Language Systems And Aphasias

Question 1

What are the 2 principle structures of the neurocircuitry of language function

Answer 1

Broca’s Area

Wernicke’s Area

Question 2

What connects Broca’s area and Wernicke’s area?

Answer 2

Accurate fasciculus and other peri-Sylvia connections

Question 3

What happens if you disrupt the arcuate fasciculus

Answer 3

Both areas work, but problems connecting the 2 areas

Question 4

Conscious auditory processing in primary auditory cortex

Answer 4

Lateral lemniscus to the MGN (medial = music)
Then to the
primary auditory cortex: superior temporal gyrus, within lateral fissure

Question 5

Where is Heschl’s Gyrus

Answer 5

On the inside portion of the temporal lobe near the insula

Question 6

Where is the temporal plane

Answer 6

On the temporal lobe, kind of a shelf when you pull it back

Question 7

How are the language areas in each hemisphere connected

Answer 7

Via the corpus callosum

Question 8

Hemispheric lateralization of language function

Answer 8

One “dominant side” processes the semantic aspects of language, while the “non-dominant” side processes non-verbal aspects of language: tone of voice, emotion, cadence, rhythm, accent

Question 9

What does the dominant side processes

Answer 9

Semantic aspects of language

Question 10

That does the non dominant side processes

Answer 10

Non verbal aspects of language: tone of voice, emotion, cadence, rhythm, accent

Question 11

What side of the brain dominant are most people

Answer 11

Left

Question 12

Non-verbal aspects: tone of voice, emotion, emphasis, cadence, rhythm, accent

Answer 12

Prosody

Question 13

In people who are left dominant, what does the left side of the brain processes

Answer 13

Semantic aspects of language: meaning

Question 14

In left dominant individuals, what does the right side of the brain process

Answer 14

Prosody

Question 15

Sequence of regions and projections for language circuitry for reading aloud or naming objects

Answer 15

1. Primary visual cortex
2. Higher order visual cortical areas
3. Parietal-temporal-occipital association cortex (angular gyrus)
4. Wernicke’s area
5. Broca’s area
6. Motor region of the face

Question 16

Fluent speech

Answer 16

• effortless, good articulation, grammatical
• prosody is intact: not a monotone or emotionally flat quality
• grammatical-caution: looking for change from patients own normal pattern

Question 17

Non fluent

Answer 17

• laborious, inarticulate
• degradation in sentence structure: missing words, adjectives, adverbs
• in severe cases, reduced to telegraphic speech- nouns and verses only

Question 18

How do you communicate with someone who does not have fluent speech

Answer 18

Switch from patient naming stimuli to asking yes-no questions

Question 19

Volume of speech

Answer 19

Amount, not volume
Quantity/speed produced

Full sentences: high volume
Few words: low volume

Question 20

Impaired/absent comprehension, but “fluent” and “high volume” of speech

Answer 20

Wernicke’s Aphasia

Question 21

Coherency of the speech in Wernicke’s aphasia

Answer 21

May or may not be coherent, but will not understand questioning during exam

Question 22

What’s another way of describing how the patient forms sentences in Wernicke’s aphasia

Answer 22

Word-Salad

-non-sense sentences with real words, real syllables, or non-words

Question 23

Patients awareness of having Wernicke’s Aphasie

Answer 23

Typically unaware if deficit; frustrates by interactions until diagnosed

Question 24

Intact comprehension, but impaired speech production

Answer 24

Broca’s Aphasia

Question 25

Low fluency/volume of speech

Answer 25

Broca's Aphasia

Question 26

Patient awareness of having Broca's aphasia

Answer 26

Patients may be aware of deficit (and distressed by it), especially before being examined and diagnosed

Question 27

Damage to Broca's also does what

Answer 27

Severs projections to ipsilateral (left) premotor cortex

Question 28

What does the damage to the projections to ipsilateral premotor cortex in Broca's area damage do

Answer 28

Makes it so patient cannot write with contralteral hand (right) Spoken/written impairment

Question 29

What do left sided infarcts do to the premotor cortex

Answer 29

Prevents activation of right premotor cortex (non injured side) thus writing apraxia for left hand

Question 30

When the patient has a deficit in Broca's area and the premotor cortex is damaged, what can the patient do to answer questions since they cannot write

Answer 30

They can still point to correctly answer questions (non language motor response, does NOT require Broca's area)

Question 31

Instant comprehension and intact speech production when tested separately, but deficit lies in coordinating comprehension and spoken responses

Answer 31

Conduction aphasia due to arcus the fasciculus damage.

