Week 6 - Language and Strokes Flashcards
Larynx changed
Larynx changed, more sounds, greater vulnerability to choking
Language is on what side for more people (laterlization)
Left
What happens for language on the right side of the brain
narrative speech, map-reading, prosody, ALSO language
Difference between left and right handers
Left handers have less lateralization (might be able to maintain more skills in a stroke)
Left handers make up 10% of populations
Left handers suspected to be smarter
Difference between left and right handers
Left handers have less lateralization (might be able to maintain more skills in a stroke)
Left handers make up 10% of populations
Left handers suspected to be smarte
Die out of langagues
6,000 languages exist, one language dies every 14 days
Aphasia
loss of ability to understand or express speech, caused by brain damage (stroke, TBI)
Most common type of stroke to produce aphasia?
L MCA
Broca’s Aphasia
Broken, not fluent –> hard time with speech production (broken, not fluid) BUT they can understand fine
Occurs anterior to motor cortex, leads to impaired speech production (think motor, need motor skills to produce language)
Expressive aphasia (condition where a person may understand speech, but they have difficulty speaking fluently themselves)
Worsens with anxiety or pressure demands
Genearlly aware they have it
Wernicke’s Aphasia
Fluent –> speak fluently, cannot understand others
Occurs: posterior portion of temporal lobe and by the primary auditory cortex (impaired comprehension, think temporal, can’t process speech)
Receptive aphasia (when someone is able to speak well and use long sentences, but what they say may not make sense)
Impaired language comprehension
Often unaware
**can occur in those who are deaf
Receptive vs expressive aphasia
Receptive: Wernicke’s (they can speak fine, but doesn’t make sense)
Expressive: Brocas (can express language, can’t understand)
Broca’s vs Wernicke’s area in the brain
Other names for strokes
Infarcts (tissue necrosis d/t stroke)
CVA (cerebrovascular accident)
Definition of strokes ands rates
occurs when something blocks blood supply to part of the brain or
when a blood vessel in the brain bursts.
Incidence: over 750,000 in US per year (top injury in hospital)
Risk Factors of CVDs
Hypertension
Diabetes
Smoking
Obstructive sleep apnea
Obesity
Hypertension: risk factors for strokes
- 77% of individuals first strokes have BPs higher than 140/90
- 50% have history of hypertension
Diabetes: risk factors for strokes
- 3x increased risk of ischemic strokes
- heightened risk in african americans and whites
- hyperglycemia at stroke onset increase chance of brain damage
Smoking: risk factors for strokes
Increase heart rate and blood pressure decrease your arterial distensibility (less able your arteries are able to construct and un-restrict)
Secondhand smoke means equal risk
Obstructive sleep apnea: risk factors for strokes
Prevalance in stroke patients: 60%
Independently increases risk by 4x
linked to other factors
CPAP and BiPAP reduce risk
Obesity: risk factors for strokes
Abdonminal obesity > greate than total body obesity
linked ot multiple other risk factors
Stroke types
Ischemic: obstructs flow of blood
Hemorrhagic: caused by bleeding in the brain
Transient ischemic attack: stroke that lasts only a few minutes
- 1/3 will eventually have a stroke
Rates of ischemic vs hemorrhagic
88% Ischemic; 12% Hemorrhagic
Brain scan Ischemic and Hemorrhagic
*remember, left is right and right is left.
Ischemic you are seeing dead cells, H you are seeing blood (blood shows white on scans)
Two types of ischemic strokes
thrombus: is a blood clot in blood vessels
embolus: a piece of material that
breaks off and is carried through the bloodstream until it reaches an artery too small to pass through
initial damage done by ischemic stroke
Initial Damage in Ischemic stroke d/t Glutamate Ecotoxicity
CELL DEATH
Immediate cause of neuron death is the presence of excessive amounts of glutamate.
- Decreased O2 leads = Neural membranes become
depolarized = ↑ Glutamate
- NMDA Receptors become over-stimulated
- Inflammation attracts microglia
- Microglia attracts WBC that attach to the region
- this all leads to cell death
Non-modifiable risk factors
age
race
family history
Circle of Willis
where the internal carotid arteries branch into
smaller arteries that supply oxygenated blood to over 80% of the cerebrum.
Three main brain arteries
anterior cerebral artery
middle cerebral artery
posterior cerebral artery
Middle Cerebral Artery (MCA) Stroke – General
90% of strokes
largest of the brain arteries
supplies most of the outer surface of the frontal, parietal, temporal lobes and the basal ganglia –> INCLUDING pre-central (sensory) and post-central (mortor) gyrus
MCA Stroke Symptoms
Contralateral weaknesses and sensory loss in upper extremities
–> remember: left effects right
Loss of visual field
Left MCA stroke: speech deficits
- brocas
- wernickes
Right MCA stroke: neglect and poor movitation
- flat prosody
- ex. neglect of left side, won’t notice if left art stuck in door
Anterior cerebral artery (ACA) stroke – general
Less common (left ACA more common than R ACA)
Feeds deep structures in brain, frontal, parietal, corupus callosum, and bottom of cerebrum
Anterior cerebral artery (ACA) stroke – symptoms
Contralateral motry and sensory loss in lower extremeties
poor gait and coordination (clumsy)
slowed initiation (abulia) –> takes longer to do things
flat affect
urinary incontinence
ACA vs MCA strokes
ACA: contralateral lower extremity deficits
MCA: contralateral upper extremity and face deficits
Posterior cerebral artery (PCA) stroke
5-10% of strokes
occipital
Symptoms:
- impaires consciousness
- nausea/vomiting
- ataxia (poor motor coordination)
- vision changes
- nystagmus (eyes shifting)
Arteriovenous malformations (AVMs)
Most common in TIAs
Tangle of arteries and veins without connecting capillaries
Aquired through inborn genetic mutation followed by secondary mutation (1-2% of strokes)
Variable size (2mm to cm)
Damage:
- compression of neighboring structures
- stealing of blood flow from surrounding regions
Presentation:
- sx onset between 10-40
- intracranial hemorrhage most common presentation
Post stroke depression treatment
Early psychopharmacologic treatment is KEY
Psychiatric Considerations Post-Stroke: Depression
GET THEM ON MEDS, therapy not enough
- Post stroke depression = 1/3 of survivors
- 6x ↑ risk of depression 2-3 years post stroke
- More common in L frontal and basal ganglia strokes
- adversely effects functional recovery
- ↑ Risk Factors = Premorbid depression & Social
isolation post stroke
Psychiatric Considerations Post-Stroke: Anxiety
1/4 meet GAD criteria post stroke
less common
Psychiatric Considerations Post-Stroke: Psychosis
- More common in right-temporo-parietal-occipito
area lesions, seizures, and subcortical atrophy - Pseudobulbar Affect (episodes of sudden uncontrollable and inappropriate laughing or crying) = 10-15% post stroke patients
- Hypomanic symptoms = 1%
If you suspect a stroke, BE FAST
This is on quiz
What can you administer to help stroke (why important to be fast)
Tissue Plasminogen (tPA) can be administered within 4.5 hours
- helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment
- After that time, has hemorrhagic effect
