Exam 1 Flashcards
What is a stroke?
generic term for brain damage that is caused by a lack of blood or bleeding
What is the technical term for a stroke?
cerebral vascular accident
What are the warning signs of a stroke?
Sudden numbness or weakness in the face, arm or leg
sudden confusion, trouble speaking, or understanding
sudden trouble walking, dizziness, or loss of balance
sudden trouble seeing in one or both eyes
sudden severe headache with no known cause
What does FAST stand for?
Face drooping
Arm weakness
Speech difficulty
Time to call 9-11
What are the two types of stroke?
icshemic and hemorrhagic
What is an ischemic stroke?
When a blood vessel becomes blocked and a portion of the brain is deprived of oxygen
What is a hemorrhagic stroke?
When a blood vessel becomes weak and ruptures or by a TBI to a blood vessel
What is the stroke belt?
The region in the US where the highest number of strokes occur
What is Eastern NC, SC, and GA considered?
the stroke buckle
How many individuals have a stroke each year in the US?
795,000
What percentage of strokes are ischemic?
80-85%
1 of 4 strokes are in people who_______.
have had a previous stroke
Do males or females tend to have more strokes?
females (could be due to the fact that we live longer ;))
Strokes kill _____ people a year.
130,000 or 1/19
What are the risk factors for stroke? (13)
Atherosclerosis Heart disease Age High cholesterol Cancer Heredity Alcohol use Smoking Diabetes Hypertension Obesity Physical inactivity Amphetamines
Which races have a greater likelihood of having a stroke?
AA and hispanics by 2-3x
What is a transient ischemic attack?
a mini or brief stroke with symptoms that usually resolve within an hour- 24 hours; Temporary disruptions of ceberal circulation accompanied by rapidly developing sensory disturbance and limb weakness
What are the layers of the brain? (starting at the scalp and going deeper) (7)
Scalp Cranium Dura mater Arachnoid Subarachnoid space Pia mater Cerebral cortex
What are the four lobes of the brain?
Frontal, Parietal, Temporal and Occipital
What does the frontal lobe control?
Motor control, concentration, planning, problem solving, speech, and smell
What does the parietal lobe control?
Sensation, taste, and body awareness
What does the temporal lobe control?
Hearing and facial recognition
What does the occipital lobe control?
vision
What does the cerebellum control?
coordination and muscle movements
What is the Slyvian fissure?
It is a lateral fissure that divides the brain horizontally. It marks the lower boundary between the frontal and parietal lobe and the temporal lobe
What is the Rolandic fissure?
It is a central fissure also known as the central sulcus and divides the brain into anterior and posterior regions
Describe the frontal cortex.
It governs aspects of behaviors, is a very complex area and diseases can vary drastically across patients even if the lesion is in the same area
What is the insula cortex?
The patch of cortex folded into the lateral cerebral fissure that controls expressive language and motor speech
What is the arcuate fasciculus?
The arcuate fasciculus is a neural pathway compiled of fiber bundles that extend anteriorly from the posterior portion of the temporal lobe to the posterior region of the inferior prefrontal lobe, thereby linking the expressive (i.e., Broca’s area) and receptive (i.e., Wernicke’s area) language centers of the cortex
What would happen if there was a stroke in the arcuate fasciculus?
Conduction aphasia–> no repeating but comprehension and expression should be intact
What is the basal ganglia?
receives input mostly from the frontal lobe. Controls major muscle groups in trunk and limbs for dealing with shifts in body weight.
What would be impaired if there was a problem with the basal ganglia?
Impairment may lead to deficits in movement and sensation.
What is the thalamus?
major relay center for motor information coming down from the motor cortex and for sensory information going up to the sensory cortex
What does the anterior thalamus control?
expressive language
What does the posterior thalamus control?
receptive language
What is the internal capsule?
the general white matter area that sits between the ventricles and the basal ganglia that contains both ascending and descending axons and fibers going to and coming from the cerebral cortex
Strokes in the internal capsule have ___ outcomes.
Poor ( results in significant sensory and motor deficits)
What is the middle cerebral artery?
Supplies most of the lateral surfaces of the brains hemispheres, plus the thalamus and basal ganglia. Majority of the artery located in the parietal lobe.
The middle cerebral artery is critical for ____.
language functions
What are the lenticulostriate arteries?
small arteries that branch from the middle cerebral artery and feed into the basal ganglia and internal capsule.
What happens if there is a stroke in the lenticulostriate arteries?
The internal capsule could be disrupted
What are watershed regions?
Areas where there is not a good overlap of blood supply
Do the watershed regions have a huge impact on speech and language areas?
No but it may change the profile of the client
What areas are considered cortical regions?
the 4 lobes
What are considered subcortical regions?
the areas below and surrounded by the lobes like the basal ganglia, thalamus, and ventricles
What is eschemia?
tissue damage
What is infarction?
tissue death
what is diaschisis?
is a sudden loss (or change) of function in a portion of the brain connected to a distant, but damaged, brain area.
