Stroke

Question 1

Cerebrovascular accident (CVA)

Answer 1

– loss of blood supply to a focal area of the brain

Question 2

Ischemic

Answer 2

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

Question 3

Hemorrhagic

Answer 3

– arterial bleed

Brain damage everywhere blood touches
Brian swells when blood touces it

2 types of hemorrhages: intracerebral & extracerebral (in meninges)

Question 4

Transient ischemic attack (TIA)

Answer 4

– “mini stroke” causes temporarily loss of blood to the brain (CDC, 2014)

Question 5

Adult Risk Factors

Answer 5

TIA
High blood pressure
High cholesterol
Heart disease
Atherosclerosis
Diabetes
Sickle cell disease
Smoking
Obesity

Question 6

Child Risk Factors

Answer 6

Heart disease
Hemorrhage
Sickle cell disease
Vascular malformations

Question 7

Vascular System

Answer 7

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

Question 8

Cerebrovascular system

Answer 8

• network of arteries, veins, and capillaries that supply blood to the brain

Question 9

Arteries

Answer 9

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

Question 10

Circle of Willis

Answer 10

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

Question 11

aneurism

Answer 11

weakness in artery wall

causes a bulge that is susceptible to bursting

Question 12

Ischemic stroke improvement:

Answer 12

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

Question 13

Hemorrhagic stroke improvement:

Answer 13

Rapid recovery over first few months

Better long-term outcomes

Question 14

CNS

Answer 14

• brain and spinal cord

Spinal cord- carries neural messages from the brain to structures outside of the brain (peripheral structures)

Question 15

Brainstem

Answer 15

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

Question 16

Cerebrum

Answer 16

• 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

Question 17

Lateralization

Answer 17

• “one hemisphere is dominant for a particular function”(Bloom, 1997, p.146)
  Language lateralized to left hemisphere
  Nonverbal, visuo-spatial perceptual information

Question 18

Brain Damage

Answer 18

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

Question 19

Lateralization

Answer 19

• “one hemisphere is dominant for a particular function”(Bloom, 1997, p.146)

Language lateralized to left hemisphere

Nonverbal, visuo-spatial perceptual information

Question 20

Localization

Answer 20

• one area of brain is responsible for a certain function

Broca’s area responsible for speech execution

Question 21

Brain Damage

Answer 21

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

Question 22

Aphasia

Answer 22

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

Question 23

Fluent aphasias

Answer 23

• caused by damage to the posterior temporal lobe

Speak a lot but it doesn’t make sense, have normal articulation and syntax

Question 24

Nonfluent aphasias

Answer 24

• 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

Question 25

Broca’s aphasia:

Answer 25

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

Question 26

Transcortical motor aphasia:

Answer 26

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

Question 27

Global aphasia:

Answer 27

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

Question 28

Wernicke’s

Answer 28

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

Question 29

Anomic

Answer 29

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

Question 30

Conduction:

Answer 30

Fluent Damage-Arcuate fasciculus Characteristics- - Mild word finding deficits - Mild auditory comprehension deficits - Severe repetition impairment (hallmark) - Writing may have syntactic and spelling errors

Question 31

Transcortical sensory

Answer 31

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

Question 32

Primary progressive aphasia

Answer 32

-slow progression of aphasia symptoms Associated with disease processes- NOT stroke

Question 33

Right Brain Stroke Damage

Answer 33

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

Question 34

Emotional Processing

Answer 34

Significant deficits in emotional processing and expression - Monotone - Flat affect - Indifferent or unaware of deficits - Difficulty interpreting other’s emotions - Prosody - Facial expression

Question 35

Aphasia Assessment

Answer 35

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

Question 36

Bilingual Aphasia

Answer 36

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

Question 37

Right Hemisphere Assessment

Answer 37

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

Question 38

Stroke Treatment

Answer 38

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