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Lecture Notes for Aphasia test 1
grojo lecture
145
Medical
Graduate
09/23/2012

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Term
What are the three leading cause of death in the US
Definition
1. Heart disease 2. Cancer 3. Stroke
Term
How many people will experience a stroke each year? of those how many will also have aphasia?
Definition
250,000-500,000 people, 80,000 people
Term
risk factors for a stroke
Definition
SPAM FOH BD...
Smoking, previous history, african american, male, family history, obesity, heart disease, birth control pills, diabetes
Term
transverse
Definition
horizontal
Term
superifical is to deep as dorsal is to...
Definition
ventral
Term
true or false ...cranial and rostral have similar meanings
Definition
true, towards the head
Term
opposite of medial is...
Definition
distal
Term
another word for coronal
Definition
frontal
Term
very deep sulcus is called
Definition
fissure
Term
the four lobes are
Definition
frontal, parietal, occipital, temporal
Term
the secondary lobe of the brain is called
Definition
the insula
Term
what does the primary motor strip do?
Definition
voluntary control of the skeletal mm on the contralateral side
Term
the inferior boundary of the frontal lobe is
Definition
the lateral sulcus or the sylvian fissure
Term
where is the primary motor strip located?
Definition
the precentral gyrus
Term
what brodmann's area is the primary motor strip?
Definition
4
Term
what does the premotor area do?
Definition
planning and initiating, sequential movements
Term
what brodmann's area is the premotor area?
Definition
6
Term
what does broca's area do?
Definition
initiating and sequencing of motor movements for speech
Term
where is broca's area?
Definition
inferior portion of premotor strip, anterior to the primary motor strip
only found in the left frontal lobe (left hemisphere)
Term
what brodmann's areas are broca's area?
Definition
44,45
Term
name three functions of the frontal lobe
Definition
planning, sequencing, volitional movements
Term
names functions anterior to premotor areas
Definition
regulating activity level, formulating plans, attention, initiating, patterns of behavior, self regulation, executive functioning
Term
brodmann's areas for primary motor strip
Definition
1,2,3
Term
the post central gyrus...
Definition
receives sensations of touch and pressure
Term
pain and temperature are noted where?
Definition
deep in the cortex
Term
brodmann's area for supramarginal gyrus
Definition
40
Term
Name four functions of the parietal lobe
Definition
perception, integration and mediating touch, body awareness and visuospatial information
Term
_____ and ______ are interpreted on the parietal lobe on the postcentral gyrus
Definition
touch, pressure
Term
stroke to parietal...
Definition
disturbance in body and space trouble walking, attention to location
Term
tactile agnosia
Definition
inability to recognize an object by touch
Term
this lobe makes up 1/3 of each hemisphere
Definition
temporal lobe
Term
this area attaches meaning to whatever we say
Definition
wernicke's area
Term
this lobe and hemisphere deal with non verbal visual information and nonverbal sound
Definition
right temporal lobe
Term
the primary visual cortex in each hemisphere receives information _____ and ______
Definition
ipsilaterally and contralaterally
Term
the occipital lobe...
Definition
interprets visual sensory information
Term
visual disturbance at the optic chiasm ...
Definition
tunnel vision
Term
the insula seems to be involved with...
Definition
social and emotional jobs, understanding and explaining guilt, empathy
Term
association cortex
Definition
interprets, applies meaning, helps process information, makes up most of the hemisphere
Term
damage to association, spare primary areas you will have...
Definition
agnosia
Term
agnosia
Definition
interpreting sensory information in a particular modality (auditory, visual, tactile)
Term
which agnosia happens mostly with reading?
Definition
visual agnosia
Term
what are larger groups of fibers or bundle of fibers called?
Definition
fasiculus
Term
arcuate fasiculus
Definition
begins in the posterior superior temporal lobe, includes wernicke's area,travels anteriorly and arcs around the lateral sulcus and ends up in Broca's area or motor association cortex
Term
what happens when blood supply is denied to the arcuate fasiculus?
Definition
1. cannot repeat (extremely difficult)
2. paraphasic errors (make multiple paraphasic errors and don't realize it)
Term
what do we call areas of higher function?
Definition
tertiary areas
Term
what do the prefrontal tertiary areas do?
Definition
personality, expression of emotion, drive ability to inhibit, set goals, solve problems, plan (not fully developed until early 20s)
Term
what do the tertiary areas in the lower and medial portions of the temporal lobe deal with?