What is thrombosis?
local coagulation or clotting of the blood in a part of the circulatory system.
What is an embolism?
the lodging of an embolus, which may be a blood clot, fat globule, gas bubble or foreign material in the bloodstream. This can cause a blockage in a blood vessel.
What is hypoperfusion?
decreased blood flow
What is an aneurysm?
a break in the blood vessel in the brain
What are the physiological responses that one may have after a stroke? (5)
- Edema
- transneural degeneration
- denervation hypersensitivity
- diaschisis
- collateral sprouting
What is edema?
swelling
What is trans-neural degeneration?
the death of neurons caused by the disruption of input from or output to other nearby neurons
What is degeneration hypersensitivity?
extreme sensitivity due to interruption of neuronal supply/ activity
What is collateral sprouting?
neurons adjacent to the damaged area may take over functions performed by the damaged area
What medical treatments could be performed for an ischemic stroke before speech therapy begins?
carotid endarterectomy
carotid stenting
tissue plasminogen activator(tPA)
cerebral stenting
What is carotid endarterectomy?
Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.
What is carotid stenting?
is an endovascular surgery where a stent is deployed within the lumen of the carotidartery to prevent a stroke by treating narrowing of the carotid artery. CAS is used to treat narrowing of the carotid artery in high-risk patients, when carotid endarterectomy is considered too risky
What is tissue plasminogen activator (tPA)?
treatment for ischemic stroke only! Must be given within 3-4 hours of stroke. Drug, dripping drug tPA directly on the clot through a catheter, it does not have to make its way though the bloodstream.
What is cerebral stenting?
Cerebral stents are used to treat the narrowing of cerebral arteries
What is a Lacunar stroke?
a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain’s deep structures
What is an extracerebral hemorrhage?
a hemorrhage that takes place in the meninges
What is a intracerebral hemorrhage?
a hemorrhage that occurs inside the cortex
What are anteriorvenous malformations (AVM)?
genetic malformations that occur in the blood vessels in the brain; mostly seen in young adults; outcome dictated by location of the AVM
What are the treatment options for a hemorrhagic stroke?
- Microsurgical clipping
- Cerebral Stenting
What is microsurgical clipping?
A small metal clip is used to stop the flow of blood
What is cerebral stenting for a hemorrhagic stroke?
putting a stent in the aneurysm. The stent clocks the aneurysm from circulation and causes the blood to clot
What medical treatment is used for cerebral spinal fluid leakage? (CSF)
- using a shunt to drain the fluid
What is a subdural hematoma?
a collection of blood that forms in the sub-dural space
What percentage of the population is left hemisphere dominant?
97%
Describe cerebral dominance
- Left hemisphere dominant for language in most right handed adults
- mirror image concept for left-handed adults
_____ handed brains may be more flexible about which hemisphere gets language responsibility.
Left
Which handedness normally lends itself to better recovery from aphasia?
Left
Which of Brodmann’s areas are responsible for expressive language?
44- Pars opercularis
45- Pars triangularis
Which of Brodmann’s areas are responsible for receptive language?
22- Superior Temporal Gyrus
39- Angular Gyrus
40- Supramarginal gyrus
41 and 42- Primary Auditory Association Cortex
What is the function of Brodmann’s area # 39 (angular gyrus)?
calculation and written expression
Aphasia is NOT…. (3)
- slurred speech
- confused language
- pragmatic problem
What is plasticity?
the ability of the brain to reassign functions when an area of the brain has been damaged
Non-fluent aphasia occurs _____ to the central sulcus.
anterior
Fluent aphasia occurs ____ to the central sulcus.
posterior
What are characteristics of non-fluent aphasia?
• Speak slowly, haltingly and with great effort, pausing between syllables and words
• Speech has machine- like quality with diminished or absent intonation and emphatic stress patterns
• Characteristics
Slow, labored speech
Grammatical constructions are restricted
Intonation reduced or absent
Function words omitted
Rely on a lot on nouns
3-4 words per breath group
Associated with agrammatism
What are the characteristics of fluent aphasia?
• Speak smoothly and effortlessly • Speech rate, intonation, and emphatic stress similar to normal speakers • Characteristics Normal/near normal speech rates Variety of grammatical constructions Intonation patterns present and usually appropriate Function words present Syntax appropriate > 5-6 words per breath group Can be associated with: Paragrammatism “word salad” “grammatically incorrect sentences
What types of Aphasia are considered non-fluent?
Broca’s and Global
Which types of aphasia are considered fluent?
Wernicke’s, Conduction, Anomic, Transcortical Motor, Transcortical Sensory
What is paraphasia?
word substitution errors produced by individuals with aphasia
What are the types of paraphasia?
Literal and Semantic
What are Literal paraphasia errors?
phonological errors in which incorrect sound replace correct sounds “trable or fable” for “table”
What are semantic paraphasia errors?
Incorrect word substitution for the correct word
“chair” for “table”
What is agrammatism?
grammar disturbances in labored non-fluent aphasia
What is anomia?
a broad term for having difficulty finding words
What is circumlocution?
