Neurogenics Chapter 1 Flashcards
Neuroanatomy & Neuropathology Material!
Nervous system is divided in two groups:
CNS- Central Nervous System
PNS- Peripheral Nervous System
CNS consists of :
Brain
Spinal Cord
PNS consists of:
Cranial Nerves 12 pairs
Spinal Nerves 31 pairs
Sensory information is ___________
AFFERENT (in to cell body)
Motor information is _____________
EFFERENT (out of cell body)
What is released during the synapse?
Neurotransmitters
What neurotransmitter is very important for muscle movement?
ACH (Acetilcholine)
Brainstem consists of:
- medulla- attaches to spinal cord
- pons
- midbrain
What is a very important function of the CEREBELLUM?
Coordinates and modulates force and range of movement
What are the main structures in the DIENCEPHALON?
- Thalamus (largest) -RELAY STATION
- Hypothalamus
- 3rd ventricle
Basal Ganglia plays a huge role in the _____________ and facilitation of movement
Inhibition
Damage to basal ganglia can cause:
Dysarthrias or dyskinesias
What are cerebral ventricles?
Interconnected cavities filled with CSF
Where is CSF produced ?
Choroid Plexus!
The Corpus Callosum connects the two…..
hemispheres
The fiber tracts in the CNS make up the __________matter of the brain
WHITE
There are 3 main fiber tracts in the CNS. Which are they? (PCA)
- Projection fibers
- Commisural fibers
- Association fibers
SHORT fibers connect ___________areas , LONGER fibers connect _____________ areas.
adjacent, distant
Longer fibers are also called ____________.
fasiciculi
Projection Fibers
- Carry info long distances
- Transmit SENSORY (afferent) info to brain
- Transmit MOTOR (efferent) info to muscles and glands in cortical areas
Those projection fibers near cortex arranged in FAN-LIKE area is called….
CORONA RADIATA
The area where those fibers are compacted and concentrated is called….
INTERNAL CAPSULE
UMN are ___________.
LMN are ____________.
UMN= tracts
LMN=nerves
Projection Fibers make up several 3 important pathways which are:
- Pyramidal pathway **
- Extra pyramidal pathway **
- Vestibular-reticular system
Which pathway is responsible of carrying VOLUNTARY MVMT messages?
a. extra pyramidal
b. pyramidal
c. vestibular-reticular system
B. PYRAMIDAL!
* it passes through an area called pyramids in the brainstem.
The pyramidal pathway has 2 different group of nerve fibers (tracts):
1) Corticobulbar tract
2) Corticospinal tract
The CORTICOBULBAR TRACT sends info from ______________ to the _______________. The fibers synapse with the _________________.
CORTEX to the BRAINSTEM.
Fibers synapse with Cranial Nerves!
The CORTICOSPINAL TRACT sends info from ______________ to the _______________. The fibers synapse with the _________________.
CORTEX to the SPINAL CORD.
Fibers synapse with the Spinal Nerves!
The cells of the UMN are located in and around the:
a. temporal lobe
b. primary motor cortex
c. primary sensory cortex
B. Primary motor cortex!
The pyramidal pathway is _________.
a. direct
b. indirect
A. DIRECT
* it travels straight from cortex to the neurons in brainstem or spinal cord. ONLY ONE SYNAPSE.
Association Fibers
- Can be short of long but ALL connect areas within ONE HEMISPHERE
- Help maintain communication among structures within a hemisphere
Which is one of the MOST IMPORTANT association fibers?
ARCUATE FASCICULUS (superior longitudinal)
- connects broca’s and wernicke’s area
- important for language acquisition, meaningful/purposeful lang. production, & verbal memory
What are two other association fibers?
- cingulum
* unicinate fasiculus
True of False:
Association fibers are intrahemispheric fibers.
TRUE
* They connect structures WITHIN the hemispheres
Commisural Fibers
- Connect corresponding areas of the 2 hemispheres which are divided by the longitudinal fissure.
Which is the MOST important and the LARGEST commisural fiber?
