Chapter 12A. Aphasia Flashcards
Question 12A-1:
Which of the following statements is true regarding handedness and language dysfunction?
A. Left-handed patients usually develop aphasia after lesions of the right hemisphere
B. The language centers of most patients who are left handed is in the left hemisphere
C. Right hemisphere lesions never result in language problems in right-handed patients
D. Recovery of aphasia is commonly better in right-handed patients than in left-handed patients
E. All are true
Answer 12A-1: B.
The left hemisphere contains the language
centers for right-handed and most left-banded
patients. However. language centers can be on
the right side for left-banded individuals so
occasional aphasia will develop in these
patients from a right hemisphere lesion. In
addition, there appears to be at least some
bilateral functionality in some right-handed
patients, such that language disturbance can
develop from a right hemisphere lesion,
though this is very rare. The bilateral
functionality in left-handed patients provides
for improved recovery from aphasia in these
patients compared with right-banded patients.(p143)
Question 12A-2:
Aphemia is a rare condition affecting language function. Which of the following are features of aphemia?
1. Causative lesion is in the dominant inferior frontal gyrus
2. Writing is preserved
3. Auditory comprehension is normal
4. Patient speaks with phoneme substitutions
Select: A = 1.2.3. B-1. 3. C =2.4. D = 4 only. E = All
Answer 12A-2: E.
Aphemia is a rare disorder whicb is more of
an apraxia of speech than a true language
disorder. It is caused by a small lesion in the
inferior frontal gyrus, Broca’s area, or the
subcortical white lesion. Writing and auditory
comprehension are normal. Patients are
initially mute, then are eventually able to
speak with phoneme substitutions and pauses.
(P145)
Question 12A-3:
Wernicke’s aphasia is characterized by al1 of the following except:
A. Lesion of the dominant superior temporal gyrus
B. Anomia
C. Deficit of auditory language comprehension with preservation of reading comprehension
D. Writing is impaired with poor spelling and impaired content of the prose
Answer 12A-3: C.
Reading comprehension is impaIred in
patients with Wernicke’s aphasia along with
deficit of auditory language comprehension,
although the auditory and reading deficits may
not be equivalent All of the other features are
true. The lesion is classically in the superior
temporal gyrus although extension into the
adjacent parietal lobule is common. Anomia is
common in patients with dominant
hemisphere lesions including the temporal
lesions causing Wernicke’s aphasia. Writing is
impaired with poor content,just as
spontaneous speech typically has poor
content. Because of the requirement for
spelling while writing. this deficit is obvious.
(P145)
Question 12A-4:
Conduction aphasia can be recognized only if specifically tested for. Typical features include all of the following except:
A. Impaired repetition
B. Coexistence of anomia
C. Lesion in the region of the arcuate fasciculus in the dominant hemisphere
D. Deficit in comprehension of purely verbal commands
Answer 12A-4: D.
Conduction aphasia is easy to miss on casual
examination. Conduction aphasia is
demonstrated by asking the patient to repeat a
phrase, and there is a deficit in repetition.
Comprehension is preservro. Deficit in
repetition is di:iringuished from a global
expressive difficulty. Patients frequently have
naming difficulty. though not as sc,’ere as the
repetition difficulty. The lesion typically
involves the arcuate fasciculus and adjacent
supramarginal gyrus. (p 149)
Questions 12A-5 through 12A-7:
For each of the following vignettes, select the language disorder from the list below which most closely fits the clinical description.
A. Transcortical motor aphasia
B. Thalamic aphasia
C. Transcortical sensory aphasia
D. Wernicke’s aphasia
Question 12A-5:
Speech is impaired, with telegraphic output.
Comprehension is good. Repetition is good.
Answer 12A-5: A.
Transcortical aphasias are distinguished by the
preservation of repetition. Transcortical motor
aphasia is the transcortical analog to Broca’s
aphasia with hesitant or telegraphic speech.
The lesion is typically in the frontal lobe,
anterior to Broca’s area. (P150)
Questions 12A-5 through 12A-7: For each of the following vignettes, select the language disorder from the list below which most closely fits the clinical description. A. Transcortical motor aphasia B. Thalamic aphasia C. Transcortical sensory aphasia D. Wernicke's aphasia Question 12A-6: Speech is fluent, although with parapbrasic errors and echolalia.. Comprehension is impaired. Repetition is normal.
Answer 12A-6: C.
Transcortical sensory aphasia has preserved
repetition, as with transcortical motor aphasia,
but there is a receptive deficit. Comprehension
is impaired. Speech is fluent but is paraphrasic
with parapbrasic naming, impaired auditory
and reading comprehension, and abnormal
writing. (P150)
Questions 12A-5 through 12A-7: For each of the following vignettes, select the language disorder from the list below which most closely fits the clinical description. A. Transcortical motor aphasia B. Thalamic aphasia C. Transcortical sensory aphasia D. Wernicke's aphasia Question 12A-7: Fluent speech although poor infonnation content Poor comprehension. Poor repetition.
Answer 12A-7: D.
Wernicke’s aphasia is characterized by
impaired comprehension and repetition.
Although speech seems clear, paraphrasic
errors are common and the information value
of the speech is low. Thalamic aphasia could
have been selected, although comprehension
is usually better than with classic Wernicke’s
aphasia. (p145-146)
Question 12A-8:
Which of the following statements are true regarding subcortical language deficits?
