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79 Cards in this Set

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Most of the brain is made up of _________ cortex.
Association
The 2 types of association cortex are:
Unimodal (modality-specific)
Heteromodal (Higher-order)
Give 4 examples of unimodal association cortex
Somatosensory Association
Visual Association
Auditory Association
Motor Association
What are the 2 motor association cortex areas?
Premotor cortex
Supplementary Motor Area
From whence does the unimodal sensory association cortex receive its primary input
Primary sensory cortex of a specific sensory modality
What does the unimodal association cortex do with the input
Performs higher-order sensory processing
What connections does the heteromodal association cortex have (direction, areas)?
Bidirectional connections with both motor and sensory association cortex of all modalities and bidirectional connections with limbic cortex
What function does the heteromodal cortex serve?
Highest-order mental functions.
In what 2 areas is heteromodal association cortex found?
Frontal lobes
Parieto-occipital junctions
What information does the limbic system provide to the heteromodal association cortex (2 types)?
emotional
motivational
Simple motor movements are controlled by the __________ hemisphere while skilled complex motor tasks for both limbs are mainly controlled by the ______ hemisphere?
contralateral
dominant/left (explains why apraxia usually due to dominant/left hemisphere damage)
Define apraxia
A disorder of formulating skilled movements
The left hemisphere is dominant for language in over ____% of R handers and ____ % of L handers
95%
60-70%
List 5 skills associated with the dominant/left hemisphere
Language
Skill motor formulation (praxis)
Arithmetic (sequential, analytical calculation skills)
Musical ability (sequential, analytical abilities in trained musicians)
Sense of direction (following written directions in sequence)
List 5 functions of the nondominant/right hemisphere
Prosody
Visuospatial analysis and spatial attention
Arithmetic (correctly line up numbers on a page)
Musical ability (untrained musicians; complex pieces for trained musicians)
Sense of direction (finding way by overall sense of spatial orientation)
Define prosody
Emotion conveyed by the tone of voice
Which hemisphere is responsible for attention to both sides?
Right (non-dominant)
Which hemisphere is responsible for spatial perception of the overall gestalt?
Right (non-dominant)
Networks with connections to which 3 areas mediate dominant/non-dominant hemisphere functions?
1. Frontoparietal
2. Connections with limbic structures
3. Reciprocal connections with subcortical nuclei
What 2 ways can these networks be disconnected?
Within each hemisphere

Between hemispheres at the corpus callosum
Where is the primary auditory cortex located?
The superior bank of the Sylvian fissure in the temporal lobe (See Blumenfeld p. 824 for diagram)
What part of the brain is responsible for identifying particular sequences of sounds and comprehending words as meaningful?
Wernicke's area
What Brodmann's are is this?
22
Where is it located
Posterior 2/3 of the superior temporal gyrus in the dominant hemisphere
What adjacent Brodmann's areas/association cortex also produce Wernicke's aphasia
37, 39, 40 (See Blumenfeld p. 828 for diagram)
What part of the brain is responsible for articulation of sounds that result in speech
Face area of the primary motor cortex
Where is this located
Inferior portion of the precentral gyrus
What part of the brain is responsible for the motor program that activates sequences of sounds to produce words
Broca's area
What is/are the corresponding Brodmann's area(s)
44, 45 (See Blumenfeld p. 828 for diagram)
What is the mnemonic to remember Wernicke's and Broca's Brodmann's areas?
Broca's (44) is twice Wernicke's (22)
Describe where Broca's area is located in the brain
In the opercular and triangular portions of the inferior frontal gyrus of the dominant hemisphere
What other adjacent Brodmann's areas (6) also can produce Broca's aphasia
9, 46, 47, 6, 8, 10
What is the subcortical white matter pathway that connects Wernicke's and Broca's areas
Arcuate fasciculus
What other pathways are involved
numerous polysynaptic connections that convey information along the intervening peri-Sylvian cortex
To what areas does Broca's area connect for higher-order motor aspects of speech formulation and planning (3)
Prefrontal cortex, premotor cortex, supplementary motor area
What other important aspect of speech formulation are these areas responsible for
Syntax (both in language comprehension and production)
Define syntax
Grammatical structure

According to the INS Dictionary of Neuropsychology: "The rules of language structure governing the assembly of words into sentences. Syntax represents the variety of relationships among words (i.e., word order) that helps convey information in a coherent and meaningful manner." (p. 155)

According to answers.com: "The study of the rules whereby words or other elements of sentence structure are combined to form grammatical sentences. "
With which other brain areas does Wernicke's area have connections (3)
Supramarginal gyrus of the parietal lobe, angular gyrus of the parietal lobe, other parts of the temporal lobe (e.g., Brodmann's area 37)
In addition to comprehension, what other aspect of language do these areas assist with
Lexicon (involved in both the comprehension and production of meaningful language)
Define lexicon
According to the INS Dictionary of Neuropsychology: "Knowledge of the phonological representation and grammatical aspects of words." (p. 97)

According to answers.com:
"The morphemes of a language considered as a group."

According to answers.com, a morpheme is: "A meaningful linguistic unit consisting of a word, such as man, or a word element, such as -ed in walked, that cannot be divided into smaller meaningful parts."

