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105 Cards in this Set

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Which of the following items are true for cerebellar lesions?

1) Ataxia is contralateral to the cerebellar lesion.
2) Unsteady gait and eye-movement abnormalities (often with intense vertigo) are associated with midline lesions (vermis, flocculonodular lobes, respectively).
3) Ataxia of the *limbs* is typically caused by lesions lateral (to the side) of the vermis
4) Ataxia is ipsilateral to the side of the cerebellar lesion.
5) Ataxia may be seen as the result of lesions outside the cerebellum, due to reciprocal interconnections with the cerebellum
6) Cerebellar lesions may also cause articulation problems, difficulty with motor learning, and cognitive processes
7) All of the above
Correct items: 2, 3, 4, 5
Ataxia, by definition, is always related to cerebellar lesions or areas connected with the cerebellum. It is always ipsilateral (affects same side of body as the lesion)--UNLIKE virtually every other area of the brain. The oldest part of the cerebellum (balance, movements of the trunk) is at the middle of the cerebellum, with progressively newer, more complex parts towards the outside (control of more distal limbs, cognitive processing) in the *lateral* areas. Articulation problems are related to the primary *motor planning* function of the cerebellum.
What is a technical term for unsteady gait caused by poor cerebellar motor control.
truncal ataxia
Note that "unsteady gait" might be caused EITHER by vertigo (dizziness) or by poor motor control, or both. Slightly different parts of the cerebellum are involved for vertigo (vermis) versus truncal ataxia (floculononular lobe).
What is a "fossa"; and what fossa is associated with the cerebellum?
A "fossa" is a reservoir-like depression in the skull. For example, the "posterior fossa" primarily holds the cerebellum, among other smaller structures.
Important for MRI evaluation--for example, an unusual gap between the posterior fossa and the cerebellum may indicate a cyst or growth.
The midline "vermis" is so named because it looks like a _______ (latin translation).
worm
vermis = worm
The primary fissue of the cerebellum, called the ________________ fissure, divides the cerebellum into an __________ lobe and a _____________ lobe.
primary, anterior, posterior.
The primary fissue is a very deep fold which runs horizontally. The anterior ("top") lobe and posterior ("bottom") lobe are demarcated by this fissure.
Multiple Choice: The primary fissure of the cerebellum runs (horizontally/vertically)
Horizontally.
The primary fissue divides the anterior from the posterior lobe.
The cerebellum forms the roof of the ___________ ventricle, and spans almost the entire length of the following brain stem structures: ____________ and _________________.
fourth ventricle; medulla and pons
It sits like a "hat" on the dorsal (back) side of the brain stem.
True or False: Ataxia is contralateral to the side of the lesion.
False
"Ataxia" by definition is a cerebellar lesion (or connected areas). Cerebellar lesions are always ipsiplateral--unlike virtually every other lesion in the brain! (B:654)
True or False: Unsteady gait and eye-movement abnormalities (often with intense vertigo) are associated with midline cerebellar lesions (vermis, flocculonodular lobes).
True
MNEMONIC: Think of what happens when someone is drunk--the "prototypical cerebellar lesion". Note also: The vermis is the oldest (most central) part of the cerebellum, and is involved with very basic functions such as controlling posture muscles and balance. It exists in similar form in many lower animals. (Lecture)
True or False: Ataxia of the limbs is typically caused by lesions *lateral* to the vermis.
True
The lateral areas are involved in "appendicular ataxia" (ataxia of the limbs). (B:654)
True or False: Ataxia may be seen as the result of lesions in other areas than the cerebellum, due to reciprocal interconnections (part of the cerebellar network)
True
Areas outside the cerebellum which may cause "cerebellar" symptoms because of reciprocal connections include, for example, damage to the cerebral peduncles, and to fiber tracts in the midbrain which connect the cerebellum and thalamus and other nuclei. (B654)
True or False: Cerebellar lesions may cause severe speech articulation problems.
True.