CORPUS CALLOSUM
- damage to corpus callosum disconnects 2 hemispheres
- results in problems w/ movement, reading and naming (disconnection syndromes)
The OUTER layer of the brain is called _______________
Cerebrum/cerebral cortex
A) Hills in the brain are called _________.
B) Valleys in the brain are called __________.
a) Gyri
b) Sulci
The 2 hemispheres in the cerebrum are divided by the : ___________
LONGITUDINAL FISSURE
What divides the anterior half of the brain from the posterior half?
a) longitudinal fissure
b) central sulcus
c) Fissure of Rolando
d) B & C
D- Fissure of Rolando and central sulcus are the same thing! (different names)
The _______________ begins at inferior frontal lobe and move laterally and upward.
Sylvian fissure (lateral cerebral fissure)
The cortex is usually divided in 2 functional categories:
- Primary cortex
* Association cortex/areas
The primary cortex is responsible for specific __________ and _________ information.
motor and sensory!
What are the important PRIMARY CORTICES?
- Primary Motor Cortex (frontal)
- Primary Sensory Cortex (parietal)
- Primary Visual Cortex (occipital)
- Primary Auditory Cortex (temporal)
- Primary Olfactory Cortex (frontal)
What are the association areas responsible for?
Interpreting sensory information and planning motor activity
FRONTAL LOBE
- Primary motor cortex
- Broca’s area
- Frontal association area - strip in front of primary motor cortex. Important for planning and voluntary mvmts.
- Homunculus - represents allocation of motor function in the motor cortex
PARIETAL LOBE
- Lies behind central fissure and above lateral fissure
- Primary Sensory Cortex - lies just behind the central fissure
- Parietal association area - behind primary sensory cortex and it is important for processing tactile info
What are the TWO important gyri in the PARIETAL lobe that are important for language!
1) SUPRAMARGINAL gyri
2) ANGULAR gyri
Damage to the SUPRAMARGINA GYRI can cause:
a) alexia
b) anomia
c) agraphia
d) Conduction aphasia
e) C & D
E- Agraphia (writing problems) & Conduction aphasia
Damage to the ANGULAR Gyrus can cause?
naming, reading, writing problems
& transcortical sensory aphasia
OCCIPITAL LOBE
- Primary Visual Cortex
TEMPORAL LOBE
- Primary Auditory Cortex
- Wernicke’s area
- Insula - structure hidden in the lateral cerebral fissure by the “operculum”
- Temporal association area
What are 3 important gyri in the TEMPORAL LOBE?
1) Superior temporal
2) Middle temporal
3) Inferior temporal
True or False:
Speech is mostly a VOLUNTARY movement.
TRUE
Explain the process of how VOLUNTARY mvmt for occurs…
- PRE-MOTOR cortex makes the plan (Broca’s area)
- Sends the intended info to the PRIMARY MOTOR cortex.
- The info leaves the cortex and sends it through the fibers (corona radiata) via the pyramidal tract.
- For SPEECH it goes through the corticobulbar
- For BODY mvmts it goes through the corticospinal
Which is the main artery of the heart?
AORTA
The aortic arch divides into 4 branches:
2 COMMON CAROTID arteries
2. SUBCLAVIAN arteries
The COMMON CAROTID arteries brain into:
Internal carotid
External carotid
Which of the carotid arteries is the major blood supplier to the brain?
a) internal carotid
b) external carotid
A- INTERNAL CAROTID
* it branches into smaller vessels which supply various portions of the brain.
What are the two main branches of the INTERNAL CAROTID artery?
1) Anterior CEREBRAL artery
2) Middle CEREBRAL artery
Which artery covers more space and areas of the brain?
a) anterior cerebral artery
b) middle cerebral artery
c) none
B- MIDDLE CEREBRAL ARTERY
* supplies entire lateral surface of cortex, including major regions of the frontal lobe! In supplies areas such as : motor cortex, Broca’s, Wernicke’s, angular gyrus and supramarginal gyrus.
