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55 Cards in this Set
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apraxia
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- impairment in capacity to program sensorimotor commands and carry out volitional movement
- lesion to frontal and/or parietal lobe in language-dominant hemisphere - often accompanies aphasia - no sensory loss or paralysis - can be speech, non-verbal or limb |
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dysarthria
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- impaired control of muscles responsible for speech
- caused by damage to CNS or PNS (upper/lower motor neurons, cerebellum or extrapyramidal tract) - oral communication impaired due to paralysis or weakness |
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aphasia
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- disruption in reception and expression of structure and rules of language
- usually caused by lesion in left cerebral cortex |
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primary cortex
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- motor: initiate and control precise voluntary muscle movements
- somatosensory - auditory - visual - olfactory |
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association cortices
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- frontal/premotor: planning and initiating complex volitional movement
- parietal: processing tactile information, physical orientation - temporal: discriminating and processing auditory information, language - parieto-occipital: discriminating and processing visual information, reading |
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lobes
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- frontal: executive functioning, voluntary muscle movement
- parietal: sensation, proprioception, reading, writing - temporal: auditory processing/memory, language (syntax, Wernicke's area) - occipital: visual input for reading, writing, pragmatics |
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brainstem
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- conduit for motor output from CNS to PNS
- conduit for sensory input from PNS to CNS - mid-brain: connects brainstem to cerebral hemispheres, CN III & IV - pons: CN V-VIII - medulla: CN VIII-XII, reticular formation |
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cerebellum
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- motor coordination (rate, force, direction, amplitude of volitional movement)
- monitors motor and sensory output - lesions cause ataxic dysarthria, CP |
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diancephalon
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- thalamus: attention center, relays outgoing information from cortex, subcortex and cerebellum, relays incoming information from spinal cord and brainstem
- hypothalamus: autonomous, regulates glands and heart movement, aggression - subthalamus: motor movement, connection to basal ganglia, thalamus, and brainstem |
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spinal cord
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- contains gray matter (central) and white matter (peripheral)
- 31 pairs of spinal nerves enter and exit spinal cord thru intervertebral foramina - dorsal: sensory - ventral: motor |
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lesions to nerve fibers
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- transverse/commissural fibers: damaged communication between hemispheres, split brain
- projection fibers: sensory or motor deficits - association fibers: conduction aphasia, damaged communication within hemispheres |
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lesion to motor strip
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contralateral weakness or paralysis (Bell's palsy, limb monoparesis, hemiparesis)
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lesion to sensory strip
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- decreased sensory thresholds
- limited tactile discrimination and identification - hemineglect |
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CSF
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- cerebral spinal fluid
- produced by choroid plexus in ventricles - flows through ventricles and sub-arachnoid space - creates buoyancy |
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basal ganglia
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- responsible for motor execution of speech
- lesions cause hypokinetic dysarthria |
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lesions to arteries above COW vs. below
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- if a blockage occurs below the COW, person is likely to be able to continue on with life post-stroke
- if it is above, person is likely to suffer brain damage |
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blood supply to brain
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- aorta splits into subclavian arteries
- subclavian splits into carotids and vertebral - carotids divide into internal and external - vertebral arteries combine to form basilar artery - internal carotids and basilar artery form COW - blood is redistributed via cerebral arteries - cerebral arteries connected by communicating arteries to allow for alternative routes in event of a blockage |
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anterior cerebral artery
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- formed by internal carotids
- supplies blood to frontal lobes, medial aspects of parietal and occipital lobes - includes motor and sensory strips |
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middle cerebral artery
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- formed by internal carotids
- supplies blood to posterior frontal lobes, parietal and temporal lobes, thalamus, basal ganglia - includes lateral parts of motor and sensory strip, perisylvian zone |
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posterior cerebral artery
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- formed by basilar artery
- supply medial area of occipital lobes, inferior aspects of temporal lobes, cerebellum, posterior diancephalon - includes hippocampus |
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ischemic stroke
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- lack of blood/oxygen
- more common - <20% fatality rate - recovery greatest in first few weeks - can be thrombolytic (gradual), or embolic (sudden) |
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treatment for ischemic stroke
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- in case of TIA, endarterectomy may prevent CVA
- TPA given intravenously to dissolve clot - anti-coagulant also given intravenously - maintenance through anti-platlets - calcium channel blocker used when there is decreased blood flow to brain |
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carotid endarterectomy
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surgical procedure used to prevent CVA (during transient ischemic attack)
- involves removal of plaque inside artery |
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hemorrhagic stroke
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- artery bursts and floods brain due to weakness of vessel wall and fluctuations in blood pressure
- begins as severe headache with vision problems, nausea and vomiting - 20% of strokes - high mortality rate (50%) die in first week - period of rapid recovery after 4-8 weeks - often results in aphasia - can be extracerebral (epi/sub-dural and sub-arachnoid) or intracerebral (aneurysm, AVM) |
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treatment for hemorrhagic stroke
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- reduce edema immediately
- reduce blood pressure - steriods, anti-epileptics - surgery (craniotomy/clipping) |
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TIA
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- transient ischemic attack, aka mini-stroke
- results in temporary disruption of blood-flow with signs lasting <1 hour, and completed within 24 - indication of possible future stroke |
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meninges