MNEMONIC: Think of what happens when someone is drunk--the "prototypical cerebellar lesion". They begin to slur their words. (Lecture)
What is a good way to remember the prototypical symptoms (signs) of a cerebellar lesion?
Visualize what happens when someone is moderately drunk:
1) staggering gait/truncal ataxia;
2) difficulty coordinating arms/appendicular ataxia;
3) slurred speech /articulation;
4) "whirlies" (vertigo);
5) poor judgment (cognitive processing).
Think of the classic "roadside sobriety test". Heel-toe walking, ability to rapidly touch finger to nose, speech difficulties, etc. (Lecture)
In the cerebellum, ridges have a different name than in the cerebral cortex where they are called "gyri". They are called ________ due to their resemblance to ___________.
folia; "leaves".
(B: 656)
Removing the cerebellum from the brain stem reveals the three__________________, which form the walls (sides) of the _______________.
cerebral peduncles; fourth ventricle.
The roof of the fourth ventricle is formed by the cerebellum itself. The three penduncles wrap like "arms" around the underlying brain stem, creating the walls for the fourth ventricle. (Lecture; B: 656)
The vermis is important in control of __________ muscles.
proximal and trunk muscles (NOT limb muscles.)
Lesions cause truncal ataxia and vertigo.
The flocculonodular lobes, situated near the vermis, are important in ________________ control.
vestibulo-ocular control (balance and related eye-movements).
Recall that when someone is very dizzy/drunk, their eye movements tend to be affected as well (e.g., roll side to side).
The inferior vermis and flocculonodular lobes regulate b_________, e_______________, and g______ through interactions with the vestibular circuitry.
balance, eye-movements, gait
Reflexive movements of the eyes and balance are closely wired together, as you can recall if you've ever had the "whirlies" due to alcohol or roller-coaster riding.
The intermediate part of the cerebellar hemispheres is mainly involved in control of more distal (distant) parts of the appendicular muscles in the _________ and ________________.
arms and legs.
"Appendicular" refers to the world "appendage". Arms and legs are both "appendages".
The largest functional unit of the cerebellar hemisphere is the _____________ hemisphere (or "area"), and is involved in m_______ p________ for the extremities.
lateral hemisphere, motor planning and some cognitive functiongs.
True or False: Virtually the entire lateral cerebellar hemisphere can be removed on one side without severe deficits.
True
This is somewhat similar to the hippocampus: You have to remove BOTH hippocampi (left and right) to cause severe memory deficits. Only slight deficits are caused by one-sided removal.
*ALL* outputs from the cerebellum are relayed by d___________ c____________ nuclei and v________ nuclei. (Outputs also have some connections from inputs on their way to the cerebellar cortex).
deep cerebellar and vestibular nuclei
The three cerebellar peduncles (superior, middle, inferior) are also referred to as the __________ __________, _________ __________, and __________ ___________ respectively.
Brachium conjunctivum, brachium pontis, restiform body.
Brachium conjunctivum decussates in the lower midbrain (fibers "converge"), brachium pontis has massive connections to the pons, and the inferior cerebellar peduncle is a rope-like body ("restiform"). (B:654)
Multiple Choice: The superior peduncle contains primarily (inputs/outputs) from the cerebellum, while the middle and inferior contain primarily (inputs/outputs) from the cerebellum.
outputs, inputs.
MNEMONIC: The highest peduncle (superior) is closest to the higher levels of processing--therefore it makes sense that it contains outputs. Conversely, it makes sense that the two lower peduncles contain inputs. (B:654)
The tentorium cerebelli is a thick, durable sheath which looks much like the dura matter, and is important because it may cause damage if the brain h__________ during swelling (e.g., after accident or anoxia).
herniates
The tentorium has relatively sharp, stiff edges where it approaches the brain stem. The gap between the brain stem is especially prone to herniation if the brain swells, putting pressure on vital structures such as the pons, midbrain, and medulla as the brain "balloons" down through the gap. (Lecture)
ALL output from the cerebellar cortex is carried by axons of the ___________ cells into the cerebellar white matter. This ouput is then relayed by the ___________ nuclei, and transmitted from the cerebellum by the _________ cerebellar peduncles.
purkinje; deep cerebellar and vestibular nuclei, superior cerebellar
(B: 658) Recall aksi that most of the output from the cerebellum are carried by the *superior cerebellar peduncles*.
