Week 7- Higher Cortical Structures Flashcards
What are the examinable components of language? For testing purposes what components paralell (and therefore you don’t usually test them separately)?
Speech
Auditory comprehension
Repetition
Naming
Writing
Reading
Reading usually paralells auditory comprehension, writing parallels fluency (a component of speech)
What are components of speech? What are 3 kinds of paraphasia?
articulation
fluency
effort
word-finding
paraphasias
- phonemic (rhyme)
- semantic (word substitution)
- neologism (made up word)
prosody (the intonation)
Name that aphasia!
non fluent, no comprehension, no repetition
Global aphasia: Broca’s and Wernicke’s both damaged, as in an MCA stroke before it splits into superior and inferior divisions.
Name that aphasia!
non-fluent, no comprehension, repetition intact
Mixed transcortical aphasia
Broca’s, wernicke’s and arcuate all spared but areas communicating with these are damaged
Name that aphasia!
non-fluent, comprehension intact, no repetition
Broca’s aphasia- can’t get words out!
Name that aphasia!
non-fluent, comprehension intact, repetition intact
transcortical motor aphasia (remember how to tell TMA from MTA because in this one the person has the motor to repeat, or in TMA the person is all mixed up because they can repeat but they can’t understand)
Name that aphasia!
Fluent, no comprehension, no repetition
Wernicke’s aphasia
Name that aphasia!
Fluent, no comprehension, repetition intact
transcortical sensory aphasia
Name that aphasia!
fluent, comprehension intact, repetition impaired
conduction aphasia- damage to the arcuate fasciculus
Name that aphasia!
fluent, comprehension intact, repetition intact
anomic aphasia- anatomically non-specific, impaired naming
What percentage of strokes are ischemic? What percentage are hemorrhagic?
85% are ischemic, 15% are hemorrhagic, of the ischemic ones 50% are in the MCA distribution, 5-10% are watershed infarcts
So you’ve got a patient with suspected stroke. You start with a NCCT. What might you see?
50% will have nothing
You might see a hyperdense MCA sign
You might see a hemorrhage, in which case you should NOT give ASA.
What are ischemic stroke mechanisms?
- large artery athersclerosis
- sm. vessl lacunar stroke (usually the result of intracranial atheroma in vessels)
- Cardioembolic (Afib is most common…has significant morbidity and mortality)
- Cryptogenic
What are features of ACA stroke?
What are the established treatments for acute stroke? What is the established secondary prevention?
First, r/o hemorrhagic with NCCT. Also, nausea/vomiting more likely hemorrhagic
- ivTPA if <3 hrs (sometimes 4.5 hrs)
- ASA
- stroke unit
- hemicraniectomy if indicated
Established secondary prevention:
- carotid endarectomy (if CT angio showed carotid atherosclerosis)
- Anticoagulation (for cardioemoblic strokes only)
- Antiplatelets (for lg and sm vessels. no need for warfarin if it is not cardioembolic)
- HTN control and statins for all!!
What is the CHADS2 score and what is it used for?
To determine if an Afib pt should be anticoagulated
CHF
HTN
Age >75
DM
Stroke/TIA (2 points for this one)
Does a lacunar stroke usually have cortical features?
No
How many mL/min of blood do you need to maintain neuronal function?
50 mL/min
Where is a hypertensive patient most likely to stroke out?
basal ganglia
What is the likelihood of stroke in a patient with symptomatic carotid ischemia?
25%- whereas the risk of carotid endarterectomy is only 3%
What is the Hunt and Hess scale?
A scale for the severity of subarachnoid hemorrhage?
What is “amyloid angiopathy” and who is it common in?
deposition of amyloid in vessel walls.. more likely in elderly and Down syndrome (the gene is on chromosome 21…they have an extra copy)
What are the treatment options for ischemic stroke?
ivTPA (<3 hrs) (pts given ivTPA are 30% more likely to have no–>minimal symptoms)
intraarterial thrombolysis
mechanical clot retrieval
What parts of the brain are involved in attention?
parietal (helps shift focus), basal ganglia, brainstem
What are the following things a test of?
- digit span
- WORLD-DLROW
- Days of the week backwards
- recall of word lists
- recall of events
- clock drawing
- figure copying
- recognizing animals (on MoCA)
- letter fluency
digit span: attention
WORLD-DLROW: attention
Days of the week backwards: attention
recall of word lists: memory
recall of events: memory
clock drawing: praxis (visuomotor)
figure copying: praxis
recognizing animals (on MoCA): gnosis
letter fluency
What parts of the brain are involved in:
- episodic memory
- sematic memory (fact)
- non-declarative (implicit)
- short term (working)
episodic memory: hippocampus, parahipppocampal gyrus (mesial temporal lobe)
sematic memory (fact): inferolateral temporal lobes
non-declarative (implicit): basal ganglia, cerebellum, supplementary motor area
short term (working): PFC and more
Types of praxis:
- ideomotor: cannot do a specific task
- ideational: cannot do a sequence
- speech (somewhere between aphasia and dysarthria)
How would you get ideational apraxia?
bilateral temporal lobe damage
What are the domains of cognition?
attention
language
praxis
gnosis
visuospatial (visuoconstruction, visuoperception (agnosia), visuoorientation)
memory
executive function (planning, organizing, mental flexibility, response inhibition…)
What branch of the external carotid supplies the submandibular gland?
The facial
Internal capsule blood supply is mainly:
The striate and anterior choroidal arteries
What does the anterior choroidal supply?
The anterior choroidal artery supplies the inferior 2/3 of the internal capsule, the amygdala, hippocampus, and globus pallidus.
The anterior cerebral artery supplies the medial surface of the frontal and parietal lobes.
The posterior cerebral artery supplies posteromedial cortical areas and the thalamus.
