Module 2: Stroke

Question 1

Carotid endarterectomy /stents

Answer 1

Start in urinary tract
Place filter to keep things out of your blood stream
use a ballot blow up artery
leave in metal piece to hold open

Question 2

Blood to the brain:

Answer 2

Posterior cerebral artery: vision
Central cerebral artery: language
Interior cerebral artery: executive functioning

Question 3

What is Aphasia?

Answer 3

disorder that results from stroke
Acquired
Neurogenic
Language based
Not a Problem of sensation, motor function, or intellect

Question 4

How many people have Aphasia?

Answer 4

~ 1 million Americans

Question 5

What causes Aphasia?

Answer 5

Damage to the language-processing areas of the cerebral cortex
Stroke
Traumatic Brain Injury
Brain tumor
Infections
Toxic exposure

Question 6

Who typically acquires Aphasia?

Answer 6

It’s most common among the elderly…

… but can effect anybody

Question 7

Brief Overview of the History of Aphasia

Major debate in the field of aphasia-

Localism vs. holism:

Answer 7

do neurons and brain areas have specific functions (localism) or is it fairly undifferentiated, working more as an aggregate field (holism)?
Localists-mental abilities are localized to specific areas of the brain 
Franz Gall (1751-1828) (localist)

Question 8

Paul Broca 1861-observation of 2 patients (Localist)

1861 Conclusions:

Answer 8

We speak with our left hemisphere
Broca’s area: Special faculty of articulated language
Term of aphemia proposed: Aphasia
But, in 1864 the term aphasia was coined.
AND the “auditory center” localized to the temporal lobe

Question 9

Carl Wernicke

1874

Answer 9

Observed that patients with damage to left temporal lobe had difficulties with speech and understanding
Hypothesis: An area in left temporal lobe responsible for speech processing
Damage=sensory aphasia
Different areas of the brain (centers) support different language functions
These centers are connected by neural pathways
Linguistic information is transmitted across these pathways

Question 10

Brodmann’s areas

Answer 10

there are 52 distinct areas in the brain. How the cell are organizes in the brain
Speech output 44
Auditory comprehension:
began loclalistic approach to how the brain functions

Question 11

Current thinking

Answer 11

extreme localation has been replaced by “connectionism”

Question 12

How to Distinguish Aphasia Types

Answer 12

Naming Problems : The hallmark of aphasia
Fluency of expression
Are they able to easily produce words and sentence, how is their grammar
Language Comprehension: to that degree is understood
Repetition: word, and phrase

Question 13

Additional Considerations: in distinguishing

Answer 13

Motor output: Are the motor systems involved with speech affected? This indicates a concomitant motor-speech disorder
Reading and writing: To what extent is reading and writing affected? This usually reflects the overall impact of aphasia on language more generally
often mirrors fluency of expression

Question 14

Naming

Answer 14

Ability to retrieve and produce a targeted word
Anomia: disturbance in the ability to name
Paraphasias (patterns of speech errors):
Phonemic: substitution or transposition of the targeted phoneme
e.g. “paker” for “paper”; “fable” for “table”
Semantic: error is related or in the same category but is incorrect
e.g. “cat” for “dog”
Neologic paraphasia: nonsense words substituted for target word
e.g. “sparndle” for “fork”
seen more in fluent aphasia

Question 15

Fluency

Answer 15

Expression of thoughts using a smooth, uninterrupted flow and rate of speech
how many words can you put together in one breath
7 or more words in phrase lenth

Question 16

Fluent aphasia:

Answer 16

spontaneous speech flow with adequate phrase length

posterior brain damage (temporal/parietal regions)

Question 17

Non-fluent aphasia:

Answer 17

diminished phrase length, slowed or labored speech production, grammatical errors
anterior brain damage (frontal lobe)
Language Comprehension
Ability to understand spoken messages
Influenced by:
Amount of information
Frequency of word usage
Personal relevance of information
Part of speech

Question 18

Repetition

Answer 18

Ability to accurately reproduce verbal stimuli
Receive and process incoming stimulus
Convey the information to regions of brain that formulate and plan motor sequence for speech
Articulate to reproduce the initial stimulus

Question 19

Reading and Writing

Answer 19

Written language disturbances usually parallel spoken language impairments

Question 20

Physical impairments

Answer 20

Hemiparesis
Hemiplegia 
Hemisensory impairment 
Hemianopsia 
Dysphagia
Seizure disorders or epilepsy

Question 21

Psychosocial changes

Answer 21

Behavior
Mood swings
Depression

Question 22

Non-Fluent Types:

Answer 22

anterior part affected
Broca’s Aphasia
Transcortical Motor Aphasia
Global Aphasia

Question 23

Marked to severe deficits in all aspects of language (Non fluent)

Answer 23

Speech nonfluent, may be limited to stereotypy
Overlearned, automatized sequences may be preserved
——counting, days of the week, singing
Result of lesion covering a large portion of perisylvian area, often caused by total occlusion of left Middle cerebral artery
May be two lesions, one anterior, one posterior

Question 24

May also result in (non fluent)

Answer 24

severe motor and sensory deficits involving right side
Visual field defects
Oral, ideomotor, ideational apraxia

Question 25

IdeomotorApraxia, often IMA,

Answer 25

is a neurological disorder characterized by the inability to correctly imitate hand gestures and voluntarily mime tool use, e.g. pretend to brush one’s hair.
The ability to spontaneously use tools, such as brushing one’s hair in the morning without being instructed to do so, may remain intact, but is often lost.



