Stroke Flashcards
Cerebrovascular accident (CVA)
– loss of blood supply to a focal area of the brain
Ischemic
arterial blockage
-complete or partial
Atherosclerosis can cause arteries to thicken blocking blood flow
Thrombosis- blockage or occlusion of an artery
Embolism- a thrombosis or blood clot that has traveled
-Embolic stroke
Hemorrhagic
– arterial bleed
Brain damage everywhere blood touches
Brian swells when blood touces it
2 types of hemorrhages: intracerebral & extracerebral (in meninges)
Transient ischemic attack (TIA)
– “mini stroke” causes temporarily loss of blood to the brain (CDC, 2014)
Adult Risk Factors
TIA High blood pressure High cholesterol Heart disease Atherosclerosis Diabetes Sickle cell disease Smoking Obesity
Child Risk Factors
Heart disease
Hemorrhage
Sickle cell disease
Vascular malformations
Vascular System
Carries blood to and from the heart
Arteries- carry blood away from the heart
Veins- carry blood to the heart
Capillaries- connect arteries and veins
Blood- supplies the brain with oxygen and glucose
BUT- blood and brain DO NOT mix
Cerebrovascular system
- network of arteries, veins, and capillaries that supply blood to the brain
Arteries
2 common carotid arteries- supplies the front of the brain
- Branches into the internal carotid arteries at the base of the skull
- Internal carotid arteries divide into smaller arteries that supply specific portions of the brain
Anterior cerebral arteries
Middle cerebral arteries
2 vertebral arteries- supplies the back of the brain
-Fuse to form the basilar artery
Circle of Willis
Carotid and vertebral arteries- come together to form a circle of arteries at the base of the brain.
Circle- redundant system that has some back-up if there is a blockage
Blockage or damage to an artery above the Circle of Willis may cause focal brain damage
aneurism
weakness in artery wall
causes a bulge that is susceptible to bursting
Ischemic stroke improvement:
Often occurs within a few weeks
Within first 3 months see significant recovery as blood reduces and brain swelling decreases
After 3-6 months recovery slows
If brain tissue dies - infarct
Hemorrhagic stroke improvement:
Rapid recovery over first few months
Better long-term outcomes
CNS
- brain and spinal cord
Spinal cord- carries neural messages from the brain to structures outside of the brain (peripheral structures)
Brainstem
Cranial nerves extend from the brainstem and then travel to other parts of the body (head, neck, face, ear, etc.)
Medulla, pons, and midbrain
Medulla has cranial nerves for tongue, laryngeal and diaphragmatic movement
Pons has cranial nerves for eye, facial, and hearing
Cerebrum
- Two brain hemispheres
Contain white and grey matter
White matter directly below the cerebral cortex
Contains fiber tracts that send information through pathways to different parts of the brain
Grey matter structures (e.g. thalamus & basal ganglia) are connected by the white matter pathways
Lateralization
- “one hemisphere is dominant for a particular function”(Bloom, 1997, p.146)
Language lateralized to left hemisphere
Nonverbal, visuo-spatial perceptual information
Brain Damage
Damage to a brain results in a specific pattern of deficits
Damage to language areas results in aphasia
Brain may not be as compartmentalized as we thought
Brain is a network of connections
Lateralization
- “one hemisphere is dominant for a particular function”(Bloom, 1997, p.146)
Language lateralized to left hemisphere
Nonverbal, visuo-spatial perceptual information
Localization
- one area of brain is responsible for a certain function
Broca’s area responsible for speech execution
Brain Damage
Damage to a brain results in a specific pattern of deficits
Damage to language areas results in aphasia
Brain may not be as compartmentalized as we thought
Brain is a network of connections
Aphasia
An acquired language disorder
Can be caused by stroke, TBI, tumor, or disease (damage to the brain)
categorized as fluent or nonfluent
Diagnosis is made based on standardized and nonstandardized test results
Discourse has to be analyzed
Fluent aphasias
- caused by damage to the posterior temporal lobe
Speak a lot but it doesn’t make sense, have normal articulation and syntax
Nonfluent aphasias
- caused by damage to the frontal lobe
Speaking short phrases or single words with reduced prosody, have syntax errors, misarticulate, and may repeat words or phrases (perseverate)
Often have weakness or paralysis on the right side of their body