The three layers of the cerebellar cortex are the __________, ____________, and the __________________. Of these, the _______________ is by far the most numerous.
granule, purkinje, molecular. Granule cells are most numerous.
(B658). Granual cells are so numerous they approach the total of the entire rest of the nervous system!
The two types of synaptic input fibers to the cerebellum are: ______________ and _________________.
mossy fibers, climbing fibers
Mossy fibers arise from numerous regions and synapse onto granule cells. Climbing fibers arise from the contralateral inferior olivary nucleus. (B:658)
All cerebellar axons projecting upward are (excitatory/inhibitory), while all axons projecting downward are (excitatory/inhibitory).
excitatory, inhibitory
Upward projecting axons are from mossy & climbing fibers, granule cell parallel fibers); downward projecting axons are from purkinje, stelate, basket, and Golgi cells). (B: 660)
The three major functional units of the cerebellum are the _____________, __________, and _____________.
1) vermis & flocculonodular lobe ("medial cerebellum"); 2) intermediate hemispheres; 3) lateral hemispheres.
The functional role of these regions is also organized from middle to lateral areas: Medial controls mainly trunk and proximal muscles as well as balance, posture, and gait--picture a person standing without arms. The lateral and intermediate areas control maily distal limb coordination. (B:660)
Multiple Choice: Cerebellar lesions are associated with (resting/intentional) tremor, in contrast to *basal ganglia* lesions which are associated with (resting/intentional) tremor
intentional (cerebellum); resting/pill-rolling (basal ganglia).
Remember the "prototypical diseases" of each structure. Intoxication causes difficulty putting the finger to nose, while Parkinson's Disease causes a "pill-rolling" tremor.
How are cerebellar and basal ganglia functions similar? (Name at least two important ways).
Possible answers: 1) smoothing motor movement, 2) involvement in higher cognitive processing, probably including attention and even reading disability, 3) some aspects of their circuitry is similar--both have a relay in the thalamus and then project to the brain (among other areas).
Name three crucial mnemonic/organizational principles for studying/understanding the cerebellum
Focus on: 1) the "prototypical disease" and its symptoms (intoxication); 2) medial-to-lateral organization; 3) similarities to basal ganglia.
PROTOTYPICAL DISEASE/SXS: Typical symptoms of intoxication (and the major sxs of cerebellar lesions) are "whirlies" (vertigo, poor balance); unstable gait (truncal ataxia); awkward arm and leg movements (appendicular ataxia, dysdiadicokinesis); slurred articulation; slowed thinking and poor judgment (higher-cognitive processing)

MEDIAL-TO-LATERAL ORGANIZATION. The medial part of the cerebellum resembles a person without arms (thus: vestibular system, trunk and proximal muscles are affected), while intermediate and lateral areas affect progressively more distal (distant) muscles in arms and legs.
SIMILARITY TO BASAL GANGLIA: Both involved in smoothing muscle movement, higher-level thinking (e.g., attention, possibly reading disorder), and both include circuits through the thalamus to the cortex (including prefrontal cortex).
Ataxia consists of two different components or aspects, _______________ and ______________________.
dysmetria, dysrhythmia
DYSMETRIA = difficulty judging the required effort to move muscles through a given distance--thus overshooting or undershooting a target.
DYSRHYTHMIA = deficit in the timing or sequencing of movement (also called "decomposition of movement")
What forms the roof of the fourth ventricle?
Cerebellum B 654 last paragraph
The walls of the fourth ventricle are formed by _____________ .
cerebellar peduncles B 656 Second paragraph.
The deepest fissure of the cerebellum is called ________ and it separates the cerebellum into an _________ and ___________ lobes.
Primary, anterior, posterior. B 654 last paragraph
The lateral hemispheres of the cerebellum are involved in m____________ planning and __________ functioning.
motor planning, cognitive functioning.
