Exam #1 Flashcards
1
Q
acquired neurogenic language disorders:
A
aphasia
primary progressive aphasia
alexia (reading disorder only)
agraphia (writing disorder only)
2
Q
acquired neurogenic cognitive-linguistic disorders
A
memory
attention
executive functions
(TBI, RHI, Dementias)
3
Q
acquired neurogenic speech disorders
A
dysarthrias
apraxia of speech (primary apraxia of speech)
4
Q
what are the four core elements of aphasia?
A
language disorder, acquired, neurological, multimodal (affecting receptive and expression)
5
Q
multimodal
A
affects the way you read, write, speak - affects multiple aspects
6
Q
what is the definition of aphasia?
A
an acquired multimodality language disorder caused by focal brain damage in the absence of other cognitive, motor, or sensory impairments
- focal lesion
- sudden onset
- bottom out and then improve…
7
Q
language
A
refers to processing that involves symbols (symbolization) to convey communicative intent
8
Q
receptive language
A
understanding language (comprehension)
9
Q
auditory comprehension
A
understanding words and sentences we hear
10
Q
reading
A
understanding written language
11
Q
expressive language
A
gestures or sign language, writing, talking
12
Q
diagram on slide 6
A
13
Q
prevalence of stroke
A
5th cause of death in the US
Mortality = 8%-12% of ischemic stroke; 37% to 38% of hemorrhagic strokes
14
Q
795,000 new cases of stroke are reported each year
A
A stroke happens every 40 seconds.
Every 4 minutes someone dies from stroke.
Up to 80 percent of strokes can be prevented
15
Q
Leading cause of disability in the US (300,000 per year)
A
87% of the strokes are ischemic
10% of the strokes are hemorrhagic
3% of the strokes are subarachnoid hemorrhage
16
Q
prevalence of aphasia (after a stroke)
A
30-40% of all CVAs have aphasia as the presenting symptom
1 million people (e.g., 1 in 250 individuals) in the US have aphasia
80, 000 new cases of aphasia are reported each year
17
Q
Patients with Wernicke’s aphasia tend to be a little older while those with Broca’s aphasia are younger
A
higher incidence of posterior strokes with age
18
Q
People with aphasia have higher healthcare costs (8.5% or $1, 700 attribute cost) and longer length of stay (LOS) in the hospital (6.5%) compared with stroke survivors without aphasia
A
19
Q
African Americans have nearly twice the risk of first stroke →
A
high blood pressure, smoking, high cholesterol levels, obesity, poor diet, and lack of exercise
20
Q
Aphasia and other types of communication disorders facilitate
A
determining localization
21
Q
They facilitate understanding of speech and language organization in the:
A
brain
22
Q
Primary Progressive Aphasia (PPA) is a…
A
language impairment
23
Q
Primary Progressive Aphasia (PPA)
A
Insidious onset
Gradual progression and prolong course
Without generalized dementia caused by a neurodegenerative condition that predominantly affects the left perisylvian region of the brain
24
Q
Cognitive-Linguistic Disorders
A
linguistic deficits, language of generalized intellectual impairment, language of confusion
25
Linguistic deficits due to right hemisphere lesions
Identifiable group of sensory, perceptual and linguistic deficits that occur
26
Language of Generalized Intellectual Impairment – associated with dementia
Involves:
Verbal and non verbal communication, decreased memory, disorientation, poor judgment
27
Language of Confusion – associated with traumatic brain injury (TBI)
Disorientation
Bizarre confabulative and irrelevant speech
Little awareness of deficit
Disorganized speaking reflects disorganized thinking
28
Apraxia of Speech
Sensorimotor disorder of articulation and prosody.
It is characterized by difficulty with the capacity to plan/program movements for volitional speech production. So, although aphasia usually co-occurs with apraxia of speech, the nature of the deficit in apraxia is motor planning/programming, not linguistic (has nothing to do with language)
29
Where will you see people with aphasia?
Hospitals
Rehabilitation centers
Skilled nursing facilities
Long-term care facilities
Continuing care retirement communities
Home health agencies
Private practice clinics
Not-for-profit communication disorders clinics
Aphasia centers
30
Aphasia vs Dysphasia
“Technically, dysphasia means impaired language and aphasia means lack of language. There have been calls to use the term 'aphasia' regardless of severity. Reasons for doing so include dysphasia being easily confused with the swallowing disorder dysphagia, consumers and speech pathologists preferring the term aphasia, and many languages other than English using a word similar to aphasia. It would appear that the term "aphasia" is more commonly encountered in North America, while "dysphasia" is more frequently found in British literature.”