What areas does the ANTERIOR CEREBRAL ARTERY supply?
The anterior cerebral artery supplies middle portion of frontal and parietal lobes as well as basal ganglia and corpus callosum.
Damage to this artery causes more COGNITIVE problems.
Where do strokes mostly happen and which one causes aphasias?
a) anterior cerebral artery
b) middle cerebral artery
B- middle cerebral artery!
VERTEBRAL ARTERY
- Branch from the subclavian arteries that merge from the aortic arch.
As the VERTEBRAL ARTERIES move up at the level of the pons they come together and form the ________________________.
BASILAR ARTERY (single)
TRUE OF FALSE:
Do the vertebral arteries enter skull and branch to supply many organs , including the spinal cord?
TRUE
Which of these arteries supply mostly the upper extremities?
a) vertebral arteries
b) common carotid arteries
c) subclavian arteries
d) a & c
C- SUBCLAVIAN arteries!
As the single BASILAR ARTERY moves up towards upper portion of the pons in then branches out again into 2 ______________________.
Posterior Cerebral Arteries (PCA)
What two arteries come together to form the Circle of Willis?
VERTEBRAL & CAROTID arteries!
If an artery is blocked BELOW the circle it will cause _______________ damage, and if the block is ABOVE the circle it will cause _____________________.
1) MINIMAL - if it’s below an alternate channel of blood flow can be maintained.
2) SIGNIFICANT - if it’s above the circle the brain will not receive any blood!
Occlusions = ___________________
BLOCKAGE
TRUE OR FALSE
Occlusions of the main branch of a cerebral artery are more serious than in the watershed areas where cerebral arteries overlap.
TRUE
Strokes are also called ______________________
CVA - CEREBROVASCULAR ACCIDENTS
What are the 3 types of strokes?
1) Ischemic
2) Hemorraghic
3) TIA (transcient ischemic attacks)
Ischemia means ______________
deficiency in blood
Infarction means______________
death of neural tissue (necrosis) due to lack of oxygen caused by blood deficiency
Ischemic strokes can be either _____________________ or _________________
thrombotic
embolic
Thrombotic strokes are caused by a thrombosis. This is when _____________
blood materials get trapped and blocks blood circulation! (does not moves)
Embolic strokes are caused by an embolism.
This is when ________________
a moving fragment of arterial debris (embolus) blocks artery! (moves!)
Hemorrhagic strokes results from ________________ cerebral blood vessels causing cerebral bleeding.
RUPTURE!
Hemorrhagic strokes can be either ______________________ or _______________________
INTRACEREBRAL
EXTRACEREBRAL
INTRACEREBRAL is when ruptures occur within the _______________ or ________________.
BRAIN OR BRAINSTEM
EXTRACEREBRAL is when ruptures occur within the ________________.
MENINGES
TIA’s are ______________ disruption of blood supply.
TEMPORARY
* last less than 24 hours and most often less than 30 minutes.
TIA symptoms:
- limb weakness
- slurred speech
- vision problems
- dizziness
- confusion
- mild aphasia which resolves completely
What is thought to be the cause of TIA’s?
Small emboli that blocks an artery then breaks up and dissolve.
TRUE OR FALSE
The pattern of recovery for ischemic and hemorrhagic strokes are exactly the same.
FALSE!
Recovery for Ischemic strokes
- Greater and sooner recovery (noticeable in first few weeks)
- Max. recovery of language in 3 MONTHS
- Neurologic recovery usually done by 6 MONTHS
Recovery for Hemorrhagic strokes
- Little recovery in first 4-8 weeks
- After 4-8 weeks more rapid recovery
- When recovering stabilizes there are RESIDUAL DEFICITS
- Neurologic recovery complete by 6 MONTHS.
What are other neurologic causes of communication disorders?
- Brain Trauma (TBI)
- Intracranial Tumors (neoplasma)
- Infections (e.g. bacterial meningitis)
- Toxemia (substances that poison nerve tissue)
- Nutritional disorders (associated with alcoholism)
Aphasia is a ________________ disorder.
