Aphasia and Other Disorders of Higher Cortical Function

Question 1

Aphasia is not the only cause of communication difficulties. What feature is a feature of essentially all aphasias that can be screened for in an exam?

Answer 1

anomia (impaired naming)

Question 2

What is impaired in Broca’s aphasia? (of fluency, repetition and compression)

Answer 2

fluency and repetition are impaired

comprehension is preserved

Question 3

What is a commonly associated neurological sign with broca’s aphasia?

Answer 3

right hemiparesis (especially of the face)

Question 4

Where is the lesion in Broca’s aphasia?

Answer 4

broca’s area

posterior part of the inferior frontal gyrus in the language-dominant hemisphere

Question 5

What is the most common cause of a broca’s aphasia?

Answer 5

an MCA stroke

Question 6

What is impaired in Wernicke’s aphasia? (of fluency, repetition and comprehension)

Answer 6

fluency is preserved, but repetition and comprehension are impaired

Question 7

What is a commonly associated neurological sign with wernicke’s aphasia?

Answer 7

right upper visual field cut

Question 8

Where is the lesion in Wernicke’s aphasia?

Answer 8

Wernicke’s area

posterior part of the superior temporal gyrus in the dominant hemisphere

Question 9

What is the most common cause of wernicke’s aphasia?

Answer 9

infarction of the inferior division of the MCA, many due to emboli from proximal locations like the heart or internal carotid

Question 10

What is impaired in a conduction aphasia? (of fluency, repetition and comprehension)

Answer 10

repetition will be impaired, but fluency and comprehension will both be preserved.

Question 11

Where is the lesion in a conduction aphasia?

Answer 11

the arcuate fasciculus ( white matter connection between broca’s and wernicke’s areas)

however, to actually much evidence to support this. really any lesion affecting the temporal or parietal lobes (but sparing wernicke’s area) can lead to this syndrome

Question 12

If smoeone has a nonfluent aphasia, but with preserved repetition, where is the lesion? What is this aphasia called?

Answer 12

frontal lobe, but superior to Broca’s area (can also be from a lesion in the supplementary motor area or in the anterior portions of the basal ganglia)

a transcortical motor aphasia

Question 13

If you have an aphasia with impaired comprehension but preserved repetition, where is the lesion? What is this aphasia called?

Answer 13

inferior portion of the left temporal lobe (lower than wernicke’s area)

transcortical sensory aphasia

Question 14

What are the most common causes of transcortical sensory aphasias?

Answer 14

left PCA infarcts

small temporal lobe hemorrhages/contusions

Question 15

Typically, reading deficits will occur in ___ aphasia, while writing deficits will occur in ___ aphasia.

Answer 15

reading deficit in Wernicke’s
writing deficit in Broca’s

so a patient with Broca’s may not be able to understand a spoken command, but may be able to understand if they read it.

Question 16

Alexia without agraphia (or pure alexia) is characterized by an inability to read, despite a preserved ability to write. Where is the lesion?

Answer 16

dominant occipital lobe, but also the splenium of the corpus callosum

Question 17

What is an apraxia?

Answer 17

an inability to carry out a learned motor task despite preservation of the primary functions needed to carry out the task

for example, someone with an apraxia may not be able to demonstrate how to hammer a nail even though they have the cognitive capacity to understand the command and the motor/sensory ability to do so

Question 18

What are the three basic ways to test for an apraxia?

Answer 18

1. pretend they are performing an action (may run their fingers through their hair when asked to demonstrate how ot use a comb)
2. mimic the examiner performing an action
3. use the actual object to perform an action

Question 19

Where is the lesion in apraxia?

Answer 19

frontal or parietal lobs of the dominant hem

frontal - they tend to be able to recognize when someone else is doing the task correctly

parietal - can’t tell when someone is doing it correctly or incorrectly

Question 20

What term is used to describe the inability to recognize objects?

Answer 20

agnosia

Question 21

Where is the lesion in agnosias?

Answer 21

generally in the sensory association areas of the brain and will depend on which sensory modality is affected – a visual agnosia (unable to identify the object by sight, but may identify it by touch) will have a lesion in the occipitotemporal visual association cortex

Question 22

Where is the lesion in prosopagnosia?

Answer 22

the fusiform face area in the right hemisphere

Question 23

What syndrome will occur with lesions in the inferior parietal lobule of the dominant hemisphere (specifically in the angular gyrus)?

Answer 23

Gerstmann’s syndrome

Question 24

What are the characteristics of Gerstmann’s syndrome?

Answer 24

agraphia
acalculia
finger agnosia

Question 25

What is the most sensitive sign of neglect?

Answer 25

extinction to double simultaneous stimulation (so moving fingers on both sides on visual field screening)

Question 26

Even though language is typically in the left hemisphere, how can right hemisphere lesions affect language?

Answer 26

can affect the prosody (of the infection/emotion) in one’s voice

Question 27

Which hemisphere typically has a lesion in anosognosia?

Answer 27

right