Cerebellum’s vermis are important in control of proximal ____________ coordination and ____________ coordination, among other functions.
Proximal limb and trunk coordination B 657 Table 15.1
Which cerebellar peduncle(s) carries mainly *outputs* from the cerebellum? Which cerebellar peduncle(s) carry main input?
Superior (output) versus middle and inferior (input). B 656 Second paragraph
What are the three layers of the cerebellum?
Granule cell layer, Purkinje cell layer and molecular layer. B 658
Multiple Choice: Purkinje cells are (inhibitory/excitatory).
inhibitory B 660 second paragraph
All cerebellar axons projecting upward are _____________ (inhibitory/excitatory).
excitatory. B 660 Second paragraph
Name three excitatory *fibers* (not cells) of the cerebellum.
Mossy fibers, climbing fibers, granule cell parallel fibers. B 660 Second paragraph
Name four inhibitory *cells* (not fibers) of the cerebellum.
Purkinje cells, stellate cells, basket cells, Gogli cells. B 660 Second paragraph
None
The lateral hemispheres of the cerebellum are involved in ____________ ___________ of the lateral extremities, as well as cognitive functioning.
Motor planning of the extremities (B 657, Table 15.1)
Cerebellum’s vermis are important in control of proximal ____________ coordination and ____________ coordination, among other functions.
Proximal limb and trunk coordination B 657 Table 15.1
MNEMONIC: The medial portion of the cerebellum resembles an armless and legless person—hence control of trunk and proximal limb muscles.
Which cerebellar peduncle(s) carries mainly *outputs* from the cerebellum? Which cerebellar peduncle(s) carry main input?
Superior (output) versus middle and inferior (input). B 656 Second paragraph
The frontal lobes are separated from the parietal lobes by the ________ ________ and from the temporal lobes by the _________ ________
central sulcus & sylvian fissure.
The frontal lobes are the largest part of the brain, comprising almost 1/3 of the cerebal cortex (B 847)
The frontal lobes are divided into three general surfaces: the l_________ surface, m_________ surface, and the o________ f_____ surface.
lateral, medial, and orbitalfrontal.
Note that the medial surface may be partially hidden within the very deep longitudinal fissure.
What area of the cortex is entirely hidden within the anterior (frontal) part of the longitudinal fissure?
The anterior cingulate gyrus.
This area is somewhat hard to visualize without a model or a drawing, but basically is the cortex (outer layer of the brain) which forms an arc around the corpus callosum. If you imagine a slice through a peach, the cingulate would be the area just around the peach pit (corpus callosum, and beneath that the ventricular system and thalami).
The anterior cingulate gyrus is an important part of the _________ system, which is involved in regulating emotions and in creation of new memory, among other functions.
Limbic system.
Recall the lesions to anterior cingulate gyrus may cause disturbance in motivation and/or memory. Remember also that the anterior cingulate is one component in the “Circuit of Papez” (what are the others?).
In the frontal lobes, the motor cortex (consisting of primary motor strip, supplementary motor areas, frontal eye-fields, premotor cortex) are part of the l_______ surface, the anterior cingulate gyrus is located on the m___________ surface of the frontal cortex, and limbic orbitofrontal cortex is on v_________ surface.
lateral, medial, ventral (or orbitofrontal) surface (B 848)
You must be able to visualize these anatomical coordinates!
The motor cortex of the brain is located in the ___________ lobe of the brain, and consists of at least the following functional areas: the p________ m_______ strip, sup____________ m__________ area, frontal e_________ f________, and p__________ c_________.
frontal lobe, and consist of primary motor strip, supplementary motor areas, frontal eye-fields, and premotor cortex. (B848).
See Blumenfeld’s illustration.
The pyramidal tract (long nerve fibers extending from cortex, the corona radiata, internal capsule, ultimately connecting to the spinal cord) originates in what specific area of the frontal lobe?
Primary motor strip.
Recall that the “giant Betz” cells are among the largest neurons of the body, and “power” the longest nerve tract in the body.