Definition
episodic memory,
Term
temporal-parietal-occipital tertiary areas are for?
Definition
integrating auditory, visual and tactile information...reading writing
Term
what brodmann's areas are in the temporal-parietal-occipital tertiary areas?
Definition
39, 40
Term
projection fibers
Definition
connect cortex with lower levels
Term
hemisphere connection fibers are called
Definition
commisural fiber
Term
our brain requires what percentage of oxygen to perform at its best?
Definition
25%
Term
the brain receives all of its blood from two sets of paired arteries...
Definition
vertebral arteries and internal carotid arteries
Term
what provides blood to your face?
Definition
external carotid artery
Term
what does the common carotid branch into?
Definition
internal carotid and external carotid
Term
what happens when blood supply is denied to the arcuate fasiculus?
Definition
1. cannot repeat (extremely difficult)
2. paraphasic errors (make multiple paraphasic errors and don't realize it)
Term
what do we call areas of higher function?
Definition
tertiary areas
Term
what do the prefrontal tertiary areas do?
Definition
personality, expression of emotion, drive ability to inhibit, set goals, solve problems, plan (not fully developed until early 20s)
Term
what do the tertiary areas in the lower and medial portions of the temporal lobe deal with?
Definition
episodic memory,
Term
temporal-parietal-occipital tertiary areas are for?
Definition
integrating auditory, visual and tactile information...reading writing
Term
what brodmann's areas are in the temporal-parietal-occipital tertiary areas?
Definition
39, 40
Term
projection fibers
Definition
connect cortex with lower levels
Term
hemisphere connection fibers are called
Definition
commisural fiber
Term
our brain requires what percentage of oxygen to perform at its best?
Definition
25%
Term
the brain receives all of its blood from two sets of paired arteries...
Definition
vertebral arteries and internal carotid arteries
Term
what provides blood to your face?
Definition
external carotid artery
Term
what does the common carotid branch into?
Definition
internal carotid and external carotid
Term
the _____ effectively combines the two main arteries that supply blood to brain. It's second job to act as safety valve
Definition
circle of willis
Term
I'm looking for three terms...they all mean the same thing.... the first word is not medical, term most commonly used or a general term that refers to the sudden onset of prominent and usually persistent neurological deficit, one is not identifying the nature or the cause of the impairment, one is the most current term used to bring awareness
Definition
stroke, cerebral vascular accident, brain attack
Term
Main warning signs of stroke
Definition
FAST,One side of face numb, one side of face facial droop, arm starts to droop on one side, can't say words (slurred), DON'T WASTE TIME!
Term
two types of stroke
Definition
ischemic and hemorrhagic
Term
which type of stroke is the most common?
Definition
ischemic
Term
__________% is caused by ischemic stroke
Definition
75-80%
Term
ischemic stroke
Definition
sudden loss of blood flow resulting in loss of blood to the brain
Term
necrosis
Definition
cell death
Term
If an ischemic stroke occurs in watershed areas or person has a well functioning circle of willis ...
Definition
there might be enough collateral blood flow to reduce the ischemia (may be able to function to almost full capacity) can minimize ischemia and may even prevent cell death
Term
what is an evolving or progressive stroke?
Definition
what some ppl call a stroke that continues for several hours
Term
what happens 3 to 5 days post stroke?
Definition
the brain is swelling, edema, swelling in tissues, reaches maximal swelling point (the brain is reacting to traumatic events)
Term
At the of the first week post stroke...
Definition
swelling and edema start to diminish
Term
By 12-21 days post stroke...
Definition
brain will reabsorb or get rid of the dead tissue. What will be left is a cavity (cavity size depends on teh amount of tissue that died) cavity will be filled with fluid
Term
What are the two types of ischemic stroke?
Definition
Thrombosis, emboli
Term
thrombosis
Definition
build up of lipids and complex carbohydrates that eventually result in stenosis of an artery.
Term
If narrowing of an artery (thrombosis) reaches a critical level (blocked greater than____) we will see...
Definition
70%, changes in the distal blood flow
Term
In an ischemic stroke damage is caused by ...
Definition
lack of blood flow
Term
___% of strokes result from bleeding from an artery in the intercranial space (___________ stroke)
Definition
16%, hemorrhagic
Term
which type of stroke leads to more death?
Definition
hemorrhagic
Term
what are the three main causes of hemorrhagic stroke?
