2.4- Stroke II Flashcards
The Primary Motor Cortex is in the frontal lobe. It is _______ to the Central Sulcus and located in the ______________.
anterior to Central Sulcus and located in the Precentral Gyrus
Where is the Motor Homunculus?
just anterior to the Central Sulcus in the Precentral Gyrus
The Primary Motor Cortex contains cell bodies of the ______ motor neurons that _________.
upper motor neurons that initiate primary voluntary motor activities
Motor Homunculus~
Lateral to medial = _______________________
face/tongue to foot and toes
The Motor Homunculus has a very large representation of ______, ______, ______, and ______. Why?
face, hands, thumb, foot because they contain many muscles to operate.
Why does the Motor Homunculus have a smaller representation of elbow, forearm, and trunk?
relatively few muscles
What is the Supplemental and Premotor Area- Area 6 responsible for?
learned motor activities of sequential nature
- sequences and helps initiate specific contractions for skilled activities like writing
- controls trunk and shoulder for postural adjustments
Where is the Supplemental and Premotor Area- Area 6?
anterior to primary motor cortex- area 4
Where is Broca’s Area- Area 44?
at base of Area 4 and 6, motor speech
left hemisphere for most people
What is active in higher brain functions and motor activity? What is active in sensory reception and interpretation?
Frontal Lobe
Parietal Lobe
What area is just posterior to the Central Sulcus and located in Postcentral Gyrus of Parietal Lobe?
Primary Sensory Cortex- Areas 1, 2, and 3
The Primary Sensory Cortex- Areas 1, 2, and 3 receive ___________.
sensation from the sensory receptors of the body- pain, temp, vibration, etc
Sensory Homunculus~
Lateral to medial = _____________________
face/tongue to foot/toes
The Sensory Homunculus has a large representation of what body parts?
lips and face, hand (esp. thumb and index fingers), and foot (proprioception)
Why are the lips and face, hand, and foot largely represented in the Sensory Homunculus?
because of lots of sensory reception in these areas
What areas have a smaller representation in the Sensory Homunculus because of their relatively little sensory feedback?
limbs and trunk
Where is the Sensory Association Area?
Posterior to the Primary Sensory Area
The Sensory Association Area receives input from _____________.
Primary Sensory Area and the Thalamus
What integrates and interprets sensory info?
Sensory Association Area
__________ - ability to tell size and shape of object by feel
__________ - orientation of body parts
Kinesthesia
Proprioception
What area helps with storage of memories linked to past sensory experiences?
Sensory Association Area
Sensory Association Area does
1.
2.
- integrates and interprets sensory info
2. helps with storage of memories linked to past sensory experiences
- posterior medial portion of the lobe
- receives impulses from the eyes
- interprets shape, color, movement, size, and location
Primary Visual Cortex- Area 17
The Primary Visual Cortex- Area 17 receives ___________ and interprets ________________.
receives impulses from the eyes
interprets shape, color, movement, size, and location
Where is the Visual Association Area?
anterior to the primary visual area
The Visual Association Area receives _____________.
impulses from the Primary Visual Area and Thalamus
What relates visual input to past visual experience for recognition and evaluation?
Visual Association Area
What is located superior to the Temporal Lobe near the Lateral (Sylvian) Fissure?
Primary Auditory Area- Area 41 and 42
The Primary Auditory Area- Area 41 and 42 interprets _____________________.
basic characteristics of sound such as pitch and rhythm
- Auditory Association Area (left hemisphere more people)
- located inferior to the Primary Auditory Cortex
Wernicke’s Area- Area 22
The Wernicke’s Area- Area 22 determines if sound is ______________.
speech, music, or noise
How does the Wernicke’s Area- Area 22 interpret meaning of speech?
by translating words into thoughts
Left Hemisphere Characteristics 1. 2. 3. 4. 5.
- Right hand control
- Spoken and written language (Broca & Wernicke’s areas)
- Numeric and scientific skills
- Sign language
- Reasoning
Right Hemisphere Characteristics 1. 2. 3. 4.
- Left hand control
- Musical and artistic awareness
- Insight and imagination
- Mental images dealing with sensory info
What type of artery lesion is uncommon?
Anterior Cerebral Artery
What supplies medial surface of the Frontal lobe and up and over to the superior surface of the Frontal and Parietal Lobes?
Anterior Cerebral Artery
Why is an Anterior Cerebral Artery lesion not necessarily a total loss?
because of contributions from the Circle of Willis (depends where the lesion is)
Anterior Cerebral Artery~
- Loss of voluntary motor of ______ on _______ side of body
- Significant sensory loss of _____ on ______ side of body
motor = LE on opposite side of body
sensory = LE on opposite side of body
What are some symptoms of an upper motor neuron lesion (Anterior Cerebral Artery)?
