Aphasia 2
Terms
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- Language promlems with Aphasia
-
-complex
-have diff. pathophysiologic impairment
-often evolve form 1 syndrome to another -
Concept stating that both hemispheres contribute in varying degreesdepending on the lang. function
-challenged by neroimaging studies - Cerebral dominance
- Handedness in relation to brain dominance
-
70% of time: Lhanded have L dominance
20-30%: lang. dominance is witched to the R side (strong family history)
*always ask about handed history -
-supported by clinicopathologocal correlations
-80% of Aphasia syndromes roughly conform to this scheme
-Theory rejects 1:1 correspondance between specific linguistic structural elements and focal segments of the brain - Localizationist-Connectionist model
- Fluent Ahpasia:
-
Weirnicke's
Transcortical sensory (TSA)
Conduction
Anomic - Non-fluent Aphasia:
-
Broca's
Transcortical motor (TMA)
Global -
-lrg. lesion in L lateral frontal, pre-rolandic suprasylvian region
-usually extends into pre-ventricular white matter deep to ____ area
-supplied by superior division of MCA - Broca's Aphasia
- Damage to Broca's area:
-
Non-sufficient or necesesary to get Broca's Aphasia
-lesion is not confined, shows damage to basal ganglia and insula
-only Broca's lesion leads to sounding like Apraxia and prosody prob. - Supplies traditional zone of language
- Middle Cerebral Atery (MCA)
-
-small anterior lesion
-may affect the supplemental motor cortex
-usually L frontal lobe anterior or superior to Broca's
-white matter underneath supplemental motor area
-seen w/ TBI
-Broca's area is spared
supplied by Anter -
*not seen often
Transcortical Sensory Aphasia -
-lrg lesion
-involves L fronto-parietal-temporal zone of lang. from Brocas to Weirnickes to angular gyrus to deep sunadjacnet white matter
-supplied by both divisions of MCA
-Affects Temporal, Frontal, Pareital - Global aphasia
- Milder version of Global
- Mixed Aphasia
-
-prod. by lesions in posterior third of superior temporal gyrus
-supplied by inferior division of the MCA - Weirnicke's Aphasia
- 2 variations of Weirnickes:
-
1. primarily temporal lesion- produces a word-deaf variant in which reading is preserved. Can't understand auditory info as easily as text
2. More posterior lesion- more difficulty w/ written text over isolated words (more parietal) -
-lesion in supramarginal gyrus and underlying white matter connecting Werinickes to Brocas
-alos by a combo lesion affecting L primary aud. cortex, insula and underlying white matter
-will be posterior - Conduction Aphasia
-
-lesion in Angular gyrus
-high functioning type of Aphasia
-some evolve to this typeduring recovery -
Anomic Aphasia
**All aphasias have a word-finding or anomic component - -involves basal ganglia, especially the head of the caudate nucleus and/or adjacent regions of the internal capsule
- Subcortical Aphasia
-
R and L carotids
R and L vertebral - Vascular supply to the cerebral hemispheres
-
runs in the anterior aspect of the neck
-divide into external and internal branches - Carotid arteries
- Internal carotid artery
- supplies much of forebrain and bifurcates into the anterior/middle cerebral arteries
- Anterior and middle cerebral arteries
- supplies the anterior and lateral surface of the cerebral hemisphere
-
-run to cranium through foramen magnum
-L and R unite to form basilar artery
-proceeds along pons and divides into posterior cerebral arteries
-imp. for brain stem, occipital area and inferior and medial aspects of the hemisphere - Vertebral arteries
- Fluency of patient
-
look at ability to retrieve words and phrase length:
9+ words-fluent
6-8 words- borderline
0-5 words- non-fluent
*avg. of 3 longest utternaces - Aud. comp. of patient
-
Ability to understand verbal speech:
-words-actions, body parts, colors
-commands
-yes/no quest.
-paragraph length - Repetition of patient
-
-single words
-phrases
-sent.
-function words vs. content - Broca's symptoms:
-
-anomia
-better comprehension than expression
-agrammatic: nouns only w/ no functor words
- some overlearned expressions
-spatial-temporal discoordination:can't get articulators tp proper area to create word - Transcortical Motor symptoms:
-
-impaired initiation of verbal output
-anomia
-short phrase length, frag. speech
-good aud. comp
-no artic. effort
-not as severe as Broca's - Global symtoms:
-
-profound dis. across lang. modalities
-want evolution - Weirnicke's symptoms:
-
-speech output better than aud. comp
-neurologic paraphasia: jargon
-sound errors
-wrong words
2 versions:
1. understand written words over aud. info
2. opposite - Transcortical symptoms:
-
-anomia
-poor aud. comp.