31
Paul Broca (1824- 1880)
Paul Broca (1824- 1880)
French neurosurgeon and physical anthropologist.
First to stated that the frontal lobe and left brain is involved in language production.
Based on case studies and pathological evidence gathered from autopsies.
“We speak with the left hemisphere”
Language area = lower, posterior portion of the left frontal lobe at the junction of lateral and central fissures.
Area concerned with motor speech = Broca’s area (a.k.a. Brodmann areas 44 and 45)
Language disorders associated with brain lesions = aphemia. Major symptoms are:
Reduced speech fluency
Agrammatic, telegraphic speech
Many language production errors
Only limited impairment of comprehension of spoken language
32
Carl Wernicke (1848 – 1905)
German neuropsychiatrist
First to describe a type of aphasia different from symptoms described by Paul Broca.
Based on clinical studies and autopsies of patients who had language disturbances.
Aphasia is caused by lesion in the posterior portion of the left superior temporal gyrus (now a.k.a. Wernicke’s area).
Symptoms are:
Fluent but meaningless speech
Grammatically correct speech
Severe problems in understanding spoken language
Difficulty in comprehending material read silently or orally
Called sensory area
33
localizationist approach
Specific function to a specific anatomic structure within the brain.
Broca and Wernicke were localizationists. – this was a praxis question
34
holistic approach
John Hughlings Jackson (1864, 1915, 1932)
Brain functions are an integrated unit in formulating and expressing language; therefore a lesion in one area affects functions of most, if not all, areas.
Denies the existence of specific anatomic structures that control equally specific language functions
Aphasia = all aspects of language are disturbed
Thought that Aphasia is more holistic
Pierre Marie (1853 – 1940)
Aphasia is a single disorder (not a collection of multiple disorders distinguished on the basis of the lesion).
Auditory comprehension deficits exist in all the aphasias
35
The study of cases in aphasia intensified after World War II.
Aleksandr Luria (1902 – 1977)
Studied patients who suffered war injuries
The brain structure may be primarily responsible for a function and yet the brain works as a whole in the comprehension and production of language.
Norman Geshwind (1926-1984)
Supported the early localizationist view of aphasia with new clinical and anatomic evidence.
Aphasia is a cortical disconnection syndrome.
Aphasia became primarily a clinical issue of how best to classify patients.
Important when classifying aphasia in patients
36
Central nervous system =
brain, brainstem & spinal cord
37
Peripheral nervous system =
nerves extending out from brainstem (cranial nerves) and spinal cord (spinal nerves)
38
Central nervous system = brain & spinal cord
Protected by bony encasing
Brain inside cranium
Spinal cord inside spinal canal created by vertebral column
39
Central nervous system = brain & spinal cord
Meninges = triple layer of tissues surrounding entire brain and spinal cord
Dura mater
Arachnoid
Pia mater
Cerebrospinal fluid = within ventricles inside brain and within meninges surrounding CNS
40
Central nervous system (CNS)
Made up of neurons (nerve cells)
Gray matter = cell bodies, process information
White matter = axons, carry signals to other neurons/structures
Axons often insulated with myelin, creating the whitish color.
41
CNS Divisions
Telencephalon (new brain)
Diencephalon (between brain)
Brainstem
Cerebellum
Basal ganglia
42
Telencephalon
Cerebrum/Cortex (left and right hemispheres)
Frontal, parietal, temporal and occipital lobes.
43
Diencephalon
Subcortical areas: Thalamus, epithalamus, subthalamus, hypothalamus
44
Brainstem
Midbrain, pons, medulla
Cranial nerves
Reticular activating system (arousal)
45
Cerebellum
46
Basal ganglia
47
Cerebral Hemispheres
Connected by corpus callosum & anterior/posterior commissure
Sulci and fissures serve as anatomic landmarks separating regions or lobes
4 lobes
48
4 lobes:
Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe
49
Corpus callosum
a bunch of white matter, and axons, that send information from one side to the other side
50
Cortex
Lobes: within each hemisphere; functions roughly assigned to each
frontal, parietal, occipital, temporal
51
frontal
motor, basic language (left hemisphere), higher level cognition
52
parietal
somatosensory, attention
53
occipital
visual processing
54
temporal
auditory, basic language (left hemisphere), prosody (right hemisphere), recognition of objects/faces, memory
55
Prosal prognosia
difficulty recognizing faces
- Can happen from right temporal damage
56
anatomical landmarks of the cerebellum
slide 9 power point 2
57
Cortical Localization Maps:
Brodmann’s Areas
58
insula
cortex deep in the sylvian fissure (frontal and temporal lobe)
Plays an important role in language and swallowing functions
59
frontal lobe is divided into:
Prefrontal area
Premotor area
Supplementary motor area
Motor area (Primary Motor Cortex)
60
frontal lobe is important to:
Speech production
Higher-level cognitive functions such as working memory, attention, executive functions.
