aphasia Flashcards
Name non fluent/ anterior aphasia syndromes
Broca’s
Trans cortical motor
Global
Name fluent/posterior aphasia syndromes
Wernicke's Conduction Anomic Transcortical sensory Transcortical mixed
key symptom of Broca’s aphasia
Agrammatic production
Used to be associated with “expressive aphasia”… Word finding is more preserved than sentence formulation. Patient is often a good communicator bc the few words produced represent some of the message accurately.
Usually accompanied by right hemiplegia and mild facial weakness
Lesion site of Broca’s aphasia
Around and including Broca’s area….area 44
Key symptoms of transcortical motor aphasia
*like Broca’s aphasia but with preserved repetition
Lesion site for transcortical motor aphasia
Varied frontal lobe locations
Key symptoms of global aphasia
Poor comprehension, minimal production
Lesion site for global aphasia
Posterior & frontal peri sylvan Lang region
Key symptom in Wernicke’s aphasia
Poor comprehension, jargon, press for speech
Key symptoms of Conduction aphasia
Surprisingly impaired repetition
Lesion sight for Wernicke’s aphasia
Wernicke’s area ( posterior portion of superior temporal gyrus)
Key symptoms for anomic aphasia
Word finding deficit, empty speech
Lesion sight for conduction aphasia
Tempo-parietal boundary (supra marginal gyrus)
Lesion site for anomic aphasia
Posterior temporal-parietal boundary (angular gyrus)
Key symptoms in transcortical sensory aphasia
Like Wernicke’s aphasia, but with preserved repetition
Lesion site for transcortical sensory aphasia
Inferior temporo-occipital border area ( perhaps PCA occlusion)
Key symptom of transcortical mixed aphasia
Like global aphasia but with preserved repetition
Lesion site of transcortical mixed aphasia
Diffuse or multifocal damage in frontal and parietal lobes
What is the most severe form of fluent aphasia?
Wernicke’s aka. Sensory, jargon, receptive
Conversation with someone with Aphasia can go smoothly, but formal testing may show that verbal expression deteriorates precipitously when repeating phrases of increasing length and complexity.
Conduction
What is often the mildest form of aphasia?
Anomic
What association tract is thought to be damaged in conduction aphasia?
arcuate fasciculus
What is a prominent feature in transcortical sensory aphasia?
Echolalia
Paraphasia
Word substitution errors, produced unintentionally
Agrammatism
Certain types of linguistic units drop out of
Utterances
Brain circulation arises from 2 pairs of arteries
The internal carotid arteries ICA
The vertebral arteries VA
The ICA enters the cranium and supplies much of the
Forebrain
The ICA bifurcates into the_______and_______
Anterior carotid artery ACA
Middle cerebral artery MCA
ACA and MCA supply the cerebral hemispheres over the ______and_______surfaces if the cerebral hemisphere
Anterior and lateral surfaces
The VAs join to form the ________which continues along the ______________and splits into the _________________.
Basilar artery
Brain stem
Posterior cerebral arteries
The PCAs supply_________parts of the brain
Posterior-inferior
Branches of the VA supply the_______
Brain stem
At the base of the brain the __________and the __________meet and make up the ___________.
Vertebral artery
ICAs
Circle of Willis
________and________ are connected by the Circle of Willis
Internal carotid
Vertebrals
Blood flow at the level of capillaries is called
Cerebral perfusion
During cerebral perfusion nutrients ________&_________are passed from___________ to _________.