LANGUAGE
* not speech!
TRUE OR FALSE
Some people believe that aphasia is a single disorder whereas others believe it is several disorders.
TRUE
Broca’s aphasia is more common in ____________ patients while Wernicke’s aphasia is more common in _____________ patients.
YOUNGER, OLDER
TRUE OR FALSE
Localizationalists do NOT believe that different parts of the brain specialize in different functions.
FALSE
Who was the first person who suggest localizations of language and other intellectual functions in the frontal lobes?
a) Paul Broca
b) Karl Wernicke
c) Franz Gall
C- Franz Gall
- physician in Vienna
- he was associated with phrenology
Who was the first person to use the localizationist model specific to aphasia?
a) Karl Wernicke
b) Paul Broca
c) Franz Gall
B- Paul Broca
- french neurosurgeon
- identified left hemisphere as being important for speech/language
Who was the first person to describe “sensory aphasia”?
a) Karl Wernicke
b) Paul Broca
c) Franz Gall
A- Karl Wernicke
- german neuropsychiatrist
- sensory aphasia aka Wernicke’s aphasia
- caused by damange in posterior temporal lobe
TRUE OR FALSE
Broca and Wenicke’s strengthened the localizationists’ theories
TRUE
Research has shown that the left hemisphere is dominant for language in about _________% of adults .
85%
Left handers with aphasia tend to have ______________ severe aphasia and recover _________.
less, better
TRUE OR FALSE
Holistic approach believe the same thing as localizationists
FALSE
- they believe the opposite
- they believe that the brain functions as an integrated unit and a lesion in one area affects functions of many other areas.
- John Jackson proposed holistic theory
Who believes that the region surrounding the Sylvian fissure (perisylvian area) in the left hemisphere is important for language?
a) localizationists
b) holistic theorists
c) connectionists theories
C- connectionists theories!
* they emphasize on connections in the brain and offering a guide to understand how language occurs in the brain
How do we comprehend? (based on connectionist model)
1) Auditory message goes into the EAR
2) Reaches the BRAINSTEM and then PRIMARY AUDITORY CORTEX (of each hemisphere)
3) The info from the primary auditory cortex in the right hemisphere is then sent WERNICKE’S area via the posterior CORPUS CALLOSUM!
4) Wernicke’s starts processing the information (meaning, syntax etc)
How do we comprehend PRINT! (using connectionist model)
1) Visual info sent to PRIMARY VISUAL CORTEX
2) Info in the right hemisphere is sent to the left hemisphere through the CORPUS CALLOSUM
3) It reaches WERNICKE’S area and it decodes the message the same way as if it were auditory info
How do we have spontaneous speech ? (using connectionist model)
1) WERNICKE’S retrieves from it’s lexicon and starts processing and building the sentence (structure, syntax, meaning etc)
2) Sends the information through the ARCUATE FASICULUS so it reaches BROCA’S area
3) BROCA’s puts the code into an action plan and sends it to the PRIMARY MOTOR CORTEX
4) The PRIMARY MOTOR CORTEX then sends the info via the pyramidal tract (CORTICOBULBAR) which causes speech muscles to move.
Which is the best task to give a person in order to view their entire language circuit?
a) reading
b) writing
c) repetition
d) naming
C- REPETITION!
- you test both receptive and expressive at the same time!
- this task requires the person to listen, process code in Wernicke’s, then sends it to Broca’s to plan speech movement !
How do we write? (using connectionist model)
1) WERNICKE’S area forms a message
2) Sends it through the ARCUATE FASCICULUS and sends it to the PRE-MOTOR CORTEX for the hand and arm
3) Then that is sent to the PRIMARY MOTOR CORTEX which is then sent through the pyramidal system (CORTICOSPINAL) to execute movement.
Which model is used currently as the best model?
a) localizationist
b) connectionist
c) holistic
B-Connectionist!
* however each can be useful to the clinician if used with limitations
Wernicke’s aphasia is considered a _______________________.