61
prefrontal area
Higher level cognition:
Executive functioning: planning, goal setting, problem solving, inhibition, personality, judgment…
Working memory (short-term memory)
Attention
Orientation
62
JAMIO:
judgment, attention, memory (short-term/working), intelligence (thinking), and orientation
63
premotor area
Pars triangularis (45) and pars opercularis (44) (lower portion) in the left frontal hemisphere are considered the traditional anatomical locations comprising Broca’s area
Related to the production of language
64
premotor area:
Broca's area
Planning/programing of complex motor movement sequences (not execution), across joints or articulators
It figures out what movements need to be made, when, and in what order
Damage causes apraxia of speech
Controls verbal/expressive language
Damage causes Broca’s aphasia
Upper portions program more general mvts (e.g., hands)
Right hemisphere – expressive emotional prosody
65
areas 44 and 45 are related to:
Brodmann's areas
66
Damage to broca’s:
can be: Aphasia, verbal output or apraxia of speech, related to planning (which movements do I need to make in order to say a word)
67
Supplementary Motor Area (SMA)
Lies on the top-middle area of the premotor cortex in the frontal lobe
Plays a role in the initiation of self-generated or willed movements (in contrast to imitative movements that bypass the SMA)
It forwards information to the premotor and motor cortices
68
If you have a lesion in the supplementary motor area:
you can have apraxia of speech
69
Primary motor cortex (motor strip/cortex/area):
pre-central gyrus (4)
Sends nerves to spinal cord and brainstem to innervate the muscles
Called “upper motor neurons” (UMN)
Pyramidal tract or direct activation pathway
Damage leads to paralysis or weakness (paresis) of the muscles (on the opposite site of the body, face)
Hemiplegia, dysarthria
motor strip
70
Motor strip is essential for:
carrying-out fine, skilled movements (oral, fingers), more gross movements rely less on motor strip… - more related to the homunculus
71
Primary Motor Cortex: Homunculus (“little man”)
Two characteristics of the motor strip reflect on the homunculus:
Location: Nerves going to specific body parts leave from specific areas of the motor strip
Degree of skilled motor control/movements exerted over a particular body part. Larger parts in the homunculus indicate that more nerves are devoted to that body part, thus allowing for greater fine/skilled motor control (e.g., hands, fingers and our articulators)
Motor strip is part of the execution system → damage can cause dysarthria
72
Parietal Lobe
Anterior parietal
Superior parietal
Inferior parietal
73
anterior parietal
primary sensory strip (Damage causes loss of feeling)
74
superior parietal
attention (left neglect – right hemisphere), body schema, visual ‘where’ pathway processing
75
inferior parietal
Left hemisphere – has a special role in language processing (reading/writing)
Right hemisphere – emotional prosody comprehension
76
Post-central gyrus primary central strip
responsible for sensory information damage causes loss of feeling
77
parietal lobe
angular and supramarginal gyri
(left) problems in selecting phonemes, word retrieval, reading, writing, and calculation
These two areas are very much engaged in selecting phonemes, word retrieval, reading, writing, and calculation
”sofa” to “fosa”
78
temporal lobe
superior temporal
inferior and middle temporal
79
superior temporal:
language processing
80
superior temporal:
Anterior left hemisphere – semantic processing (how do I know that a dog is an animal and an apple is a fruit)
Posterior
Left hemisphere – language comprehension
Right hemisphere – emotional prosody comprehension
81
Inferior and middle temporal:
Episodic and semantic memory
Olfactory processing
82
Wernicke’s area in terms of semantic processing is in:
superior and middle temporal gyrus, but for sure superior gyrus
83
Primary Auditory Cortex: Heschl’s gyrus
(41, 42)
84
Primary Auditory Cortex: Heschl’s gyrus
Receives auditory fibers from the ear via the thalamus
Unilateral damage does not cause deafness (subcortical awareness of sound…where is the sound coming from?)