Broca’s aphasia:
Non-Fluent
Damage- cortical and subcortical areas in the lower left frontal lobe
Including the precentral gyrus
Characteristics-
- Apraxia
- Agrammatic- short utterances that contain only content words
- Mildly impaired naming abilities
- Repetitions of sentences are agrammatic
- Oral reading and writing deficits
Transcortical motor aphasia:
Non-Fluent
Damage- frontal lobe in the area that connects Broca’s and the supplementary motor cortex
Broca’s area is NOT damaged
Characteristics-
- Articulation is intact
- Sentences contain syntactic errors
- Can repeat sentences
- Auditory comprehension is relatively good
- Reading and writing deficits are similar to Broca’s aphasia
Global aphasia:
Non-Fluent
Damage- large lesion affecting Broca’s and Wernicke’s areas
Including white matter deep to these structures
Characteristics-
-Limited verbal speech- meaningless or repetitions
Severe naming and sentence repetition -deficits
-May have some automatic speech
-Severely impaired auditory comprehension
-May be able to answer some yes/no questions and respond to basic commands
-Reading and writing severely impaired
-May have no functional reading
Wernicke’s
Fluent
Damage- posterior 1/3 of the superior temporal gyrus
Characteristics-
-Talks a lot and fast- without articulation errors
-Language can be empty or vague
-Neologistic jargon
-Paragrammatic-small grammar mistakes
-Auditory comprehension is severely impaired (hallmark)
-Naming and repetition are severely impaired
Reading and writing skills are variable, but impaired
Anomic
Fluent
Damage- Angular gyrus or the second temporal gyrus
Characteristics-
- Mild-moderate auditory comprehension deficits
- Severe word finding deficits- makes conversational speech appear empty (hallmark)
- Reading and writing
- Angular gyrus damage-severe impairments
- Second temporal gyrus- mild deficits similar to those heard in their speech
Conduction:
Fluent
Damage-Arcuate fasciculus
Characteristics-
- Mild word finding deficits
- Mild auditory comprehension deficits
- Severe repetition impairment (hallmark)
- Writing may have syntactic and spelling errors
Transcortical sensory
Fluent
Damage- Posterior parietal-temporal area (Wernicke’s NOT damaged)
Characteristics-
- Severe auditory comprehension deficits
- Severe naming deficits
- CAN repeat
- Good oral reading, poor comprehension
- Writing is severely impaired
Primary progressive aphasia
-slow progression of aphasia symptoms
Associated with disease processes- NOT stroke
Right Brain Stroke Damage
Characteristics-
- May have mild naming and auditory comprehension deficits
- Selective attention deficits
- Unilateral neglect on left side
- May not eat food on left side of plate
- Severe cases can ignore left side of body
- Literal interpretation of language
- Difficulty interpreting humor and figurative language
- Discourse deficits
- Disorganized
- Difficulty integrating narrative information
- Discourse deficits impair functioning in everyday activities
Emotional Processing
Significant deficits in emotional processing and expression
- Monotone
- Flat affect
- Indifferent or unaware of deficits
- Difficulty interpreting other’s emotions
- Prosody
- Facial expression
Aphasia Assessment
Focused on differential diagnosis btwn
Aphasia & Other communication disorders
Collect a detailed case history-
Talk with the patient and family
Review medical history
Standardized and nonstandardized language assessments
Assessment is on-going to determine treatment goals
Reading, writing, and speaking must be assessed
Bilingual Aphasia
Determine preferred language
Three recovery patterns:
- The first language acquired is less impaired and shows better recovery
- Most familiar or most recently used language recovers first
- The language with the most emotional attachment recovers first
Right Hemisphere Assessment
Language deficits may not be apparent on standardized language assessments
Need to administer right hemisphere specific assessments:
-RIC Evaluation of Communication -Problems in Right Hemisphere Dysfunction (RICE)
Need to assess:
- Discourse
- Visuo-spatial
- Reading and writing
- Complex language- metaphors & idioms
Stroke Treatment
Interdisciplinary approach
General SLP treatment goals:
- Educate and provide support to the family
- Develop compensatory strategies that improve the individual’s ability to communicate and understand communication
- Promote cognitive and linguistic recovery
- Promote independence