Broca’s aphasia is considered __________________.
Wernicke's = FLUENT Broca's = NON-FLUENT
Wernicke’s aphasia is when there is damage to the ____________ region of the sylvian fissure while Broca’s aphasia is caused by damage to the ______________ region of the sylvian fissure.
POSTERIOR- wernicke’s
ANTERIOR - broca’s
What are some FACTORS used in classifying the aphasia?
- speech fluency
- paraphasias (verbal/semantic or phonemic)
- repetition
- language comprehension
- site of lesion
Which are the NON-FLUENT APHASIAS?
- Broca’s Aphasia
- Global Aphasia
- Transcortical Motor Aphasia (TMA)
- Mixed Transcortical Aphasia (MTA)
Which are the FLUENT APHASIAS?
- Wernicke’s Aphasia
- Transcortical Sensory Aphasia (TSA)
- Anomic Aphasia
- Conduction Aphasia
What are some the aphasias caused by damage to cortical centers for language. These regions serve the MIDDLE CEREBRAL ARTERY.
- Broca’s Aphasia
- Wernicke’s Aphasia
- Global Aphasia
What are some of the aphasias caused by damage to the ASSOCIATION FIBER tracts important for language.
- Conduction Aphasia
* Transcortical aphasias (sensory, motor, and mixed)
BROCA’S APHASIA
damage?
- damage to the ANTERIOR branch of the MIDDLE CEREBRAL ARTERY or damage to BROCA’S area
- this aphasia usually has RIGHT-SIDED hemiparesis or hemiplegia.
Language characteristics of BROCA’S APHASIA
- non-fluent
- comprehension may be intact or better than expressive
- good self-monitoring
- use word “and” frequently
- agrammaticism (telegraphic)
- monotonous speech
- misarticulations
- more content words (nouns, verbs, some adj) no function words (articles , preposition)
- impaired repetition!
- write as they speak
WERNICKE’S APHASIA
damage?
- damage to the POSTERIOR branch of MIDDLE CEREBRAL ARTERY or damage to WERNICKE’S AREA
- damage to POSTERIOR SUPERIOR TEMPORAL LOBE of language dominant hemisphere (left)
Language characteristics of WERNICKE’S APHASIA
- Fluent but makes no sense (empty speech)
- Impaired auditory comprehension
- speech contains paraphasias and neologisms (jargon)
- if aphasia is mild, they might be aware of errors
- write as they speak ( no sense)
- may have circumlocution
- less concern with speech compared to broca’s
- may have visual deficits due to nearness of optic tract.
GLOBAL APHASIA
damage?
- damage to TRUNK OF MIDDLE CEREBRAL ARTERY which causes massive damage to the entire perisylvian area
Language characteristics of GLOBAL APHASIA
- severe decifits in all language modalities
- server impaired comprehension (even answering yes or no is difficult)
- may be able to perform non-verbal tasks (e.g. picture matching)
- better performance when info is personal
CONDUCTION APHASIA
damage?
- Damage to the association fiber (arcuate fasciculus) insula, or supramarginal gyrus
- very rare aphasia about 5-10%
Language characteristics of CONDUCTION APHASIA
- DIFFICULTY WITH REPETITION!
- comprehension somewhat spared
- rate, intonation, and stress usually normal
- may produce literal and verbal paraphasias
- difficulty reading out loud
- word retrieval problems
- writing is usually legible
- self-corrections are not common
What are the 3 types of transcortical aphasias?
- Transcortical Motor
- Transcortical Sensory
- Mixed Transcortical
What is something usually preserved in transcortical aphasias?
REPETITION- defining characteristic of this aphasia!
TMA (transcortical motor aphasia)
damage?
- damage thought to be in ANTERIOR SUPERIOR FRONTAL LOBE also affecting association pathways.
Language characteristics of TMA
similar to Broca’s
- reduced speech output
- GOOD REPETITION
- good auditory comprehension
- disturbed writing
- difficulty INITIATING SPEECH - INERTIA
- may have right sided hemiparesis or hemiplegia
- attentive and alert
TSA (transcortical sensory )
damage?