The largest part of the frontal lobes is the _________ cortex, which is involved in many higher-level cognitive functions
Prefrontal cortex.
Located anterior to the motor cortexes and is primarily responsible for higher-order functioning and many frontal lobes disorders, especially disorders of “executive functioning” (B 848)
The frontal lobes' cortical connections are primarily to the a____________ areas (cortex) of the rest of the brain, including cortex in the parietal, temporal, occipital lobes
Association cortex.
Probably the most important subcortical connections of the brain include the t__________ nuclei and the b_______ g_________.
Thalamus & basal ganglia.
Remember that “subcortical” refers primarily to areas “inside” the brain but usually does NOT include the hippocampus inside the temporal lobes.
As described by Blumenfeld, one theoretical classification of frontal lobe functions consists of three general abilities/functions: ____________ , ____________ , and __________________. (These functions are part of the general "umbrella" of "goal-oriented behavior" or "overriding automatic pilot", described in class.)
Restraint (or inhibition), initiative (or drive), and order (or ability to sequence information/activities). (B 849)
This can be remembered by the mnemonic “RIO” , as in “Rio Grande” or “Big River”. Another possibilty might be "ORDR" (O-rder, R-straint, DR-ive)
The dorsolateral prefrontal cortex has been shown to be very important in the functioning of _______ memory, which is often measured by the WAIS-III subtests _____________ and ___________
working memory, digits backward and letter-number sequencing.
This is one of the few areas of the brain where we have relatively specific neuropsychological tests. Note that the dorsolateral cortex also has a key role in ability to shift cognitive set, verbal fluency/productivity, and selective attention. (B 850).
Multiple Choice: Lesions on the (dorsolateral prefrontal cortex/orbitofrontal cortex) are often associated with impulsive, disinhibited behavior, while lesions on the (dorsolateral prefrontal cortex/orbitofrontal cortex) are often associated with apathetic, lifeless states.
Orbitofrontal (impulsive/disinhibited), dorsolateral (apathetic).
Like the left/right frontal lesions, many exceptions exist to this dichotomy. (B 850, table 19.9 on 847)
The association cortex is divided into what two kinds of regions?
Unimodal association cortex (modality–specific) and heteromodal association cortex (higher order).
These two types of association areas are distinguished from each other by the “level of processing”. Thus, unimodal processing is specific to just one modality such as vision, while “heteromodal” refers to aspects of experience which transcend a single modality. For example, the location of an object in space may be mediated by sound, sight, or touch. Another example is shape, which may be appreciated by touch, sight, or language (‘square’). Another example is receptive language in general, which can be understood either through vision (printing), sound (spoken speech or even through sign-language or Braille).
True or False: Most left-handers have language primarily in the right-hemisphere, while most right-handers have language primarily in the left-hemisphere.
False.
About 60-70% of left-handers are left-hemisphere dominant for language, although lateralization may be less complete than for right-handers children.
The nondominant hemisphere is specialized for certain specialized “nonverbal” aspects of spoken language. Name two such “nonverbal” linguistic functions.
prosody (tone-of-voice and inflection), “pragmatic language” (appreciation of implied meaning of language, such as hidden social meanings, humor, slang).
Autism-spectrum disorder and nonverbal learning disability are typically characterized by dysprody and difficulty with “pragmatic language”—thus, such individuals tend to talk in a mechanical, monotonic way, with little appreciation of the social context. For example, they may drone on despite signs of discomfort by the other party. These functions are generally considered right-hemisphere functions of language.
What is hemineglect syndrome, and what is by far the most common cause?
Hemineglect = neglect/lack of atttention for half of the external world as well as one’s own body. Lesion in the nondominant (usually left) parietal lobe.
For example, someone may only brush the left half of their teeth. It is almost always caused by a lesion in the *right* hemisphere, usually a stroke or tumor, and only rarely in the left hemisphere. “hemi” = “half”.
Difficulty naming something is called what kind of disorder?
Anomia or Dysnomia.
A=no nomia=name. Anomia=no name
Which hemisphere is more important for attentional mechanisms in most individuals?