According to the INS Dictionary of Neuropsychology, a morpheme is: "The smallest unit of meaning in a language. Morphemes include words as well as meaningful prefixes, suffixes, and affixes." (p. 109)
What part of the brain is also particularly involved in written language
Language areas of the dominant parietal lobe, such as angular gyrus
Describe the pathway taken by information that is read
Primary visual cortex in occipital lobes, processed in visual association cortex, travels anteriorly via the angular gyrus to language areas
What role does the right/non-dominant hemisphere play in language
Recognition and production of affective elements of speech
What pathway is involved
Via the corpus callosum
What language dysfunction do individuals with non-dominant hemisphere lesions display
Difficulty judging the intended expression in the tone of voice, difficulty producing emotional expression in their voice
Lesions in which subcortical areas reciprocally connected with language areas can produce similar language deficits (3)
Thalamus, basal ganglia, subcortical white matter
Define aphasia/dysphasia
"A defect in language processing caused by dysfunction of the dominant hemisphere" (Blumenfeld, p. 829)

INS Dictionary of Neuropsychology: "Acquired disorder of symbolic language processing." (p. 15)
What 5 other general conditions/situations must be ruled out before giving a diagnosis of aphasia
1. Disorders of speech production, 2. Auditory disorders, 3. Defects in arousal and attention, 4. Psychiatric disorders, 5. Lack of cooperation
Name 3 disorders of speech production
Dysarthria, aphemia (verbal apraxia), mutism
How can disorders of speech production be distinguished from aphasia
The content and grammar are normal; written language is often normal; mutism may result from severe aphasia or from motor disorders, but writing may be intact
Name 3 auditory disorders
Peripheral hearing loss, pure word deafness, cortical deafness
How can auditory disorders be distinguished from aphasia
Reading and other aspects of language are intact
Name some conditions that result in defects in arousal and attention
Global confusional state (toxic/metabolic, post-ictal, brainstem ischemia), narcolepsy
Name a couple of psychiatric conditions that may cause disruption of language
Schizophrenia, conversion disorder and other somatoform disorders
What are some aspects of langauge that characterize psychiatric disorders
Disordered, nonsensical, clanging speech full or neologisms
What is the most common cause of aphasia
Cerebral infarction
List 7 causes of aphasia
1. Cerebral contusion; SDH, EDH
2. Ischemic or hemorrhagic vascular events
3. Ictal or post-ictal related to focal seizures in dominant hemisphere
4. Mass lesions (brain tumor, abscess, toxoplasmosis)
5. Inflammatory/autoimmune disorder (e.g., MS, vasculitis)
6. Developmental disorder (language delay, autism)
7. Degenerative disorder (primary progressive aphasia, moderately advanced Alzheimer's Disease, Huntington's Disease)
See neuroexam.com Videos 8-12 for 6-step bedside exam
What is the most common cause of Broca's aphasia
Infarct in the territory of the L MCA superior division
What are other non-language features generally associated with Broca's aphasia (5)
R hemiparesis affecting the face and UE>LE; dysarthria; frustration; depression; L sided and oral-buccal-lingual structures apraxia
What is the most common cause of Wernicke's aphasia
Infarct in the L MCA inferior division territory
What non-language features are generally associated with Wernicke's aphasia (4)
Contralateral visual field cut, usually R upper quadrant; apraxia (difficult to tell due to reduced comprehension); anosagnosia (acting as if conversation is normal); angry or paranoid behavior (may appear psychotic)
What 3 aspects of language determine the type of aphasia
Fluency, comprehension, repetition
What are the 8 general types of aphasias
Global, Mixed transcortical, Broca's, Transcortical Motor, Wernicke's, Transcortical Sensory, Conduction, Anomic
What are the 4 aphasias related to reduced fluency
Global, Mixed Transcortical, Broca's, Transcortical Motor
What are the 4 aphasias related to relatively intact fluency
Wernicke's, Transcortical Sensory, Conduction, Anomic
Given reduced fluency, what 2 aphasias are related to reduced comprehension
Global, Mixed Transcortical
Given reduced fluency, which 2 aphasias are related to relatively intact comprehension
Broca's, Transcortical Motor
Given reduced fluency and comprehension, which aphasia cannot repeat
Global
Given reduced fluency and comprehension, which aphasia can repeat
Mixed Transcortical
Given reduced fluency and generally intact comprehension, which aphasia cannot repeat
Broca's
Given reduced fluency and generally intact comprehension, which aphasia can repeat
Transcortical Motor
Given relatively intact fluency, which 2 aphasias demonstrate reduced comprehension
Wernicke's, Transcortical Sensory
Given relatively intact fluency, which 2 aphasias demonstrated generally intact comprehension
Conduction, Anomic
Given relatively intact fluency and reduced comprehension, which aphasia cannot repeat
Wernicke's
Given relatively intact fluency and reduced comprehension, which aphasia can repeat
Transcortical Sensory
Given relatively intact fluency and comprehension, which aphasia cannot repeat
Conduction
Given relatively intact fluency and comprehension, which aphasia can repeat
Anomic
Draw the flow chart of Classification of Language Disorders using a decision tree of fluency, comprehension, and repetition
See Blumenfeld Figure 19.4, p. 834
Draw a lateral view of the dominant/L hemisphere and for each disorder (except anomic aphasia) indicate the usual area of infarction and the vascular/watershed territory usually involved
See Blumenfeld p. 834