Question 26

Ideational apraxia (IA)

Answer 26

is aneurological disorderwhich explains the loss of ability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects in everyday life.(sometimes lumped with limb apraxia)

Question 27

apaxia

Answer 27

a condition in which an individual is unable to plan movement related to an object because he has lost the perception of the object’s purpose.
Characteristics of this disorder include a disturbance in the idea of sequential organization of voluntary actions. The patient appears to have lost the knowledge or thought of what an object represents

Question 28

Global Aphasia

Answer 28

Associated brain areas: large anterior and posterior lesions
Speech-language characteristics
All language functions severely impaired
Limited communication: combination of stereotypic utterances, facial expression, & gestures
Attentive, task-oriented, socially appropriate
Often have a recurring utterance (e.g. Bees, bees, bees)

Question 29

Broca’s Aphasia

Answer 29

Speech is effortful, nonfluent, consisting of short phrases or single words
May vary from complete loss of speech to mild deficit characterized by word-finding difficulties
Automated sequences usually preserved
Comprehension relatively spared
Result of lesion in posterior part of inferior frontal gyrus, the insula, and the frontal operculum

Question 30

“Broca’s area” (third frontal convolution of the left frontal lobe)
Associated brain area:

Answer 30

left frontal, suprasylvian, pre-Rolandic
Speech-language characteristics
Abnormal prosody 
Poor articulation
Paraphasias
Telegraphic speech (mostly nouns and verbs); may have few function words 
Relatively good comprehension
Naming and repetition deficit

Question 31

Transcortical Motor Aphasia

Answer 31

Speech is nonfluent
Naming may be spared or mildly affected
Repetition usually good, even “parrotlike” (echolalia)
Reading aloud and writing impaired
May have coexisting dysarthria, sensory and motor arcuate facillulus is spared disorders
Result of damage to, variously
Frontal region anterior or superior to Broca’s area
Supplementary motor area
Cingulate gyrus
Possibly subcortical damage
Associated brain area: anterior superior frontal lobe
Speech-language characteristics
Poor initiation & maintenance of speech output; more dysfluencies and effort than Broca’s
Relatively good auditory comprehension

Question 32

Fluent Types

Answer 32

Wernicke Aphasia
Anomic Aphasia
Conduction Aphasia
Transcortical Sensory Aphasia

Question 33

Wernicke’s Aphasia

Answer 33

Verbal output is fluent, characterized by the presence of:
phonemic and semantic paraphasias
Neologisms
Empty speech
When severe, this may be called jargon aphasia
Impaired comprehension, unaware of their disorder (anosognosia)
Repetition, naming, read
Asociated brain area-posterior third of superior temporal gyrus

Question 34

Transcortical Sensory Aphasia

Answer 34

Speech is fluent
Speech may be meaningless or unintelligible
Jargon
Paraphasias
Neologisms
Comprehension of oral and written language, naming, reading, and writing are severely impaired
Prominent characteristic is preserved repetition, may be echolalia
Result of lesions posterior to perisylvian region, in parietal-occipital region

Question 35

Transcortical Sensory

Associate brain areas:

Answer 35

Posterior parieto-temporal lobe, sparing Wernicke’s area
Speech-language characteristics:
Severe naming deficits
Poor auditory comprehension
Word and Sentence repetition intact
Echolalia

Question 36

Conduction Aphasia

Answer 36

Speech is relatively fluent, but characterized by phonemic paraphasias and word-finding difficulties
Repetition is compromised
Patients often aware of paraphasias and may make multiple attempts at correction
The more they correct, the worse they get
Comprehension relatively spared
Deficits in naming and writing
Result of lesion in left temporal-parietal junction
Possible more extensive lesion that may include:
Insula
Primary auditory cortex
Supramarginal gyrus
Associated brain area: arcuate fasciculus
Speech-language characteristics:
Grossly impaired repetition
Phonemic paraphasias
Relatively preserved language comprehension
Aware of errors, often say “Why can’t I say that?”;
Dysprosodic (pauses, hesitations, and word finding problems)
bc all the attempt of self correction
articulate ficiculate is damaged

Question 37

Anomic Aphasia

Answer 37

Verbal output is fluent, but riddled with word-finding difficulties, frequent pauses, and circumlocutions
Repetition, comprehension, and reading aloud are spared
Hallmark sign is inability to name people or objects, despite awareness of their nature
Result of small lesion affecting posterior language areas
Angular gyrus (in parietal lobe, near the superior edge of temporal lobe)
Middle temporal gyrus

Question 38

Anomic aphasia is frequently the “ending point” for many recovered aphasia syndromes,

Answer 38

so lesion site is not “tight” as confrontation naming can result from damage to several different areas of the brain
Associated brain area: no clear localization
Speech-language characteristics
word retrieval difficulties 
spontaneous speech & naming tasks
Naming severely impaired
Nouns & Verbs
Preserved auditory comprehension
Preserved repetition

Question 39

Speech-language characteristics: wernicke’s

Answer 39

Severely impaired comprehension of spoken and written language
Overly fluent speech
Paraphasias are frequent—phonemic or semantic
Neologisms
Empty speech (e.g. thing; stuff)
Circumlocution
Impaired short-term retention & recall of verbal materials
They have fine motor function
Just need speech and language (not seen in a rehab hospital)
Result of lesions of the posterior left perisylvian region
Particularly posterior part of superior temporal region