Right Hemisphere
What is hemineglect syndrome, and what is by far the most common cause?
Hemineglect = neglect/lack of atttention for half of the external world as well as one’s own body. It is typically caused by lesions in the dominant (usually right) hemisphere--usually the parietal or frontal lobe. Lesions in the nondominant (usually left) hemisphere RARELY causes neglect.
For example, someone may only brush the left half of their teeth.
If the lesion is in a dominant hemisphere, in visual-spatial analysis the
patient tends to understand the whole, while omitting _______________. On the other
hand, if the lesion is in the non-dominant hemisphere, the patient will have
problems with appreciating ________________ .
Omitting important details, Gestalt (B:846)
Contralateral hemineglect usually occurs from lesions in ______________
and ______________ cortex.
Right parietal and frontal cortex. (B:841).
The area especially important in spatial analysis and thus involved in
hemineglect syndrome is ______________.
Parietal association cortex (usually right side).
(B:840).
A person who is asked to imagine facing a particular place (e.g.
cathedral on a plaza) and to recall objects around that place can only
recall details on the right side. What type of neglect does this show?
Conceptual neglect. (B:846)
Sensory hemineglect may appear in a variety of different sensory modalities, including __________, __________, and _________________.
Visual, tactile, auditory.
(B:842)
Gerstmann's syndrome consists of what four clinical findings? (Aarf!)
Agraphia, acalculia, right-left disorientation, finger agnosia.
MNEMONIC: AARF! Remember agraphia=impaired writing; acalculia=problems in mechanical arithmetic (addition, subtraction, mult, division); right-left disorientation=difficulty identifying the right side vs. left side of your or examiner's body; finger agnosia=inability to name or identify individual fingers while blindfolded which have been touched by the examiner (B: 836).
What does it mean diagnostically if not all four components of the Gerstmann's syndrome?
When fewer than all four components are present, Gerstmann symptoms have greatly reduced localizing value and can be seen in a variety of brain disorders
It is important to remember that when all 4 components are present, it typically means that the syndrome is strongly localizing to the dominant inferior parietal lobule (B:838).
What is Aphemia?
It is severe apraxia of speech articulatory apparatus
For example these patients have normal written language, but effortful, poorly articulated speech. It can even lead to muteness in some children (B:837).
Gerstmann's what syndrome consists of four clinical indicators? (Aarf!)
agraphia, acalculia, right-left disorientation, finger agnosia
MNEMONIC: AARF! Remember agraphia=impaired writing (NOT reading!), acalculia=problems in basic arithmetic, right-left disorientation=difficulty identifying right from left on one's own or other's body; finger agnosia=inability to identify which finger(s) have been touched with eyes shut. (B: 836).
What does it mean diagnostically if fewer than all four Gerstman symptoms are present?
When there are fewer than four components, the Gerstmann has greatly reduced localizing value and can be seen in a variety of brain disorders
It is important to remember that when all 4 components are present, it means that the syndrome is strongly localizing to the dominant (usually left) inferior parietal lobule (B:838).
What is apraxia, and what other disorder is it commonly associated with?
The most common form of apraxia is the inability to carry out a simple motor action in response to verbal command, such as hammering a nail, brushing teeth, using a key to open the door. This is called IDEOMOTOR apraxia. It is commonly associated with APHASIA (language-disorder)
An example in mild apraxia patients would be using index finger like a toothbrush instead of holding imaginary toothbrush in hand, when asked to pantomime brushing one's teeth. (B:837).
What is the most dramatic syndrome in clinical neurology and what neuroanatomical area does it usually affect?
Hemineglect Syndrome. It is most often seen with infarcts or other acute lesions of the right PARIETAL or right FRONTAL lobes
Patients with this syndrome usually exhibit profound neglect for the left half of the external world as well as neglect of left half of their own body. An example of this would be a patient who is unaware that anything is wrong, even unaware that the left side of their body belongs to them. (B:841).