Definition
1. rupture of a blood vessel which causes a hematoma
2. rupture of a aneurysm (ballooning or bulging of artery wall because it is weak of a weakened blood vessel)
3. (not very common) Alteriovenous malformation)...congenital...veins grow together and twist together, have a tendency to bleed, (very challenging medical condition to stop bleeding and still allow adequate blood flow to the area)
Term
What are three areas hemorrhagic strokes tend to occur?
Definition
1. parenchyma (deep in our cortex , 60% occur in our basal ganglia)
2. subarachnoid space ( almost always because of an aneurysm...in brain aneurysms are always at the base of the brain on the vertebral arteries)
3. subdural space (damage:caused by increased pressure to the area of the brain where the blood is flowing, if you can stop bleeding and reduce pressure function will return)
Term
_____% mortality rates for hemorrhagic strokes
Definition
80-90%
Term
if you survive a hemorrhagic stroke it is _____ and ______ to return to function than an ischemic stroke
Definition
quicker and easier
Term
transient ischemic attack/accident
Definition
ministroke, transient symptoms of a stroke, greater chance of having a stroke, brief cerebral event, develop quickly ...2 min-24 hours
Term
What are the symptoms of a TIA?
Definition
motor dysfunction (lack or weakness of limbs, one or more extremities could be paralyzed temporarily), numbness or tingling in face and extremities, gait or posture abnormalities (can't sit up straight in a chair, can't get up and walk...feel stuck), double vision, dysarthric briefly, dysphagic briefly, dizziness (with another symptom, slurred speech, inability to understand what ppl are saying, possible visual disturbance, facial drooping
Term
Primary Progressive Aphasia (PPA)
Definition
aphasia, but not sudden onset, don't have other physical symptoms, unique progressively deterioration of language functioning ...do not expect improvement
Term
why do we stroke?
Definition
blood vessels in our brain are more frail than the rest of our body and react quicker and stronger than the rest of our body does, easier for blood vessels in our blood to rupture (thinner walls)
Term
what are the primary characteristics and focal signs of stroke
Definition
paralysis of one side of the body, speech production problems, speech comprehension problems, memory loss, confusion, sensory impairment
Term
Definition
onset is usually sudden and abrupt, intensity may come and go but because worse within a few hours or actual onset, headache is common but not universal, stupor or coma can be present only in the early phases, vomiting and convulsions may occur
Term
what are the three structural or static imaging techniques
Definition
cerebral angiography, Computer tomography (ct), magnetic resonance imaging (mri),
Term
which imaging technique involves an injection of radiopaque material in an extracranial artery to obtain xray images of the cerebral vascular system
Definition
cerebral angiography
Term
what are the strengths of cerebral angiography?
Definition
strengths: identify structural abnormality in intracranial blood vessels (stenosis or occlusion, aneurysm, AVM)
2. used to confirm brain death
Term
what are the weaknesses of cerebral angiography?
Definition
invasive with risks of dislodging arterial plaque, producing emboli
Term
which imaging technique takes pics of structures (in small slices of your brain), shows a point in time, almost always what stroke pts receive...
Definition
computer tomography
Term
on computer tomography whitish areas are ______ and darker areas are ....cerebral infarcts will be...
Definition
blood and bone (high density tissue), ventricles (lower density areas), dark because it's a cavity
Term
what are the strengths of computer tomography?
Definition
most widespread and economical of imaging techniques, helps identify where a person had a stroke
Term
what are the weaknesses of computer tomography?
Definition
invasive (xray), doesn't allow immediadte visualization of thrombotic and embolic infarctions, may fail to identify lacunae or tiny lesions
Term
which imaging technique will be used for ppl suspected of tumors, hemorrhages, and TBI?
Definition
Magnetic Resonance Imaging (MRI)
Term
with magnetic resonance imaging blood and bones are ____ and the cerebrum has more water in it than bone so it will appear ______
Definition
white, darker
Term
what are the strengths of magnetic resonance imaging?
Definition
good visualization for gray vs. white matter and small lesions and quicker identification of infarct and edema, visualize damage related to demyelinating disease, tumors, infections, degenerative disease
Term
what are the weaknesses of magnetic resonance imaging?
Definition
can't be used with pts who have pacemakers or other metallic implants or prostheses because of strong magnetic forces, long scanning time, not good for ppl with movment disorders
Term
what are the three types of functional/dynamic imaging techniques?
Definition
Positron emission tomography (PET), single phonton emission tomography (SPECT), functional magnetic resonance imaging (fMRI)
Term
which imaging technique involves injection of radioisotopes into extracranial artery to visualize changes in regional cerebral blood flow, glucose metabolism, or neurotransmitter levels, not common for ppl with aphasia
Definition
PET
Term
what are the strengths of PET?