-use nondescript words i.e. thing
-frequ. semantic paraphrasic errors
-*good repitition skills (due to outside of lang. zone) - Conduction symptoms
-
-anomia
-repetition worse than spontaneous speech
-normal phrase length
tries to self-correct
-good aud. comp. - Anomic symtpoms:
- Really only word finding problems
- Subcortical aphasia types:
-
1.Thalamic lesion
2. Anterior Capsular/Putaminal or Basal Ganglia lesion
3. Posterior Basal Ganglia lesion - Subcortical Thalamus lesion symptoms:
-
-anomia
-variable phrase length
-good repetition
-low volume
-grammatically correct syntax
-word-finding prob. - Subcortical Anterior Capsular/Putaminal or Basal Ganglia lesion symptoms:
-
-anomia
-variable phrase length
-good aud. comp and repetition
-low volume
imprecise artic.
-phomenic and semantic errors - Subcortical posterior basal ganglia lesion symtpoms:
-
-variable phrase length
-poor aud. comp and repetition
-good artic.
-low volume
-paraphasias -
Forms by Anterior Comm. Artery (AcomA)
-links 2 AcomA - Circle of Willis
- Ability of collateral arteries to take over and supply an adequate blood supply to the affected area
- Collateral Circulation
-
-largely supplied by the MCA
-if lesion is outside of this area the patient can repeat - Zone of language
-
Excision within the artery
-excise the carotid artery and remove clots from obstructing the artery and flow to the brain - Endarterectomy
-
-Computerized axial tomography
-PET
-Static/functional - Neuroimaging
- complete or partial artery occlusion. Cells begin to die and infarct devlops with necrosis and loss of tissue bulk
- Ischemic
-
-most common ischemic stroke
-arteriosclerosis: proliferation of smooth muscle calles of arterial wall and expansion and deposition of lipid w/in associated connected tissue
-narrowing of an artery - Thrombosis
-
-narrowing of an artery
->70%= change in distal blood flow andincreased risk of stroke - Stenosis
- Breaking off of a clot into the bloodtream which can occlude a distal artery for an reason
- Embolism
-
Rupture of blood vessel w/in intercranium
-occurs in:
1. brain
2. subaracnoid
3. subdural space - Hemmorrhagic stroke
- Brief focal cerebral event where symptoms develop rapidly and last < 24hrs.
- Transient Ischemic Attack(TIA)
- Every language act involves networks of neurons widely distributed in brain functioning in series and parallel
- Accepted classical theory
- Confrontational naming tests:
-
word length
semantic classification
frequency of occurance
phonation complexity
emotional valence
*Boston naming test - Discourse testing
- descriptive:naming about... procedural: Tell me about...
- Generative naming testing
-
word fluency
ability to subclassify
use of working memory
i.e. name animlas or things beginning with "a" - Fluency testing
-
-reponse to open-ended ?s
-desciption of a pictured scene
-repsonse to emotional or historic event - Aud. comp testing
-
*ability to understand verbal speech
-words: actions,objects, body parts, colors
-commands: single and multi-step
-yes/no quest
-paragraph level material - repetition testing
-
-single words
-phrases
-sentences
-word frequ, length, phonological complexity, semantic category, etc.
-functor vs. content words -
-bleeding that originates in subcortical grey matter (thalamus or putamen)
-usually massive rupturing into ventricular system and affects conciousness
-survivors result in dense hemiplegia and subcortical aphasia - Intercerbral hemmorhage from CVA
-
-less than 2 cm. in area from occulsion of small artery due to changes in these arteries caused by increased blood pressure
-often bilateral and deep in frontal lobe, periventricular white or subcortical grey matter
-symptom of Aphasia -
Lacunar Infarct
*may not be bad enought to go to hospital - heart attacks and stroke
- 25% of CVA patients with artherscleriosis have had previous heart attacks
- Diabetes and stroke patients
- diabetes exacerbates clogging of arteries (artherscl.)
- Insult to the brain, not of the degenerative or congenitial nature, but caused by an external force, that may produce a diminished pr altered state of conciousness
- TBI
-
Twisting or shearing of axons due to the twisting of the brain
-non-penetrating - Diffuse Axonal Injury
- Brain hit on impact and then boucong backwards and hit on the opposite side as well
- "coup" and "contracoup"