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- dura mater: outermost membrane, two fused layers
- arachnoid: no vessels, covers sub-arachnoid space where CSF circulates - pia mater: two layers adhere tightly to brain's surface, outer layer has many blood vessels |
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traumatic hemorrhage types
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epidural: between skull and dura, caused by skull fractures, 20-30% mortality, arterial more deadly
- sub-dural: venous, between dura and arachnoid, twice as common with 60% mortality rate, caused by MVAs - sub-arachnoid: mostly arterial, between arachnoid and pia, less common, due to vasospasms - intracerebral: within brain tissue, due to axonal and acceleration injuries |
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CT scan
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- computerized tomography
- uses radiation - can identify skull fracture, hemorrhage, neoplasms and infections |
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MRI
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- magnetic resonance imaging
- more detailed images than CT - can detect subtle structural changes such as atrophy, CSF leak, infarcts, axonal injuries and contusions |
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connectionist model: language reception and comprehension
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- message received through ears
- encoded in primary auditory cortex - sent through corpus callosum to Wernicke's - meaning is constructed based on previous semantic/syntactic knowledge |
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connectionist model: reading comp
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- information travels through optic tract to primary visual cortex
- message is encoded in visual association cortex - sent through corpus callosum to Wernicke's - message is interpreted and given meaning |
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connectionist model: spontaneous speech
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- Wernicke's area retrieves semantic, phonologic and syntactic info
- send message through arcuate fasciculus to Broca's - info is translated into an action plan and sent to primary motor cortex - message is sent through pyramidal tract to cranial nerves - Wernicke's area monitors message and makes revisions prn |
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connectionist model: writing
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- Wernicke's area constructs message using semantic/syntactic info
- sends through arcuate fasciculus to premotor cortex - motor movements are planned and sent to motor cortex for execution - Wernicke's area monitors info through visual cortex and makes revisions prn |
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connectionist model: gestural responses
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- info is received and sent to Wernicke's
- sent to premotor cortex in left hemisphere where response is planned - plans transferred to motor cortex in appropriate hemisphere and sent down corticospinal tract to appropriate muscle groups |
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Broca's aphasia
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- lesion at posterior region of left inferior frontal gyrus
- speech is non-fluent, telegraphic, agrammatic, labored - poor naming and repetition - comprehension is better than expression but still impaired - small MLU - hemiparesis/hemiplegia/dysarthria commonly present |
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Wernicke's aphasia
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- lesion in posterior region of left superior temporal gyrus
- fluent speech characterized by inappropriate semantics, paraphasias and jargon - poor reading, repetition, and auditory comprehension - normal articulation and syntax - typically no hemiparesis/hemiplagia/dysarthria |
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global aphasia
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- large lesion to perisylvian area
- severe language deficits - largely reliant on facial expression, symbols and contextual cues for communication |
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right hemisphere
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- parietal: attention, neglect, identify absurdities, spatial recognition
- temporal: nonverbal memory, context, facial expression, prosody - frontal: pragmatics, problem solving, behavior regulation, prosody, figurative speech, attention |
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dementia
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- condition resulting in diffuse impairments in intellect and cognition
- can be cortical, subcortical or mixed/lacunar - caused by genetics and microscopic changes in brain (neurofibrillary tangles, neuritic plaques, and granuvacular degeneration) |
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intracranial tumors
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- astrocytoma: most common and most benign glioma
- glioblastoma: malignant and rapidly growing - meningioma: relatively common, benign, slow growing, well defined - metastatic carcinoma: caused by movement of cancer cells from other locations, poor prognosis |
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non-acceleration head injury
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- aka fixed head trauma
- less severe, meninges often initially intact - impression trauma: elastic skull is depressed inward - ellipsoidal: skull is forced into circular shape putting pressure on deep tissues |
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acceleration head injury
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- caused by MVA, boxing, shaken baby syndrome
- linear type (causes coup/contra-coup effect) - angular type (caused by twisting forces, damage to connection boundaries, more severe) |
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neurons
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- receive input through dendrites
- transmit output through axons |
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hypoperfusion
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blood pressure too low to reach small arteries
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herniation
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when tumors or edema push cerebral tissues against skull
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cerebral angiography
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contrast medium injected into brain to view cerebral arteries and locate contusions and stenosis
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myelogram
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contrast medium injected into sub-arachnoid space to see spinal column and nerves
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echoarteriograms
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ultrasound of carotids
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doppler
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measures blood flow in cerebral artery
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PET
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observes metabolic activity in brain during specific activity
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positron emission tomography
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fMRI
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MRI done during activity
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EEG
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detects neural activity in brain
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electroencephalogram
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lumbar puncture
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used to detect viruses/bacteria in blood
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EMG
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fine needle electrode inserted into muscle and records electrical activity to detect muscle disorders
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electromyography
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