1.
2.
3.
- increased tone
- spastic paralysis
- positive Babinski’s reflex
What is Ataxia?
uncoordinated gait characterized by wide stance, lifting feet high to take a step, and slap foot down due to proprioceptive loss from feet
What artery lesion causes bowel and bladder incontinence?
Anterior Cerebral Artery
Why should you not leave Anterior Cerebral Artery lesion patients unattended?
impaired judgment, planning, insight, and self awareness
increased emotion
What supplies midbrain, medial surfaces of occipital lobe wrapping up and over to superiolateral portion of occipital lobe, parts of medial and inferior Temporal lobe, Thalamus?
Posterior Cerebral Artery
What is Thalamic Pain Syndrome?
intolerable burning pain
- all sensory input is noxious, little control of emotions (related to limbic system)
- all sensation is painful
What is Alexia?
loss of ability to read due to loss of association area
What is Visual Agnosia?
inability to recognize familiar objects or faces
What is Cortical blindness?
inability to process incoming visual info even though the nerve is intact
What is the loss of vision in temporal half of one visual field and nasal portion of the other (half crosses and half doesn’t)?
*hole in vision
Homonymous Hemianopsia
What artery lesion has difficulty making new memories (person will have trouble learning from us)?
Posterior Cerebral Artery
What cranial nerve can become paralyzed with a posterior cerebral artery lesion?
Cranial Nerve III- Oculomotor
4 symptoms of paralyzed Cranial Nerve III- Oculomotor 1. 2. 3. 4.
- Loss of constriction of the pupil
- Can’t open eyelid
- Loss of medial deviation for accommodation
- Loss of ability to look up, down, and medial
* affected eye would be positioned lateral and down as a result
70% of strokes are _____________.
Middle Cerebral Artery
What supplies surface of cerebral hemispheres, deep frontal and parietal lobes (includes internal capsule which contains projection fibers running to the primary motor cortex)?
Middle Cerebral Artery
Results of Middle Cerebral Artery Blockage:
Motor =
Sensory =
Motor = Hemiplegia of face and greater UE; less loss in LE
Sensory = primarily face and greater UE; less loss in LE
What causes Homonymous Hemianopsia in Middle Cerebral Artery?
optic path is affected as it goes back to the opposite side
What is Agnosia?
lack of ability to recognize persons and things (loss of primary and association sensory areas)
What is Dysphagia?
difficulty swallowing
Hallmark sign of Middle Cerebral Artery
Middle Cerebral Artery Left Hemisphere lesions~
1.
2.
- Do have judgment
2. Aphasia- lack of ability to communicate (affects Broca’s and Wernicke’s because they are on the left)
What is Aphasia?
lack of ability to communicate
What is Global Aphasia?
can’t speak, write, or understand written or oral language
- receptive or sensory aphasia
- language comprehension is impaired (can produce sound but it is meaningless)
- generally not frustrated- not aware
Wernicke’s Aphasia
- motor aphasia
- understand speech, know what to say, but can’t make oralmotor structures produce speech
- can count, sing, and swear- not learned in same ways as normal speech
- very frustrated- aware of deficit
Broca’s Aphasia
What are 3 aphasias affected in the left hemisphere by middle cerebral artery lesion?
Global Aphasia, Wernicke’s Aphasia, and Broca’s Aphasia
Middle Cerebral Artery Right Hemisphere lesions~
1.
2.
- very impulsive- lack judgment
- affects language differently- can speak but not as socially appropriate
- no facial expressions
- no intonation of voice
- difficulty with spatial relations
If brainstem stroke occurs above crossing (decussation), effects are seen on the ___________
opposite side
If brainsteam stroke occurs below the crossing, effects are seen on the _____________
same side
What is Alternating Hemiplegia?
involves one side of the head and opposite side of the body b/c of cranial nerves that do not cross
- one half of the body is affected by an upper motor neuron lesion while the opposite side of the face is affected (usually upper motor for body, lower motor for face)
What type of brainstem lesion affects the same side of the body and face?
usually upper motor neuron lesion
Anterior, Middle, or Posterior Cerebral Artery???
- Loss of voluntary motor and sensory in LE
- Affects opposite side of face and greater UE
- Do not leave unattended
- Thalamic Pain Syndrome
- Memory impairment
- Dysphagia- difficulty swallowing
- Ataxia
- Bowel and bladder incontinence
- Aphasia
- Homonymous Hemianopsia
- Anterior
- Middle
- Anterior
- Posterior
- Posterior
- Middle
- Anterior
- Anterior
- Middle
- Posterior and Middle
How does Homonymous Hemianopsia differ between the Posterior Cerebral Artery and the Middle Cerebral Artery?
Posterior- affects processing area
Middle- affects track (optic path) coming back