___________ (lack of awareness of one's own illness) may be seen in patients confused by right hemineglect.
Anosognosia
MNEMONIC: a="no", nos="own", gnosia="knowledge". Mild forms of anosnosia are also frequently seen among individuals with right-hemisphere lesions even WITHOUT hemineglect. One famous example is that of a former U.S. Supreme Court Justice, William O. Douglas, who had a severe right-sided stroke but denied any intellectual problems while sitting as a member of the court! (pg. 845).
A rare disorder resulting from right hemisphere lesions, characterized by patients insisting their friends or family members gave all been replaced by identical looking imposters.
Capgras syndrome
Personality and emotional changes are not uncommon in right hemisphere lesions. Some patients are overtly psychotic and have delusions and hallucinations (pgs. 846-847).
_____________'s area is involved in comprehension of speech. It's located near the ear, in the superior, posterior dominant __________ lobe.
Wernicke's area, temporal
Distinctive features are poor comprehension AND "word-salad" but grammatical word production. Wernicke’s aphasia is much less common than Broca's aphasia, so if someone has "word-salad" speech be SURE to consider things like diabetic coma, psychiatric illness, and the like.
_________'s area is involved in speech production by activating particular sequences of spoken sounds to produce words. It's located in the dominant ____________ lobe.
Broca's aphasia, frontal lobe
Distinct symptoms are very halting, dysfluent, "telegraphic" speech (mainly nouns and a few verbs, short length). In addition, there is often a right-sided weakness because Broca's is typically caused by stroke involving the motor area of the brain.
The arcuate fasiculus is the white matter pathway which connects ________ __________ and _________ _________, allowing them to communicate. When this pathway is interrupted, the patient exhibits a distinctive problem in ______________ spoken words, due to disconnection.
Broca's area, Wernicke’s areas, *repetition* of words spoken by the examiner.
The client can fluently *produce* and *comprehend* grammatical sentences, even though they cannot repeat.
Connections through the massive fiber tract called the ____________ ___________ allow the nondominant hemisphere to assist in language processing.
corpus callosum
Recall that prosody (inflection, tone of voice) and "pragmatic" aspects of language (implied meaning, social meaning) depends on intact nondominant (usually right) hemisphere functioning.
Broca's aphasia is characterized by ____________ of spontaneous speech, subtle comprehension deficits, and often motor weakness on the __________ side of the body.
dysfluency (halting speech, typically limited to 5 words), right side.
The difficulty with grammar is often subtle and requires some probing to elicit--for example, difficulty understanding passive sentence construction, e.g. "The ball was hit by the boy" vs "The boy hit the ball".
Aphasia is classified into several different types by evaluating three key characteristics: __________, ___________, ___________
spontaneous fluency, repetition, comprehension
In addition to classification based on spontaneous fluency, repetition, and comprehension, ALL aphasias have at least mild naming problems ("anomia", or "dysnomia").
What deficit is present in at least mild form in ALL aphasia?
naming ("anomia", "dysnomia")
The presence of naming deficits in all aphasias is the reason that a naming test is always part of neuropsychological screening exams.
_______________is abnormal rhythm and timing of movements.
Dysrhythmia (B:672)
People with ____________ ____________ have a wide based unsteady gait that resembles the gait of a drunk person.
Truncal Ataxia (B: 673)
Patients with cerebellar regions may exhibit __________ dysmetria, in which saccades overshoot or undershoot their target.
Ocular dysmetria (B:673)
Wernicke's and Broca's areas communicate with each other through several different
connections. The best known area is
subcortical white matter known as the a________ f___________.
Arcuate fasciculus
Communication between Broca's and Wernicke's area
is complex because each area has pathways into many other brain structures.
True or False: Broca's and Wernicke's area are the primary areas that perform the operations involved in production and comprehension
of language.
False. They are perhaps the best known and best studied, but not the only critical areas.
Both Broca's and Wernicke's area are connected with other critical language areas. Disorders in these other language areas cause a variety of different types of aphasias.
Common symptoms of ________ _______ are dysfluent speech, naming difficulties, difficulty repeating phrases, reading and writing are slow with
grammatical difficulties, and frustration and
depression. A ________-side motor weakness is another frequent symptom.