May result in difficulty interpreting a sound or locating a sound in space
85
Secondary Auditory Cortex Wernicke’s area
(22)
86
Secondary Auditory Cortex
Processing of auditory information, important to the development and use of language
On left: Processing of speech sounds to identify a word
Wernicke’s aphasia
On right: More involved with music and environmental sounds…
87
Temporal lobe is also...
auditory information
88
Heschl’s gyrus
(41 and 42), very engaged in the ability to hear sounds
89
Wenicke’s area
(22), when you process information from the sound that you hear. Left side: “cup” you hear it and you understand what it means, they may hear it but don’t understand
Right side: can hear but can’t interpret sounds
90
occipital lobe contains:
primary visual cortex and secondary visual cortex
91
primary visual cortex
Banks of Calcarine fissure (17, 18)
92
Primary Visual Cortex : Banks of Calcarine fissure (17, 18):
Receives fibers from eye via the thalamus
Damage does cause blindness in opposite visual half-field…
93
Secondary Visual Cortex:
medial and lateral surface of occipital lobe (18 and 19)
94
Secondary Visual Cortex: medial and lateral surface of occipital lobe (18 and 19)
enhances interpretation of visual information
95
Perisylvian Cortex/Area
Cortex surrounding the sylvian fissure in the left hemisphere
96
Perisylvian cortex/area
Zone for the major neurologic components for understanding and producing language
- Broca’s area
- Wernicke’s area
- Supramarginal gyri
- Angular gyri
- Arcuate fasciculus (long association nerve tracts)
97
Sylvian fissure
divides the lobes
98
perisylvian area
zone for the major neurologic components for understanding and producing language
99
Arcuate fasciculus
A bunch of white matter that connects broca’s and Wernicke’s area
100
cerebral connections
how do the parts of the brain interact?
association nerve fibers
commissural nerve fibers
projection nerve fibers
101
association nerve fibers
connections lining cortical areas within the same hemisphere
short fibers: connect adjacent areas
long fibers: connect distant areas
102
commissural nerve fibers
connections linking areas in the two hemispheres
103
projection nerve fibers
carry information to cortex (ascending, sensory/afferent)
carry information away from cortex (descending, motor/efferent)
104
axonal tracts: association fibers:
communication between cortical areas that within the same hemisphere (intra-hemisphereic)
short association fibers
long association fibers
105
Association fibers, cont.
Superior longitudinal fasciculus
b/t frontal and parietal and occipital lobes
106
Arcuate fasciculus
runs along with superior longitudinal fasciculus
area (Broca’s and Wernicke’s) connects anterior and posterior speech and language
107
Inferior longitudinal fasciculus
connects temporal and occipital lobes
Role in object recognition, memory and visual discrimination
108
Uncinate fasciculus
connects anterior frontal and temporal lobes
109
Perpendicular fasciculus
Connects temporal, occipital and parietal lobes
110
If you have a rupture in the arcuate fasciculus, it tends to generate a type of aphasia called
conduction aphasia
111
association fibers: language network
FAT: Frontal Alant Tract (driving of speech)
Dorsal stream - phonological processing (SL/AF)
Ventral stream - semantic processing
112
left peri-sylvian region
dorsal stream:
phonological processing
113
dorsal stream: phonological processing:
arcuate fasciculus
superior longitudinal fasciculus
114
dorsal stream:
learning new vocabulary
115
dorsal stream: learning new vocabulary:
heschel gyrus
superior temporal gyrus
broca area
arcuate fasciculus
superior longitudinal fasciculus
116
left peri-sylvian region
117
ventral stream: semantic processing
inferior fronto-occipital fasciculus
middle temporal gyrus
118
axonal tracts:
commissural fibers:
communicate information to cortical areas in the contralateral hemisphere (inter-hemispheric)
- corpus callosum
119
corpus callosum
connects the left and right brains
120
axonal tracts:
projection fibers:
nerve fibers connecting the cerebral cortex to other sensory or motor centers in the brain
121
afferent neurons
are sensory neurons that carry nerve impulses from sensory stimuli towards the central nervous system and brain
sensory of touch
122
efferent neurons
are motor neurons that carry neural impulses away from the central nervous system and towards muscles to cause movement
123
laterality issues
124
sensory-motor
each hemisphere relates to opposite side of body
125
association areas may be proportionally larger on ___ with tertiary areas larger on ___
left;
right
126
left brain
analytical, sequential, better temporal resolution (see parts, show things in parts)
heavily engaged in language: auditory comprehension, verbal expression, reading and writing
127
right brain
simultaneous, gestalt (see whole picture, multi-tasking); better at processing novel information (meanings, intents)
interference and identification of the speaker's intent (understand jokes, irony, sarcasm, inferencing)
128
left and right brain
semantics, pragmatics
right hemisphere is heavier on the pragmatic aspect of language than the left
129
thalamus
egg like structure in the middle of the brain
lies beneath the cortex in each hemisphere
130
thalamus function
part of the forebrain neural circuitry
- cortex-basal ganglia-thalamic projections
131
thalamus consists of:
a collection of subcortical nuclei
132
four main important functions of the thalamus
1. relay/channel
2. integrate
3. control
4. coordinate and synchronize
133
thalamus: relay/channel
projections of sensory* (i.e., pain, taste, temperature, audition, and vision) information entering the lower levels of the nervous system to specific cortical areas.
