Chapter 1-3

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Chapter 1-3
2014-03-04 19:15:13
SP14 200

Spring 2014
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  1. Aphasia
    A language disorder.
  2. Aphonia
    A voice disorder - lack of voice, individual can not phonate but can whisper. 

    Was used to describe symptoms of aphasia in earlier times.
  3. Agraphia/Alexia
    Writing problems associated with recent brain injury.
  4. Brain Hemispheres
    Left Hemisphere - language.

    Right Hemisphere - reasoning.
  5. Phrenology
    A pseudoscience that correlated mental and intellectual skills with the shape and size of a person's skull.
  6. Paul Broca - Aphemia
    French Neurosurgeon - was first to offer clinical and pathological evidence relating the frontal lobe and left brain to language production.  He introduced that lesions in the lower posterior portion of the left frontal lobe lead to language disorders (Aphemia-Broca's term to describe language disorders with brain lesions).
  7. Broca's area
    The left lower and posterior portion of the frontal lobe on the inferior frontal gyrus, at the juncture of the lateral and central fissures - this area is responsible for speech production (motor speech function).
  8. Broca's Aphasia
    Associated with Dysarthria in the geriatric population.  Subjects exhibit reduced speech fluency, agrammatic, telegraphic speech, many language production errors, but have only limited impairment of comprehension of spoken language. 

    Meaningful language and better auditory comprehension than those affected by Wernicke's Aphasia.

    Poor speech.
  9. Carl Wernicke
    A German Nueropsychiatrist who introduced that the posterior 2/3 of the superior temporal gyrus in the left, or dominant hemisphere is concerned with comprehension and formulation of speech.  Wernicke was the first to describe a type of aphasia that in many ways contrasted the symptoms of aphasia that Broca described.  A different kind of aphasia is caused by lesion in the posterior portion of the left superior temporal gyrus (now Wernicke's area).
  10. Wernicke's Aphasia
    • Subjects affected with Wernicke's Aphasia present fluent but meaningless speech which is grammatically correct but have severe problems understanding spoken language and difficulties comprehending material read silently or orally.

    • Poor auditory comprehension and poor language.
  11. Localizationist
    A person who views that particular behavioral functions are strictly controlled by specific structures within the brain (Broca and Wernicke).
  12. Associationist
    Most localizationists are associationists.  According to associationists patients who are pahsic have intact intellect but have lost the typical association between words and verbal concepts to the actual objects and events.
  13. Pierre Marie
    A Frenchman and early opponent of Broca's.  He argued against localizaion of brain function.  Believed patients with aphasia were affected with auditory comprehension and intellect deficits.
  14. Holistic Approach
    Advocates that the brain functions as an integrated unit and that a lesion in one area affects functions of most, if not all , areas.  It denies the existence of specific anatomic structures that control equally specific language functions.  So they believe that all aspects of language are disturbed in patients with aphasia.
  15. Cognition
    Intellectual functions:  knowledge, memory and the resumed modes of information processing in the brain.

    Because speech is a part of thought, aphasic patients with disturbed speech and language are also disturbed in thought processes.
  16. Brain - 4 primary lobes
    Primarily responsible for:

    Hypothesis about brain is that language is in the hemisphere on the opposite side of the preferred/dominant hand.  However, language can be stored in both hemispheres.

    Frontal lobe (anterior/front) - most important for speech and language (Broca's area)

    Parietal lobe (superior/top) - important for perception and sensory.

    Occipital lobe (posterior/back) - important for vision = is the smallest lobe.

    Temporal lobe (inferior/lower) - important for language comprehension (Wernicke's area).
  17. Aphasia -

    Chain of events leading to Aphasia
  18. Edema
    Swelling of the brain, pressure needs to be released to avoid necrosis of brain tissue.
  19. TIAs - Transient Ischemic Attacks
    Mini-strokes which last a few seconds, patient recovers but should consider the mini stroke as a warning sign to change lifestyle.
  20. Stroke
    A syndrome with acute onset resulting in focal brain damage caused by distrubed cerebral blood circulation (lack of oxygen).