Broca's Aphasia, right-sided
Unlike Wernicke's aphasia, patients are usually aware
of the dysfunctions which cause the frustration and
depression. Wernicke's aphasia is also usually not associated with right-sided motor weakness.
Common symptoms of ________ ________ include impaired comprehension, empty and meaningless speech, lack of insight, paraphasic errors
(errors like using the wrong words and neologisms), and angry or paranoid behavior.
Wernicke's Aphasia
Wernicke's aphasia usually has some overlapping features with
Broca's Aphasia, especially naming difficulties and problems
reading and writing.
True or False: Psychiatric disorders are sometimes
confused with aphasia.
True. This is especially true of Wernicke's aphasia, because of the nonsensical-sounding speech, frequent lack of insight into their inability to speak, and occasional paranoia and rage.
Remember: Wernicke's is relatively rare compared to Brocas. So if you see disordered speech, lack of insight, rage, paranoia, be sure to rule out medical causes first, such as insulin crisis.
The c________ c_________ assists in
dual-hemisphere language processing. Dual-hemisphere processing is important because the non-dominant (usually right) hemisphere is
important in recognition and production of the affective elements of speech, such as p_____________ and p_________ language.
corpus callosum, prosody, pramatic language
The "nonlinguistic" aspects of language are often prominent problems in autism-spectrum disorder such as Aspergers, nonverbal learning disability, and any injury to the nondominant hemisphere such as car accident.
The prefix "dys" and the prefix "a" have slightly different meanings. Describe how their meanings differ. (For example, "dyscalculia" versus "acalculia".)
"a" = complete absence,
"dys" = some disability but not complete.
MNEMONIC: "a" as in "absence", "dys" as in "disability". Note that the "a" prefix is favored by neurologists (M.D.s), while "dys" is preferred by neuropsychologists--even when referring to the same symptoms!
"Acalculia ( or "dyscalculia") is part of the ________________ syndrome, and refers to _____________________.
Gerstmann syndrome. Difficulty with basic arithmetic functions (-, +, x, /).
The Gerstmann syndrome is a very old classification and continues to be somewhat controversial. However, when all four signs are present (AARF!), it has good localizing value (dominant parietal lobe).
"Agraphia" ( or "dysgraphia") is part of the ________________ syndrome, and refers to _____________________.
Gerstmann syndrome. Difficulty forming letters when printing or writing.
The Gerstmann syndrome is a very old classification and continues to be somewhat controversial. However, when all four signs are present (AARF!), it has good localizing value (dominant parietal lobe).
Left-right confusion is part of the ________________ syndrome and is frequently seen in dyslexia, and refers to _____________________.
Gerstmann syndrome. Reduced efficiency in identifying left and right sides of one's own or examiner's body. (More difficult if done quickly and when identifying examiner's left-right.)
The Gerstmann syndrome is a very old classification and continues to be somewhat controversial. However, when all four signs are present (AARF!), it has good localizing value (dominant parietal lobe).
F_______ a________ is part of the ________________ syndrome, and refers to _____________________.
finger agnosia (or "dysnosia"). Gerstmann syndrome. Difficulty identifying which fingers have been touched while the client is blindfolded.
The Gerstmann syndrome is a very old classification and continues to be somewhat controversial. However, when all four signs are present (AARF!), it has good localizing value (dominant parietal lobe--specifically, the inferior parietal lobule).
Symtoms of the Gerstmann syndrome are caused by a lesion in the dominant ______________ lobe, and are located near the angular and suprmarginal gyri.
parietal lobe (specifically the area called the "inferior parietal lobule").
Similar symptoms are often observed in READING DISABILITY (dyslexia), due to the proximity of the angular gyrus
What gyrus of the dominant hemisphere has been especially linked to dyslexia (reading disability)?
angular gyrus.
This is primarily "dysphonetic" dyslexia (inability to sound out words/difficulty with phonics). This type is about 2/3 of all dyslexias.