Serves as a channel for sensory information (pain, touch, temperature, taste), all of this info comes from the peripheral nervous system --> thalamus --> lobes
The only sensory information that bypasses the thalamus is smell (olfactory), there is a cranial nerve
134
thalamus: integrate
sensorimotor information and project afferent from the basal ganglia, limbic system and cerebellum to the primary and premotor cortices.
135
thalamus: control
access of sensory information to the cortex according to the sleep-wake cycle
136
thalamus: coordinate and synchronize
activity of widespread cortical areas for arousal and cognitive function (e.g., language, speech, and memory)
- except for olfaction
137
thalamic nuclei
slide 35
138
cerebrovascular system
blood supply to the brain comes directly from the heart, via the aorta
139
cerebrovascular system
branches of the aorta, such as the common carotid, subclavian, and vertebral arteries give rise to cerebral arteries
140
subclavian -->
vertebral arteries --> basilar arteries
141
carotid arteries -->
internal carotid arteries
142
internal carotid arteries and basilar arteries form the...
circle of Willis at the base of the cerebrum
143
How the arteries and veins nourish and provide the brain with blood
External carotid: Provide blood supply to face
Internal carotid: keeps going up
Subclavian artery:
Vertebral artery: goes through the spinal column, then becomes the basilar artery
The internal and basilar artery will subdivide and become the cerebral arteries (anterior, middle, and posterior)
144
Circle of Willis (COW)
distributes blood to the cerebrum
145
COW and cerebral vascular territories
slide 38
COW in relationship to cerebral blood supply distributions
146
how do the ACA, MCA, and PCA and the COW all connect?
slide 39
147
cerebral vascular territories
slide 40
on transverse and coronal slices
148
anterior cerebral artery
disrupted ACA flow:
paralysis and sensory loss to legs and fee
frontal lobe syndrome
abulla
apraxia of speech
149
frontal lobe syndrome
executive dysfunction, decreased spontaneity, impaired judgment + concentration (attention)
150
abulla
delayed speech initiation, patient's speech is brief, unelaborated and concrete
takes them a while to talk, not a word retrieval problem - they know - just takes a second for them to initiate speech
151
apraxia of speech
supplementary motor area
152
disrupted middle cerebral artery (MCA) flow:
- paralysis and sensory loss (arms, legs, voice)
- aphasia apraxia of speech, dysarthria (brain left side)
- visual-spatial deficits, left-side neglect (brain right side)
153
branches of the MCA
MCA stroke (anterior/superior division)
MCA stroke (posterior/inferior division)
154
MCA stroke (anterior/superior division)
- contralateral face and arm weakness
- broca's aphasia (left side)
- apraxia of speech
- dysarthria
155
MCA stroke (posterior/inferior division)
- contralateral sensory loss
- wernicke's or conduction aphasia (left side)
contralateral visual defect
156
disrupted posterior cerebral artery (PCA):
homonymous hemianopsia (visual field cut)
pure alexia (or alexia without agraphia) - if you have a stroke
157
watershed regions
provides double coverage for areas of overlap between two vascular territories (e.g., ACA & MCA; MCA & PCA)
158
watershed vessels:
are small diameter (terminal branches), so they are susceptible to small vessel disease
159
basal ganglia and thalamic vascular territories
slide 46
160
basal ganglia blood supply
MCA gives rise to the lenticulostriate arteries that supply the basal ganglia
tiny arteries that go to subcortical areas of the brain, goes to basil ganglia, thalamus, and provide blood supply to those areas
161
what causes aphasia?
