Physiology-Aphasia, Agnosia Flashcards
What circuit is disrupted in aphasias?
Wernicke’s (speech comprehension) -> Arcuate Fasiculus (hear & repeat or hear & send to Wernicke’s for understanding) -> Broca’s area (verbal output)
What is not an aphasia?
Not a disorder of speech, trouble with articulation (slurring), a motor disorder (dysarthria) or trouble with hearing or vision.
A patient presents to the ED complaining of knowing what they wanted to say, but it came out not sounding right. Do they have an aphasia?
No. This is a dysarthria. An aphasia would be a patient who knew what they wanted to say, but just couldn’t get it out.
A patient presents with difficulty pronouncing words. Does she have an aphasia?
No, this is a dysarthria.
A patient presents with difficulty getting words out. He can write just fine. Does he have an aphasia?
No, he has a dysarthria. It Broca’s aphasia, the patients will write the same way they speak.
A patient presents with difficulty speaking. She also presents with weakness, numbness and tingling in her face. Does she have an aphasia?
Yes. Sensory input is affected because Broca’s area is near the motor cortex and Wernicke’s is near the sensory cortex.
What 6 things should you test in a patient with a suspect aphasia?
Naming (faucet, outlet), fluency (80-100 wpm or 4-5 words per sentence), comprehension (with your pen, touch the quarter, turn it around), repetition (no, ifs ands or buts), reading and writing.
What are the two categories of aphasias?
Non-fluent (Broca’s, transcortical motor, mixed transcortical or global aphasia where patients speak less than 4-5 words per sentence) and fluent (Wernicke’s, transcortical sensory or thalamic aphasia where patients get frustrated because you can’t understand them)
Patients do nothing but repeat what you say.
Mixed transcortical aphasia and transcortical sensory aphasia.
High imagery words with right hemiparesis in the face and arm.
Broca’s aphasia
Hyperfluency, neologisms (made up word) and very poor comprehension.
Wernicke’s aphasia
A patient presents with clumsiness. His wife says that he grabs a knife to eat his cereal with instead of a spoon and he has a hard time figuring out how to shave in the morning. What does he have?
Apraxia. This is an inability to do a skilled, learned movement without any motor or sensory defect.
Where is apraxia always found?
Always in the dominant hemisphere, mostly in the parietal lobe and sometimes in the frontal lobe.
A patient presents with difficulty using a saw at his carpentry shop he has worked at for the past 20 years. On examination he cannot pretend to brush his teeth or blow out a candle when you ask him to. What does he have? What side of the body will his symptoms most likely present on?
Ideomotor apraxia. Most apraxias are located bilaterally.
A patient presents to your clinic, when you show her keys, she has no clue what they are. But if she feels them or hears them jingle, she can tell you they are keys. What is your diagnosis?
Visual agnosia.
A patient presents who can’t match colors. What might she have?
Color agnosia.
A patient presents who can’t tell you what specific sounds are?
Auditory agnosia.
Inability to recognize a familiar face, but able to recognize people by their clothes and the way they walk.
Prosopagnosia. Random person vs. wife, “Who would you rather have dinner with”…might pick the random person because they don’t recognize their face.
