Neural Basis Of Language Disorders

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Cerebral Blood Circulation

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trophic function=provides oxygen and glucose to the brain, removes carbon monoxide

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brain and oxygen deprivation

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cerebal cortex cells are more susceptible to oxygen deprivation than brainstem cell

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oxygen and glucose usage

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brain uses 20% of total cardiac output and 1/5 of oxygen and glucose

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Vascular network

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comprised of arteries and veins

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Vascular branching

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arteries>arterioles>capillaries>venules>veins

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Carotid system

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Begins with common carotid which divides behind the jax into internal and external carotid

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External Carotid

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perfuses the facial muscles, forehead, oral, nasal, and orbital cavities

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Internal Carotid

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major source of blood to the brain

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Collateral Blood Suply

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Circle of Willis

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Circle of Willis

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below the circle damage won't be as serious, If it's at or above the circle, that area won't receive blood.

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Circle of Willis

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Heptagonal vascular structure at midline of the brain, at its base.

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3 major arteries from Circle of Willis

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anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries

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Anterior Cerebral Arteries

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left and right connected by anterior communicating artery. Supplies superior frontal lobe and parietal lobe

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Middle Cerebral Arteries

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course laterally. provides supply to lateral surface of cerebral hemisphere and deep structures of frontal and parietal lobe

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Posterior Cerebral Arteries

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supplies occipital lobe, thalamus, inferior and medial portions of temporal lobe in each hemisphere

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Basilar Artery

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supplies the pons,medulla, cerebellum, midbrain, and portion of cerebral spinal cord,

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Broca's Aphasia:
production

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most common aphasia, Non-fluent, mute, sparse output, effortful speech, restricted vocabulary, telegraphic speech, nouns easier than verbs, aggramatical speech, simple sentences more than complex, over-learned stereotypical utterances, abnormal prosody

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Broca's Aphasia:
Repetition, Aud. Comprehension

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repetition of words and sentences are impaired;Aud compehension relatively spared but trouble with reversible sentences;difficulty understanding grammatically complex sentences;most difficulty with non-canonical and reversible

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Broca's Aphasia:
Writing and Reading

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writing and reading aloud similar to spoken otput;mild to moderate deficits in reading comprehension.

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Broca's Aphasia
other problems

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Oral apraxia, right upper extremity spasticity, right lower facial weakness

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Broca's Aphasia
lesion sites

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broca's area (44 &45), premotor area and motor strip, insula, basal ganglia if large enough

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Wernicke's Aphasia
production

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fluent, normal prosody, paraphasic output, impaired naming, verbal and phonemic paraphasias, lacking in content, no self-corrections

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Wernicke's Aphasia
repetition and Aud. comprehension

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impaired repetition, paraphasic errors, same as in spontaneous speech, may repeat if they're higher level;usually impaired aud.comprehension.

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Wernicke's Aphasia
writing and reading

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writing and reading aloud same as spoken output; reading comprehension may also be impaired called paralexia, somewhat disordered comprehension.

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Wernicke's Aphasia
other problems

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unaware of deficits, seems confused to unskilled person not accompanied by hemiparesis 'cause it's not affecting motor strip.

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Wernicke's Aphasia
lesion sites

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posterior lesion, superior temporal gyrus, may extend to supramarginal gyrus and angular gyrus, middle temporal gyrus, primary and secondary auditory cortes

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Conduction Aphasia
production

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fluent spontaneous output, difficulty in phonological selection, numerous phonemic paraphasias, impaired naming, confrontational naming is impaired

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Conduction Aphasia
repetition and Aud. comprehension

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repetition severely impaired. most common to have repetition with phonemic paraphasia, often omit or substitute words, or fail to repeat anything if functor words are requested (hallmark sign);Aud. comprehension relatively impaired, may understand conversations, may comprehend defectively repeated sentences

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Conduction Aphasia
Writing and reading

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writing may be impaired, substitutions and letter reversals; reading aloud usually impaired; reading comprehension may be impaired.

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Conduction Aphasia
other problems

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aware of their deficits, self-correct, occasionally right paresis depending how severe a lesion.

