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What is the point of solving neurological problems?
want to know where the vertical information transects the horizontal info
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What is the vertical info?
coming from some area in Sc and terminating in pre-central gyrus
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Name the vertical information:
- spinothalamic tract (spinal lemniscus)
- dorsal column (fasciculus gracilis and fasciculus cuneatus) --medial lemniscus
- spinocerebellar tract
- corticospinal tract
- corticobulbar tract
- trigeminal lemniscus
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What is horizontal info?
always there and doesn't move
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Name the horizontal info:
- all CN and their pathways
- motor and sensory CN nuclei
- specific parts of brain: basal ganglia, cerebellum, internal capsule, hypothalamus, thalamus, crus cerebri, etc
- spinal nn and ventral horns of SC
- absence of reflexes
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Why is horizontal info better?
b/c it locks into which part of cortex is not working
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Where is the lesion?
where the vertical and horizontal info cross
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Pt lost proprioception from L side of body and experienced adduction of R eye, where is the lesion?
- uses Dorsal column pathway so lesion is in:
- R Pons
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Pt lost pain and temp from L side of body and experienced flaccid paralysis of facial mm on R side, where is the lesion?
- uses spinothalamic and CN VII (motor nuclei in pons)
- Therefore, lesion is in R Pons
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What are the different types of aphasia?
- Broca's
- Wernicke's
- Conduction
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What does the motor speech cortex allow?
initiation of speech y influencing portions of precentral gyrus that control skeletal m for speech (larynx, pharynx, tongue, face, and mouth)
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Where is the Broca's area?
located around inferior frontal gyrus in frontal lobe
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What is the Broca's area?
- primary cortex for motor speech
- technically association area of frontal lobe that finesses pre-central gyrus
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Broca's area = Broadmann's areas:
44 and 45
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What does damage to the Broca's area cause?
Broca's aphasia (often done in a stroke)
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Aphasia:
general term for language disorders to include reading, writing, speaking, or comprehension of written and spoken words, generally due to cerebral cortex or conduction dysfunction
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Broca's aphasia (motor aphasia, non-fluent aphasia):
- caused by damage to Broca's area
- generally in stroke of middle cerebral A
- pt con't or has difficulty forming words even though vocal cords and innervations are normal "cerebral cortex dysfunciton"
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What are the symptoms of Broca's aphasia?
speech is slow and elaborate, deliberate; pt must concentrate
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Does Broca's aphasia apply to speech or writing?
both
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How is a pt with Broca's aphasia compromised?
verbally and graphically
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90% of humans are dominant in which hemisphere?
left
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90% of humans have the Broca's area strongest in which hemisphere?
left
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Pt presenting w/ stroke and affect R-side will have severe damage to:
Broca's area (L hemisphere)
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Why is Broca's aphasia considered non-fluent?
words do not flow, despite ability to perceive language and organize thought processes
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Are pts aware that they can't get words out?
yes, and they get very frustrated
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What problems often accompany Broca's aphasia?
hemianopsia and paralysis of facial mm on R
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Hemianopsia:
loss of half a visual field
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What 3 symptoms usually appear together concerning Broca's area?
- Broca's aphasia
- hemianopsia
- paralysis of facial mm on R
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Why do Broca's aphasia, hemianopsia and paralysis of facial mm on R often appear together?
b/c optic pathway nad internal capsule are close to Broca's area
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What is the language cortex called?
Wernicke's area
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Where is the Wernicke's area?
90% in posterior part of superior temporal gyrus
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What does the Wernicke's area control?
comprehension of spoken words and written and auditory language
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Where is the other 10% of the Wernicke's area located?
extends into parietal lobe (still considered a function of temporal lobe)
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Which hemisphere is more dominant considering the Wernicke's area?
L hemisphere in 90% of population (same as Broca's area)
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Wernicke's aphasia (fluent aphasia, receptive aphasia):
involved w/ comprehension of spoken and written language
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What happens with Wernicke's aphasia?
able to speak and write words but the sequence is not normal, so they don't make sense
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Are pts aware that they don't make sense?
yes and they become frustrated
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How is a pt compromised with Wernicke's aphasia?
linguistically
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How is a pt compromised with Wernicke's aphasia if it is a large lesion?
visual and linguistic ability compromised
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Wernicke's area must be able to receive input from where?
other areas of brain
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What happens when the Wernicke's area doesn't receive visual or auditory info properly?
Wernicke's aphasia
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Empty speech:
- part of Wernicke's aphasia
- speaking but it doesn't make sense
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What are sub-types of empty speech?
- paraphasia
- neologisms
- jargon aphasia
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paraphasia:
substitute one word for another
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neologism:
- create new and meaningless words and put them into sentences
- (that have nothing to do with the sentence)
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jargon aphasia:
- words and phrases are strung together w/ no meaning
- speech is incomprehensible but seems logical to pt
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Which artery feeds the Broca's and Wernicke's areas?
middle cerebral A
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Conduction aphasia:
occurs when something impairs the conduction from Wernicke's (language comprehension) to Broca's (speech formation)
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With conduction aphasia, what exactly is damaged?
arcuate fasciculus (efferent connection from Wernicke's to Broca's areas)
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What are the characteristics of conduction aphasia?
- less fluent in language than pts w/ Wernicke's aphasia
- may make paraphasic errors (substitution of 1 word for another)
- comprehension is good, ability to repeat is limited/poor
- naming is impaired
- reading aloud is impaired, but pt can read silently w/ good comprehension
- writing (Broca's) is abnormal w/ misspelled and omitted words
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Global aphasia:
- most severe form of aphasia
- inability to use language in any form due to extensive damage to Broca's, Wernicke's, and arcuate fasciculus
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How is a pt compromised with global aphasia?
linguistically and verbally (unable to read/write well, unable to comprehend speech, unable to produce intelligible speech
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Which hemisphere does global aphasia generally occur in?
Left
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Is global aphasia a common presentation?
no b/c a stroke this catastrophic has low survival rates
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apraxia:
impairment of voluntary skeletal m activity which is not due to lack of comprehension, innervation, or mm physiology (something wrong w/ specific part of cortex...that means it is horizontal issues)
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Agnosia:
impairment of ability to recognize, or comprehend the meaning of sensory stimuli due to lesions of the cerebrum
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R and L sided neglect are due to damage in which lobe?
parietal lobe
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Primary functional areas of cerebral cortex:
- REVIEW THESE ON OWN
- look to previous notes...
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Homonymous Hemianaopia:
- caused by strokes
- loss of visual fields affect similar location for 2 eyes (homonymous)
- hemianopsia: loss of visual fields in each is is 1/2
- L homonymous hemi=loss of L half of visual field in both eyes
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