Oxygen
Glucose
Capillaries
Neural tissue
Perfusion is measured in
ml/100g min -1
Gray matter perfusion =
60ml/100g min -1
White matter perfusion=
30-40 ml/100g min -1
Ischemic stroke occurs with complete or partial______ of arteries
Occlusion
Perfusion below ___ results in necrosis
20 ml/100 g min -1
Ischemic stroke is either _______ or ________
Thrombotic
Embolus
Dead tissue is referred to as a
Lesion
Area around the lesion that may not be getting enough perfusion for neural firing but is not (yet) dead is called
Ischemic penumbra
Brain swelling around the lesion is usually referred to as
Edema
Edema usually reaches peak around ____days post-stroke but clears up in the following days
3
Atherosclerosis is associated with what type of ischemic stroke
Thrombotic
Greater than ______% occlusion results in thrombotic stroke
70
The site of occlusion of the artery is referred to as
Thrombus
Emboli stroke is
A traveling mass (embolus) that occluded an artery
An embolus may have been formed elsewhere…
In ventricles of the heart
Large blood vessels (breaks off from thrombus, breaks from arterial plaque)
Hemorrhagic stroke
Ruptured blood vessels cause bleeding
Causes of rupture
Weakened arterial walls (aneurysm or arterial venous malformation)
High and fluctuating blood pressure
Trauma to the blood vessel
Types of hemorrhagic stoke
Intracerebral
Extra cerebral
Sudden onset of stroke symptoms
Headache Vomiting Coma Paralysis Sensory loss Confusion Memory loss Speech lang problems
Insidious processes (slow and gradual onset)
Tumors
Obstructive hydrocephalus
Toxic damage
Infections
Primary brain tumors
Originate in the brain
Most common 25-50yr olds
Heredity and former sites of injury invoked
Brain tumors
Benign or cancerous
Primary or metastatic
Meningiomas
Tumors within the meninges
More localized
Focal symptoms
Most effectively removed
Obstructive hydrocephalus
Swollen tissue may obstruct flow of cerebrospinal fluid
Intracranial pressure increases
Affects brain function
Toxic damage
Drug overdose
Drug interactions
Ischemic brain damage
Ischemic damage is due to lack of oxygen tissue
What can cause ischemic brain damage
Breathing difficulties
Slowed heart rate
Constricted cerebral blood vessels
Dementia
Acquired neurological syndrome associated with persistent and progressive deterioration in intellectual functions
*few cases dementia may be static… 10-20% may be reversible in varying degrees
Brain damage associated with dementia is ______ as compared with focal damage in aphasia
Diffuse
Causes of reversible dementia
Infections
Metabolic disorders
Drugs
Toxic factors
Alzheimer’s disease causes roughly ______% of all reported dementia
50
Other causes of dementia other than Alzheimer’s
Vascular dementia Pick disease Parkinson's disease Progressive supra nuclear palsy Creutzfeldt-jacob disease Huntingtons disease
Dominant findings in Alzheimer’s disease (AD)
Neurofibrillary tangles
Senile plaques
Granulovacuolar degeneration
Other findings in AD patients
Apolipoprotein E (ApoE)--- gene Acetylcholine (deficient neurotransmitter)
Senile plaque
Minute areas of cortical and sub cortical tissue degeneration, disturb neuronal transmissions
Granulovacuolar degeneration
Degeneration of nerve cells bc of formation of small fluid filled cavities containing granular debris
Often found in hippocampus
Neurofibrillary tangles
Neurofibrils are filamentous structures in nerve cell body dendrites, and axons
Become twisted and tangles
Explain word processing model
Sensation- detection of sound
Perception- detection of speech
Recognition- word recognition
Comprehension- word meaning
Wernicke-lichtheim Model
Broca’s area lesions cause impairment in speech production
Wernicke’s area lesions cause impaired auditory comprehension
Disconnect between frontal and posterior lang areas causes conduction aphasia
A- auditory
M- motor
B- ideation
Dual stream model
Ventral stream processes speech signals for comprehension
Dorsal stream maps acoustic speech signals to frontal lobe articulatory networks
Model assumes ventral system is largely bilaterally organized
Dorsal stream is strongly left-hemisphere dominant
Brain mass is % of total body mass, yet it gets % of blood and uses up % of total oxygen and glucose in the blood stream.
2
20
20
Main Arguments Against Classifying Aphasia into Types
The brain functions as an integrated unit in controlling language (Damasio)
Different sites of lesion affect most, if not all, language functions or modalities
Variations in fluency are due to variations in severity
Comprehension of spoken language is impaired in all patients, but only to varying degrees
Dominant symptoms do not create syndromes because they are present in other patients (presumably belonging to other syndromes)
The appearance of distinct syndromes is created by limited and biased observations that emphasize some symptoms while ignoring others
Longitudinal studies show that aphasic patients are similar in later stages
Paraphasia
Unintended word or sound substitutions
Many consider it a central sign of aphasia
Generally absent in automatic speech
Different types of paraphasias
Types of Paraphasia
Verbal paraphasia
Neologistic paraphasia
Phonemic (Literal) paraphasia
Verbal paraphasia
Entire word is substituted.
Two types
Semantic: substituted word is similar in meaning to the one intended i.e. son for daughter.
Random: substituted and intended words are not semantically similar.
Neologistic paraphasia
Use of a meaningless, invented word.
Phonemic (Literal) paraphasia
Substitution of one sound for another i.e. ling for sing
or an addition of a sound i.e. sring for sing;
some part of the intended word is intact