Question 32

How do you confirm comprehension in conduction aphasia due to accurate fasciculus damage

Answer 32

By patient nodding head to answer questions (comprehension and non verbal response)

Question 33

How can speech production be confirmed in patients with conduction aphasia due to accurate fasciculus damage

Answer 33

By examiner pointing to elicit spoken answers rather than asking spoken questions. Patient can correctly name family members if examiner points to them

Question 34

What is conduction aphasia due to arcuate fasciculus damage called

Answer 34

Disconnection syndrome

Question 35

What would an infarct to MCA superior territory cause

Answer 35

Broca's or conduction aphasia

Question 36

What would infarct to MCA inferior territory cause

Answer 36

Wrenickes or conduction aphasia

Question 37

What would MCA superior and inferior infarct cause (proximal to bifurcation)

Answer 37

Global aphasia, combination of Brocas and wernickes

Question 38

MCA-ACA watershed infarct

Answer 38

-motor transcortical aphasia (mild version of Broca's) -isolates an intact Broca's area from other motor areas Non fluent or low fluency like Broca's except the patient can repeat words or doe so spontaneously/repetitively -other motor defects, especially proximal arm/leg

Question 39

What's the difference between regular Broca's aphasia and the type of aphasia you see with an MCA-ACA watershed infarct

Answer 39

It's low fluency like broca's, but the patient can repeat words or does so spontaneously/repetitively

Question 40

MCA-PCA watershed infarct

Answer 40

- Sensory transcortical aphasia - isolates an intact Wernicke's area from visual areas, fluent aphasia like in Wernicke's bu patient can repeat words or does so spontaneously/repetitively

Question 41

What's the main differnce between the symptoms of an MCA-ACA watershed infarct and an MCA-PCA watershed infarct

Answer 41

MCA ACA: like Brocas but can repeat words MCA-PCA: like Wernicke's but can repeat words

Question 42

What is the common theme with the symptoms associated with MCA-ACA and MCA-PCA watershed infarcts

Answer 42

They both have different types of aphasias but in both types of infarct, they can repeat words

Question 43

What kind of infarct results in a motor transcortical aphasia

Answer 43

MCA-ACA watershed infarct

Question 44

What kind of infarct results in a sensory transcortical aphasia

Answer 44

MCA-PCA watershed infarct

Question 45

Classification tree for apshasia and infarcts

Answer 45

1. Is patient fluent? 2. Comprehends language? 3. Can repeat single words?

Question 46

What are the most common types of aphasias

Answer 46

- broca's aphasia - Transcortical motor aphasia - Wernicke's aphasia - transcortical sensory aphasia

Question 47

Inability to name stimuli presented

Answer 47

Anomic

Question 48

What's the difference between Broca's aphasia and transcortical motor aphasia?

Answer 48

Transcortical motor aphasia the patient repeats words, in brocas they don't repeat

Question 49

What is the difference between Wernicke's aphasia and transcortical sensory aphasia

Answer 49

Transcortical sensory aphasia the patient repeats words, in Wernickes they do not

Question 50

Wernicke's and Broca's areas are intact, but are disconnected from each other. Can comprehend and language output is fluent, but cannot produce desired verbal response to a question.

Answer 50

Conduction aphasia

Question 51

An infarct along the MCA-PCA watershed or isolated MCA branch occlusion in the parieto-occipital-temporal junction would cause what kind of aphasia

Answer 51

Conduction aphasia

Question 52

Fluency in Brocas

Answer 52

Nonfuent

Question 53

Fluency in Wernickes

Answer 53

Fluent

Question 54

Fluency in conduction aphasia

Answer 54

Fluent

Question 55

Fluency in global aphasia

Answer 55

Nonfleunt

Question 56

Expression in Brock's

Answer 56

Impaired

Question 57

Expression in Wernickes

Answer 57

Unintelligible

Question 58

Expression in conduction aphasia

Answer 58

Some paraphrasing (some unintelligible)

Question 59

Expression in global aphasia

Answer 59

Impaired

Question 60

Comprehension in Broca's

Answer 60

Relatively preserved

Question 61

Comprehension in Wernicke's

Answer 61

Impaired

Question 62

Comprehension in conduction aphasia

Answer 62

Preserved

Question 63

Comprehension in global aphasia

Answer 63

Impaired

Question 64

Naming in broca's

Answer 64

Impaired

Question 65

Naming in Wernickes

Answer 65

Impaired

Question 66

Naming in conduction aphasia

Answer 66

May be impaired

Question 67

Naming in global aphasia

Answer 67

Impaired

Question 68

Lesion site for Broca;s aphasia

Answer 68

Left frontal operculum

Question 69

Lesion site for Wernickes

Answer 69

Left superior temporal and inferior parietal corticospinal

Question 70

Lesion site for conduction aphasia

Answer 70

Left accurate fasciculus

Question 71

Lesion site for global aphasaia

Answer 71

Whole perisylvian region

Question 72

Loss of ability to read words, typically after PCA infarct

Answer 72

alexia

Question 73

When do you typically get alexia

Answer 73

After PCA infarct

Question 74

Alexia without agraphia

Answer 74

Alexia without the loss of ability to write (including written responses to the examiner )

Question 75

Circuitry affected in alexia without agraphia

Answer 75

Infarct in left primary visual cortex not only induces right homonymous hemianopsia, but also blocks projections from intact right visual cortex from crossing midline and reaching the left angular gyrus

Question 76

Alexia without agraphia and reading

Answer 76

Loss of reading using wither eye. Also cant see left half of space