Talking around words in context
What are the two models of aphasia?
Localization of function and connectionist
Describe the localization model.
Assignment of impaired functions to a damaged region of the brain when damage in a region of the brain produces a given pattern of impairment
What are the limitations of the localization model?
- localized damage to Broca’s and Wernicke’s areas does not produce aphasia
- aphasia can be caused by damage to the sub-cortical structures
What do anti-localizationalists believe?
the brain operates as an integrated whole
Describe the Connectionist model.
Language is ordered in a diffuse way
What are the two steps to the Connectionist model?
- activation is added to the semantic features of a word
2. phonological encoding
What are the error patterns in naming for the connectionist model? (5)
For the word cat:
- Semantic: same category “dog”
- Formal: morphological error “mat or cap”
- Mixed: both formal and semantic “rat”
- Unrelated: “pen or log”
- Non-words: “lat or lom”
Which types of Aphasia are considered to be from damage to the cortical structures? (3)
- Broca’s
- Wernicke’s
- Global
Which types of aphasia are considered from damage to the fiber tracts? (4)
- Conduction
- Transcortical motor
- Transcortical sensory
- mixed transcortical
Which type of aphasia is considered to be of unknown origin?
anomic
Describe fluency, comprehension and repetition in Broca’s aphasia.
F: poor
C: intact words and simple sentences
R: poor, non-fluent
Describe fluency, comprehension and repetition in Wernicke’s aphasia.
F: good
C: poor
R: poor, fluent jargon
Describe fluency, comprehension and repetition in Conduction aphasia.
F: fair-good
C: intact words and simple sentences
R: poor
Describe fluency, comprehension and repetition in Transcortical motor aphasia (TCM).
F: poor
C: intact words and simple sentences
R:good
Describe fluency, comprehension and repetition in transcortical sensory aphasia (TCS)
F: good
C: poor
R: good
Describe fluency, comprehension and repetition in global aphasia.
F: poor
C: poor
R: poor
Describe fluency, comprehension and repetition in anomic aphasia.
F: good
C: good
R: good
What are other names for Broca’s aphasia?
Expressive, Motor, Anterior, Non-fluent
Describe characteristics of Broca’s aphasia.
- Non-fluent
- Agrammatic output
- comprehension relatively preserved but not “normal”
- poor nonfluent repetition
- preserved self-monitoring
- writing is similar to verbal output
What causes chronic agrammatic aphasia? (in Broca’s)
lesions in Broca’s areas extending into anterior insula cortex and temporal and parietal regions
What are the differences between little Broca’s and big Broca’s?
Little B’s are smaller lesions that resolve quickly while Big B’s are full blown and produce complex aphasia
What are other names for Wernicke’s aphasia?
Sensory, receptive, posterior, fluent
What are characteristics of Wernicke’s Aphasia?
- fluent speech
- frequent semantic paraphasia
- paragrammatism
- jargon
- impaired repetition
- poor comprehension
- poor self monitoring
- anosognosia (poor self-monitoring)
What are characteristics of global aphasia?
- severe impairments in all areas
- difficulty with basic comprehension
- limited verbal output
What are characteristics of conduction aphasia?
- fluent verbal output
- occasional verbal paraphasia
- impaired repetition
- relatively preserved comprehension
- poor oral reading
What are characteristics of transcortical motor aphasia?
- reduced speech output
- good repetition
- good auditory comprehension
What are characteristics of Transcortical sensory aphasia?
- poor comprehension
- good repetition
- fluent empty speech with paraphasia
What are characteristics of anomic aphasia?
- word retrieval in verbal output and writing
- fluent and grammatically correct
- unusual pausing and circumlocutions
What is considered to be the residual state of many aphasic syndromes AFTER time of improvement?
anomic aphasia
What are the characteristics of subcortical aphasia?
o Deficits may have impact on quality of life
o Comprehension deficits are mild-mod
o Written comprehension is more preserved than oral
o Verbal memory deficits may contribute to reduced language scores
o Phonemic and semantic paraphasias can be present
o Category specific and proper name anomia can be present
What is Alexia with Agraphia?
(not a motor issue; language impaired)
• Oral reading grossly impaired
• Cannot identify words spelled out by the examiner
• Copying printed material is better than writing to dictation
• Common component of aphasia syndromes and rare in isolation
What is Alexia without Agraphia?
(Not a motor issue)
• Pure Word Blindness
• Demonstrate ability to write complex sentences or narratives but cannot read what they have written
• May retain the ability to identify familiar words
• Difficulty copying material
What is Apraxia?
- motor planning
- Don’t respond to visual cueing
-can coexist with a stroke
2 types - ideational- • Inability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects in everyday life
- ideomotor- • Inability to correctly imitate hand gestures and voluntarily mime tool/object use
What is the Pseudobulbar affect?
neurologic disorder characterized by involuntary crying or uncontrollable episodes of crying/laughing
