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What is aphasia?
a disorder of language, acquired secondary to brain damage
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What is dysphasia?
congenital language disorder
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What is speech?
articulation and phonation of language sounds
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What are 4 disorders that commonly affect content of speech?
- Schizophrenia
- Neologisms new words
- Word Salad cannot connect a patient's thoughts
- Loose associations ideas expressed are unrelated
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What is the purpose of Wernicke's area?
- for langague discrimination
- is located in the posterior part of the left superior temproal gyrus (brodmann area 22)
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What does Broca's area do?
- programs the neurons in adjacent motor cortex for larynx and mouth
- important for repetition and spontaneous speech
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In Right Handed people, where is the dominant hemisphere for speech?
the left hemisphere
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If you destroy the non-dominant hemisphere, you're likely to have many problems, what are soem of the speech problems you will have?
- speech is flat and unemotional
- loss of prosody or emotional intonation (robot sounding)
- loss of emotional comprehension
- stress and emphasis within sentences are affected
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What are the 8 steps to a bedside language examination?
- 1. observation of speech and comprehension during the clinical interview
- 2. follow-up examinations: good for stroke or tumor which could produce Wernicke's aphasia
- 3. Describe the patient's speech: fluent vs. non-fluent, rate, prosody, errors
- 4. Ask patient to name objects, object parts, pictures, colors *recall NIH Stroke pictures
- 5. Auditory comprehension
- 6. Repetitionof words and phrases "No ifs, ands, or buts" "methodist episcopal"
- 7. Reading
- 8. Writing
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What are the symptoms of Broca's Aphasia?
- Speech is Non-Fluent
- Omition of small grammatical words, but says principal words
- Naming is impaired
- Repetition is impaired
- Reading is often impaired
- comprehension is intact
- most patients will have a right hemiparesis and right hemisensory loss
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What is lesioned in Broca's Aphasia?
Broca's Area in posterior part of the inferior frontal gyrus (superior branch of MCA)
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What is the difference in onset between a large lesion and a small lesion in Broca's Aphasia?
- large lesion initially causes global aphasia will resolution in Broca's Aphasia
- small lesion initially causes Broca's Aphasia and resolves completely
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What would two findings of radiological origin be in Broca's Aphasia?
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What are the symptoms of Wernicke's Aphasia?
- Wernicke's Aphasia is a receptive/sensory aphasia
- Fluent speech
- speech is empty of meaning with neologisms and paraphasic errors
- naming is deficient
- auditory comprehension is deficient
- repetition is impaired
- no hemiparesis or sensory loss
- right (contralateral) partial or complete homonymous hemianopsia
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Where is the lesion in Wernicke's aphasia and what is the common cause?
- Brodmann's Area 22
- Inferior Division of the Left MCA
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What additional symptom will a patient suffer from in Wernicke's Aphasia if there is a disconnection from Broca's Area?
impaired repetition
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What is the breakdown of Aphasia?
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What are the common symptoms of Transcortical Motor Aphasia?
- impaired fluency
- normal comprehension
- normal repetition
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What is the common cause of transcortical motor aphasia?
- ACA-MCA watershed infact
- Also caused by subcortical lesions involving BG or thalamus in the dominant hemisphere
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What are the symptoms of Transcortical sensory aphasia?
- Fluent
- impaired comprehension
- intact repetition
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What are the symptoms of Mixed transcortical aphasia?
- impaired fluency
- impaired comprehension
- intact repetition
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What causes transcortical sensory aphasia?
- PCA-MCA watershed infactAlso caused by subcortical lesions involving
- BG or thalamus in the dominant hemisphere
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What is the cause of mixed transcortical aphasia?
- ACA-MCA and MCA-PCA watershed infact
- Also caused by subcortical lesions involving
- BG or thalamus in the dominant hemisphere
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Alexia without Agraphia
Cause
Symptoms
- PCA infaction of occipital lobe of dominant hemisphere (lesion of posterior copus callosum)
- Patient cannot read, but can write
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Gerstmann's Syndrome
Cause
Symptoms
- lesion of dominant inferior parietal lobule and region fo the angular gyrus
- agraphia, acalculia, right/left disorientation, finger agnosia (cannot name/identify fingers)
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What is Apraxia?
- the inability to preform an action, not due to weakness or ataxia
- some aphasia patients may have apraxia
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What are the 2 patterns seen in langauge with patients with dementia?
- Pattern 1: reading adn writinga are first to deteriorate, conversations become simple, muteness (cocktail chatter)
- Pattern 2: gradual progressive aphasia which gradually worsens
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What are the most common cause of aphasia?
- Vascular lesionss, ischemic stroke
- ALSO though, hemorrhagic stroke, tumors, neurodegenerative disorders, seizures (post-ictally as Todd's Phenomenon)
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When is the greatest recovery after a stroke for Aphasia?
3 months
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