1. Thalamic aphasia resembles Wernicke’s aphasia
2. Basal ganglia hemorrhage can cause anterior subcortical aphasia
3. Basal ganglia infarction produces language dysfunction resembling Broca’s aphasia
4. Thalamic aphasia can result from a right-thalamic lesion in a left-handed person
Select: A= 1,2, 3. B = 1,3. C = 2, 4. D =4 only. E = All
Answer 12A-8: E.
All are true. Thalamic aphasia is related to
Wernicke’s aphasia, with impaired
comprehension, though to a lesser degree than
cortical aphasia. Speech is fluent. A right
thalamic lesion can produce this type of
aphasia in left-handed patients, indicating that
language dominance extends to the subcortical
structures. Basal ganglia hemorrhage or
infarction cao produce an aphasia resembling
Brn,ca’s aphasia, although with greater
dysarthria and lesser language difficulty.
(p150)
Question 12A-9:
Which of the following statements are true regarding pure alexia without agraphia?
1. Patients cannot write
2. Patients can only read their own writing but not others writings
3. Lesion is usually infarction in the superior temporal gyrus
4. Hemifield visual defect is present in most patients
Select. A= 1,2,3. B = 1,3. C= 2,4. D=4 only. E= All
Answer 12A-9: D.
Pure alexia without agraphia is the ability to
write but not to read, even the patient’s own
writing. The lesion is usually in the
distribution of the posterior cerebral artery. in
the medial occipital and temporal lobe.
Because of the occipital lobe involvement..
some degree of visual field defect is common.
including a right hemianopia or right upper
quadrant defect. (p 152)
Question 12A-10:
Which of the following statements regarding language in dementia froin Alzheimer’s disease are true?
I. Grammar and receptive vocabulary are affected early in the course of AD
2. Early stages of AD are associated with cognitive and memory deficits with less prominent language deficits
3. Reading and writing are preserved until later stages of AD
4. Patients with early AD often have anomic aphasia
Select: A= 1,2,3. B-1, 3. C = 2,4. D = 4 only. E = All
Answer 12A-10: C.
Early in the course of AD, cognitive and
memory deficits eclipse the language deficit.
Anomia is common early in the course,
however. Reading and writing are learned at a
young age, but are affected relatively early in
AD prior to the development of other
language deficits. Grammar and vocabulary
are relatively preserved in the early stages of
AD. (p155)
Questions 12A-11 through 12A-13 For the following vignettes_ select the most likely cause from the following list. A. Left hemisphere cortical infarction B. Left thalamic infarction C. Left occipital infarction D. Left basal ganglia hemorrhage E. Any of these Question 12A-11: Abrupt onset of headache and right hemiparesis along with dysarthria and expressive difficulty.
Answer 12A-11: D.
Basal ganglia hemorrhage is typically
associated with the symptoms of acute
intracranial bleed plus the associated language
disturbance. Patients often have headache,
hemiparesis, associated with marked elevation
in blood pressure. The language disturbance
with basal ganglia hemorrhage can be varied
with expressive and/or receptive features.
When a Broca’s-like aphasia is present,
dysarthria is more prominent than the
language deficit. (p150)
Questions 12A-11 through 12A-13 For the following vignettes_ select the most likely cause from the following list. A. Left hemisphere cortical infarction B. Left thalamic infarction C. Left occipital infarction D. Left basal ganglia hemorrhage E. Any of these Question 12A-12: Naming difficulty.
Answer 12A-12: E.
Anomic aphasia is of little localizing value,
and has a multitude of potential causes,
including infarction, hemorrhage, mass
lesions. and degenerative diseases such as
Alzheimer’s disease. In anomic aphasia,
speech is fluent, though there is commonly
some word-finding. Repetition, reading, and
writing are preserved, except for the anomia
through writing. Comprehension is preserved.
(P149)
Questions 12A-11 through 12A-13 For the following vignettes_ select the most likely cause from the following list. A. Left hemisphere cortical infarction B. Left thalamic infarction C. Left occipital infarction D. Left basal ganglia hemorrhage E. Any of these Question 12A-13 You are asked to see a patient because of the acute onset of confusion. Examination shows no motor deficit, and the patient is able to speak, but the speech is relatively devoid of content, and there are frequent paraphrasic errors.
Answer 12A-13: A.
The patient has Wernicke’s aphasia and most
likely has damage to the superior aspect of the
temporal lobe, supplied by the inferior
division of the middle cerebral artery. Speech
is fluent but there are frequent paraphrasic
errors. and the speech has little content
Repetition. naming. and comprehension are all
impaired, including both auditory and reading
comprehension. (p145)
Question 12A-14:
Degenerative dementia can be characterized by which of the following language deficits?
1. Anomia
2. Progressive aphasia without dementia
3. Global aphasia
4. Alexia without agraphia
Select: A = 1.2,3. B = 1, 3. C = 2, 4. D = 4 only. E = All
Answer 12A-14: A.
Patients with degenerative dementias develop
anomia early in the course of the disease.
Progressive aphasia without dementia can be
an initial presentation of some patients who
ultimately have a degenerative dementia.
Global aphasia develops with progression of
degenerative dementias, although the stage at
which the patient loses language differs
between patients. Alexia without aphasia
would nol be expected, since writing difficulty
develops early in the course of most
degenerative dementias. (p155)