stroke, tbi, braintumor, bacteria and viruses, toxemia, degenerative process
162
cerebrovascular accidents (CVA), stroke, brain attack (all the same thing)
risk factors:
hypertension, diabetes, excessive weight, smoking, stress, inactivity, high consumption of alcohol, cholesterol, fat and sodium
163
what can be done to prevent stroke?
lifestyle factors (smoking, diet, physical activity)
pharmacological intervention (hypertension medications, anticoagulants, antiplatelets, vasodilators)
surgical intervention (endarterectomy, angioplasty)
164
what is a stroke? (A.k.a., cerebrovascular accident (CVA); brain attack)
A temporary/permanent disruption of blood supply to the brain
The most common cause of primary neurogenic speech and language disorders
165
occlusive stroke:
thrombotic (blockage of entire artery)
embolic (when you have a build up of fat and it breaks apart and a particle travels away and lodges in a little artery and blocks blood flow)
166
hemorhagic stroke:
Irupture of an artery and blood is getting in contact with the brain
ntracerebral: meninges layers
Subarachnoid: meninges layers
Subdural: meninges layers
167
ischemic stroke
caused by blockage of blood flow to any area of the brain
- arteries are flexible, elastic, and smooth
168
ischemic stroke
- blockages are commonly caused by atherosclerosis (fatty deposits "plaques" containing cholesterol and other wast products accumulate, narrowing the artery)
169
atherosclerosis
arteries become hard, stiff, and thick
170
two types of ischemic stroke:
embolism
thrombosis
171
embolism
part breaks off and lodges in a smaller artery downstream, more typical type of stroke in younger people (30s, 40s, 50s, 60s)
172
thrombosis
accumulation continues until artery is blocked off, more common in older people (70s, 80s)
173
penumbra
- ischemic core of a lesion is dead and cannot regenerate
- penumbra is the area around the blockage and ischemic core
- blood perfusion to the penumbra is restricted but function can be restored if edema is reduced
174
what is a transient ischemic attack (TIA)?
(mini-stroke)
- a temporary blockage of the blood supply to any area of the brain
- usually lasts less than 30 minutes
- often occur before a full blown stroke
175
causes of TIA
a thrombus or embolus
a change in blood pressure
176
following TIA, many people have noticeable challenges with...
motor, sensory, cognitive, or linguistic functions
177
FAST
face
arm
speech
time
178
drug treatment for ischemic stroke
- anti-platelet drugs
- anti-coagulants
- vasodilators
- clot-busting (thrombolytic) drug
- tPA - just for an ischemic stroke
179
anti-platelet drugs
make platelets less stick and likely to clot
- aspirin in low dosages (81 mg)
- plavix or Ticlid
180
anti-coagulants
help prevent formation or extension of clots but do not dissolve clots
- heparin
- coumadin (warfarin)
181
vasodilators
prevent the walls of the arteries from tightening/narrowing
182
clot-busting (thrombolytic) drug
tPA: tissue plasminogen activator
- injected into artery to dissolve existing clot
- must be used within 3 or 4 hours
- usually requires a CT scan so there is not a risk of bleeding elsewhere
183
surgical tx for ischemic stroke
- Carotid endarterectomy
- Angioplasty
184
What happens during carotid endarterectomy?
- open the carotid and clear clot out
- done in the first part of carotid at the neck level
- when greater than 70% clogged, good results
- some people can be quite clogged with no symptoms
185
what happens during an angioplasty?
- a balloon-tipped catheter is inserted in the artery
- balloon is inflated, pushing the clot against the artery wall
- a stent is inserted to prevent recurrent narrowing
- newer stents have drugs that help prevent new clotting, scar tissue, build-up
186
Hemorrhagic stroke - types
- bleeding into the brain
- intra-cerebral hemorrhage
-aneurysm
187
hemorrhagic stroke - bleeding into the brain - what is it?
- it is toxic to nerve cells
- space occupying (e.g., subdural hematomas)
188
hemorrhagic stroke - intra-cerebral hemorrhage - what is it?