- damage to POSTERIOR TEMPOROPARIETAL region sparing wernicke’s!
Language characteristics of TSA
- FLUENT but empty speech
- preserved REPETITION
- NO INERTIA
- may have ECHOLALIA (repeats what is said to them)
- Lesion isolates Wernicke’s area from the rest of the brain, so major deficits in comprehension of spoken and written language.
- difficulty reading
- difficulty following commands
MTA (mixed transcortical)
damage?
RARE APHASIA
- damage that spares the major language areas but separates them from rest of brain
- damage often occurs in WATERSHED AREAS
Language characteristics of MTA
- Similar to global aphasia but better REPETITION!
- Echolalia
- non-fluent
- no functional auditory comprehension
- severely impaired reading and writing skills
ANOMIC APHASIA
damage?
- no clear localization
* damage may occur to angular gyrus or inferior temporal gyrus
Language characteristics of ANOMIC APHASIA
- difficulty NAMING
- may have mild auditory comprehension impairment
- word-retrieval problems
- circumlocution
- reading and writing is good
SUBCORTICAL APHASIAS
-anterior syndrome-
damage and characteristics
- caused by damage to internal capsule and lenticular nucleus and extending to ANTERIOR white matter
- hemiplegic
- slow dysarthric speech
- GOOD comprehension
- good repetition
- poor oral reading and writing
- poor confrontational naming ( what is this? what is that? )
SUBCORTICAL APHASIAS
- posterior syndrome-
damage and characteristics
- damage to putamen and internal capsule extending into POSTERIOR white matter.
- hemiplegic
- fluent speech NO dysarthria
- POOR comprehension
- good single word repetition
- impaired reading and writing
- poor confrontational naming
SUBCORTICAL APHASIAS
-anterior posterior syndrome-
damage and characteristics
- damage to internal capsule and putamen with both ANTERIOR AND POSTERIOR extension of white matter.
- mixture of symptoms consistent with both Broca’s and Wernicke’s aphasia
THALAMIC APHASIA
damage and characteristics
- damage to THALAMUS!
- hemiplegic
- difficulty initiating speech (inertia)
- speech is echolalic and neologistic
- auditory comprehension and reading is good
- writing is impaired
- word finding problems
TRUE OR FALSE
Disconnection syndromes cause aphasias
TRUE
- damage to fiber tracts in corpus callosum (info is not passed to left side)
Damage to ANTERIOR CEREBRAL ARTERY produces ________________.
Damage to the POSTERIOR CEREBRAL ARTERY
produces _______________.
- Anterior disconnection syndrome
* Posterior disconnection syndrome
Visual field blindness is caused by damage in the __________temporal lobe damage or _________ parietal lobe damage. It causes __________ damage.
a) posterior, high, ipsilateral
b) anterior, low, contralateral
c) posterior , low, contralateral
d) anterior, high , ipsilateral
C - posterior , low , contralateral
Hemianopia = ?
HALF VISION!
Homonymous = ?
Same part of visual field is affected in each eye!
TRUE OF FALSE
A person with apraxia has problems with their muscles.
FALSE!
* it is a motor planning problem not muscles! Problems with muscles is dysarthria
Ideomotor apraxia has 3 types :
- limb apraxia
- buccofacial apraxia (oral)
- apraxia of speech
They ALL have problems with VOLITIONAL (ON COMMAND) MOVEMENTS!
What is AGNOSIA?
a) a motor impairment
b) a sensory impairment
B- sensory impairment!
* group of perceptual impairments where parts do NOT recognize stimuli in a sensory modality but PERCEPTION IS NOT AFFECTED!
What are the 4 types of agnosia?
- Visual= Can see but can’t recognize objects visually
- Tactile= Can touch objects but can’t recognize objects by touch
- Auditory = Can’t interpret or comprehend info
- Auditory -verbal = Comprehension SEVERLY DAMAGED but other aspects of language are ok!