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Global Aphasia
production

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mostly non-fluent; severe deficits crossing all language modalities, non-fluent stereotypic utterances;fluent-jargon, mumbling;can gesture well

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Global Aphasia
repetition and Aud. Comprehension

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impaired repetition; aud. comprehension= simple nouns and verbs, comprehension of functor words or syntactically complex sentences very poor

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Global Aphasia
writing and reading

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writing is impaired as well as reading aloud and reading comprehension

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Global Aphasia
lesion

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extensive damage: broca's area from 44, 45 to prefrontal cortices and posteriorly to the Insula, extending to the angular gyrus, Wernicke's, Supramarginal gyrus, Arcuate Fasciculus, Aud. Association cortex, Motor, supplem. motor

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Anomic Aphasia
production

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fluent but very empty speech, naming difficulty, circumlocutions, nouns worse than verbs, semantic paraphasias

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Anomic Aphasia
repetition and Aud. comprehension

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unimpaired repetition; Aud. comprehension unimpaired

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Anomic Aphasia
writing and reading

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writing and reading aloud are unimpaired;reading comprehension is impaired with increased length

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Anomic Aphasia
lesion

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posterior lesion but nonlocalizing in the temporoparietal area, left temporal cortex

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Transcortical Motor Aphasia
production

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non-fluent, sparse output, reduction in syntactic complexity, phonemic paraphasias, perseverations, loss of connective words

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Transcortical Motor Aphasia
repetition and Aud. comprehension

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good repetition (hallmark sign) ; relatively unimpaired aud. comprehension or conversation, impaired when tested formally for complex syntactic comprehension

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Transcortical Motor Aphasia
writing and reading

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writing, reading aloud, and reading comprehension are impaired

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Transcortical Motor Aphasia
lesion

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border zones, frontal areas outside Broca's area, above the frontal opercular area, extends anteriorly to the premotor cortex, also involves deep white matter

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Transcortical Sensory Aphasia
production

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fluent speech, neologist paraphasias, circumlocutory empty speech, cannot access meaning of word spoken, severely impaired naming

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Transcortical Sensory Aphasia
repetition and Aud. comprehension

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good repetition (hallmark sign),
Aud. comprehension severely impaired, context dependent comprehension,

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Transcortical Sensory Aphasia
writing and reading

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writing is impaired; reading aloud is relatively impaired; reading comprehension is impaired

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Transcortical Sensory Aphasia
lesion

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border zones, outside Wernicke's area, posterior mid-temporal gyrus, angular gyrus, white matter underlying these areas

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Transcortical Mixed Aphasia
production

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sparse verbal output, non-fluent, reduced syntactic complexity, impaired naming

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Transcortical Mixed Aphasia
repetition and Aud. compehension

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good repetition; Aud comprehension is poor.

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Transcortical Mixed Aphasia
writing and reading

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writing and reading comprehension is impaired; reading aloud is relatively impaired.

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CT scan

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computed tomography. Non-invasive radiological procedure, uses x-ray scanning machine that rotates around structures to take images

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Functional Neuroimaging

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areas of regional cerebral blood are correlated with certain behaviors (PET and fMRI)

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Basic principles of PET and fMRI

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changes in the cellular activity of the brain are accompanied by changes in regional blood flow. Increase in blood flow=heightened glucose utilization & oxygen consumption

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PET scan

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blood flow changes that occur under certain tasks are direclty measured

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PET scan
cons

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invasive procedure, intravenous injection of a radioactive isotope.

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PET scan
cons

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has poorer spatial resolution than fMRI

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fMRI

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blood oxygen level dependent (BOLD) signal is detected

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fMRI

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non-invasive procedure, no contrast, subject only has to lie still & perform the behavioral tasks presented

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fMRI

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less expensive & can be performed in hospitals where MRI scanners are usually available

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fMRI
cons

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sensitive to motion artifacts;regions near the orbital frontal cortex & the anterior temporal lobes are difficult to image

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Event-related potentials (ERPs)

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Electroencephalography(EEG)
Magnetoencephalography(MEG)