Definition
look at brain's ability to utilize glucose for feeding nerve tissue, look at blood flow in brain and what's actually functioning within the brain, impaired functioning?
Term
what are the weaknesses of PET?
Definition
expensive, invasive because of exposure to radioacctive material
Term
what are the weaknesses of spet?
Definition
less precides than pet in terms of spatial resolution and ID their etiology of CBF changes (e.g., tumor vs. stroke)
Term
what are the strengths of spet?
Definition
allows visualization of changes in cerebral blood flow
Term
what are the strengths of fmris?
Definition
able to show more structure compared to PET (can se ventricles and have a sense of position and shape of the cerebrum), analyzes blood flow, looks at highly oxygenated blood vs. less oxygenated blood (look at color and intensity of blood), can look at areas of brain that aren't getting enough oxygenated blood so you can pinpoint area of hemorrhage of thrombosis
Term
The corticospinal tract travels from the _________to spinal nerves (then travels through the______ ______, courses down through the brain and decussates (crosses over) at the level of the ______, connects with ____ on the ________ side of the body (________ which travel out to _____ and ____)
Definition
precentral, internal capsule, medulla, LMN, contralateral
Term
corticobulbar tract travels from the precentral to _____ ______, through the ________, courses down the brain and connects with the _____ of the _____ at the level of the brainstem
Definition
cranial nerves, internal capsule, LMN, cranial nerves,
Term
a stroke/lesion involving corticospinal fibers of a hemisphere above the medulla produces...
Definition
weakness or paralysis on contralateral arm and leg
Term
a stroke/lesion below the medulla produces...
Definition
weakness of paralysis on the ipsilateral arm and leg
Term
A stroke in the L corticobulbar tract would result in ...
Definition
r facial weakness (below forehead...eyelids and lips), deviation of tongue to the r
Term
its unusual to have an injury to only one tract b/c ...
Definition
they are so close to each other
Term
If there's a lesion the L hemisphere above the brainstem to both tracts, physical symptoms would be
Definition
contralateral paralysis or weakness, contralateral face droop/paresis or paralysis, upon protrusion tongue deviates to weak side
Term
Apraxia
Definition
motor speech disorder/impairment in the motor programming of volitional speech movements/loss of voluntary control of speech production (can't sequence syllables in correct order or coordinate movements for speech sound production; omissions
Term
dysarthria
Definition
motor speech disorder/impairment in the execution of speech movment due to mm weakness, slowness or dyscoordination (strained, decreased volume, breathy or dyscoordination)
Term
primary progressive aphasia
Definition
aphasia characterized by deteriorating performance in language abilities, gradual onset, and lack of acute neurological injury
Term
aphasia
Definition
a language impairment resulting from a stroke. It is characterized by impairment in all language modalities including: speaking,reading, writing, and listening although not necessarily to the same extent in each. May be acccompanied by impairment
Term
verbal paraphasic error
Definition
Term
ischemia
Definition
lack of oxygen to region of brain due to reduced blood flow
Term
necrosis
Definition
cell death due to lack of oxygen in the brain
Term
infarct
Definition
areas of dead cells where tissue breaks down and is reabsorbed in the brain and leaves a cavity
Term
hematoma
Definition
a mass of blood or swelling caused by a break in an blood vessel
Term
hemorrhagic
Definition
bleeding of circulatory system
Term
stenosis
Definition
narrowing
Term
edema
Definition
excessive fluid in body tissues
Term
lesion
Definition
umbrella term for an abnormal change in structure due to injury or disease
Term
parenchyma
Definition
essential part of organ which is concerned with its function
Term
atrophy
Definition
shrinking
Term
arteriosclerosis
Definition
thickening and hardening and loss of elasticity to the arterial walls
Term
atherosclerosis
Definition
a buildup of fat, calcium deposits, carbohydrates, blood on arterial wall
Term
ischemic stroek
Definition
interruption of blood flow due to thrombosis or emboli
Term
hemorrhagic stroke
Definition
bleeding the brain
Term
thrombosis
Definition
buildup of fat, ect. resulting in stenosis and occlusion of artery
Term
embolus
Definition
thrombosis breaks away and travels to a distant part of the artery
Term
tia
Definition
transient ischemic attack
Term
ppa
Definition
primary progressive aphasia...
deteriorating lang impairment with gradual onset, not due to a stroke
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