- common site is lenticulostriate arteries
- very bad - this is the type of stroke where the blood is in the brain
189
hemorrhagic stroke - aneurysm - what is it?
- ballooning of a weak artery wall
- can rupture, spilling blood
- 1-5% of population have these, but asymptomatic
190
How can an aneurysm affect brain function?
every time a lobe is squeezed by the ballooning of an artery wall, it affects the function of that lobe, affecting the person and what they can and can't do
191
Surgical tx for aneurysms:
- clipping
- embolization (coiling)
192
What is clipping?
- tiny clamp placed at the base of aneurysm keeping blood out of it
- prevents it from bursting or re-bleeding
193
What is embolization?
- a tiny platinum coil is inserted via a catheter into the aneurysm
- it fills the aneurysm, causing it to clot and seal off from the artery
- coiling
194
More hemorrhagic stroke:
- Arteriovenous malformations (AV malformations)
- Lacunae
195
What is an arteriovenous (AV) malformation?
- congenital tangling of the artery-vein connections
- can rupture
196
treatment for AV malformations
- smaller ones in accessible locations can be surgically removed
- embolization: blocking small arteries feeding the AVM, it then shrinks
197
What is a Lacunae?
(aka lacunar infarcts/stroke, or small vessel disease)
- are a special group of deep cerebral infarctions caused by hypertension or single small emboli that block tiny arteries in the brain
are small subcortical infarcts (<15 mm in diameter) in the territory of the deep penetrating arteries (lenticulostrate arteries)
198
Other aphasia etiologies include:
bacteria and viruses
199
what are bacteria and viruses?
microscopic organisms that may cause inflammation in the brain
200
neurogenic communication disorders due to bacterial/viral infections:
- encephalopathies
- meningitis
- meningoencephalitis
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what are encephalopathies?
infections that affect the cortex
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what is meningitis?
an inflammation of the meninges surrounding the brain
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what is meningoencephalitis?
an inflammation caused by an infection
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HIV/AIDS
- HIV = Human Immunodeficiency Virus
- AIDS = Acquired Immunodeficiency Syndrom
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what is neoplasm?
- An abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should
- New growth of a tumor
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what are the two major types of tumors?
- Malignant (cancerous)
- Benign (non-cancerous)
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Etiologies of tumors:
- primary tumors result from uncontrolled growth of two types of cells (glial cells) and meningeal cells (meningioma)
- secondary (metastatic) tumors)
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What are glial (gliomas) cells?
cells in the cortex that provide protection, nutrition, blood supply
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What are secondary (metastatic) tumors?
- spreading tumors arising from elsewhere in the body and travel to the brain via the blood supply or lymphatic system
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when a person has a tumor in the brain, what can be some of the symptoms?
- anomia
- loss of vision
- visual field disturbances
- memory and attention problems
- confusion
- nausea
- seizure activity
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what is anomia?
when a person is having difficulty finding the words they want to say, word finding and difficulty
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What are the 3 primary brain tumors?
- Astrocytoma
- Oliogodendroglioma
- Gliblastoma multiforme
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what is Metastatic (or "brain metastases")?
- may migrate from other parts of the body to the brain via lymphatic or other systems
- may migrate from primary brain tumor to other sites
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What is toxemia?
the poisoning, irritation, or inflammation of nervous system tissue through exposure to harmful substances
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what is toxic encephalopathy?
brain dysfunctions related to metabolism at the cellular level
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examples of toxins that are harmful to brain tissues:
- excessive use of alcohol
- recreational drugs such as methamphetamines ("ecstasy")
- excessive usage of certain dietary substances, such as refined sugars
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Symptoms of toxemia:
- reduced cognitive functioning
- somnolescence (sleepiness or drowsiness)
- personality changes
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Traumatic Brain Injury (TBI)
a blow (or jolt) to the head or a penetrating head injury that disrupts the function of the brain
219
Closed Head Injury (CHI):
- the head forcefully hits an object (non-penetrating wound), the brain is not exposed
- focal damage and diffuse damage to axons
- effects tend to be broad (diffuse)
- no penetration to the skull
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Examples of closed head injury:
resulting from a slip and fall, motor vehicle crashes, bike accidents, etc.
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Open Head Injury:
- an object passing through the skull and piercing the brain (penetrating wound)
- the brain and meninges are exposed
- largely focal damage
- penetration of the skull
- effects can be just as serious as closed brain injury
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Examples of open head injury:
bullet wounds, knife, etc.
