the effects of the damage are usually bilateral
• “use a key” or “hammer a nail” = would use their body parts as the key or the hammer
• they usually notice they are doing something strange

Front 34

Conceptual apraxia

Back 34

• basically dementia = where the whole person cannot “think” clearly