    Third highest cause of death in the USA.
  21. Stroke Symptoms
    • Severe headache
    • Altered consciousness
    • Impaired speech and/or comprehension
    • Impaired vision
    • Dizziness, sudden falls, inability to stand or walk
    • Paresis (weakness) or paralysis (loss of muscle function)
    • Impaired sensation
    • Vomiting
    • Seizures
    • Coma
  22. Types of Strokes
    Ischemic - occlusion
    Hemorrhagic - rupture
    Ischemic:  most common, caused by vascular disorders that block or interrupt blood flow to a region of the brain (clogged artery) which results in tissue death.  Blood supply is interrupted by Thrombosis or Embolism.  (TIA/RIND) Patient has higher chance of recovery.

    Hemorrhagic:  second most common type which results from a ruptured vessel, causes cerebral bleeding. Causes of ruptures:  weakened arterial walls, malformations of the blood vessels, high and fluctuating blood pressure.
  23. Embolism
    Debree which blocks a small artery.
  24. Embolus
    A travelling mass that may have been formed further away from place where it originated (a part of a mass which has broken off).
  25. Thrombosis
    A blood clot formed by artheriosclerosis.
  26. Anneurism
    A balloon-like swelling of a weak artery that causes it to rupture (garden hose).

    Can cause a hemorrhagic stroke.
  27. Brain Trauma
    Auto accidents. gunshot wounds, blow to the head.
  28. Tumor
    A space occupying lesions that cause swelling, increasing pressure.  If the pressure is not released it causes necrosis - tissue death.
  29. Metastasis
    A spreading of cells throughout the body.
  30. Tumor Grading
    I - IV (I - slow, IV - aggressive)
  31. Infection (Bacterial vs Viral)
    Bacterial - bacterial meningities, meninges and cerebrospinal fluid are infected.  Symptoms include fever, headaches, lethargy, drowsiness, coma may follow.  Fatal if not treated with antibiotics.

    Viral-rabies, AIDS, mumps, measles, syphilis, herpes simplex, encephalitis (high mortality).
  32. Brain Abscess
    Inflamed and has pus, bacterial, fungi, parasites migrate into the brain.  Treated with surgical drainage and antibiotics.
  33. Cerebral Toxemia
    poisonous/toxic factors into the brain (drug overdose, drug interactions, heavy metal poisoning, such as lead and mercury).

    Cocaine, crack, amphetamines, heroin create a risk for stroke, especially in individuals younger than 35.
  34. Epilepsy
    Seizure disorder.
  35. Progressive neurological diseases
    Diseases associated with aging, ex: Dementia.
  36. Causes of Aphasia
    • TIAs - mini strokes
    • CVAs (Ischemic, Hemorrhagic)
    • Brain Trauma - accidents, gunshot wounds blow to head
    • Tumors
    • Infections of the brain - bacterial, viral
    • Toxemia
    • Epilepsy
    • Progressive neurological disorders - related to aging
  37. Anatomic Orientation
    • Superior - top
    • Inferior - bottom
    • Lateral - side
    • Anterior - front
    • Posterior - back
  38. Neuron
    Also referred to as nerve cells.  Neurons are the basic building blocks of the nervous system.  

    Neuron receives information from other neurons through its dendrites, processes the information in its cell body, and transmits the information through its axon to other neurons.

    ⇧damage = ⇩neurons
  39. Dendrite - receive info - Afferent
    Short fibers extending from a cell body (tree/Greek).
  40. Axon - send/transmit - Efferent
    A long nerve fiber (string of sausages) which makes contact/communicates with another via neural impulse to send information away from the body.

    Injured Axons of CNS do not regenerate to the extent that function is recovered. With severe brain injury, cognitive functions may not fully recover.
  41. Nerves
    Bundles of axons and dendrites are called nerves.

    Motor nerves - Efferent nerves - transmit impulses from the brain to the muscle (OUT) which cause muscle contraction/ movement.  Ex. It's hot = take off coat.

    Sensory nerves - Afferent nerves (carry info about body's internal and external environment toward the center - IN) carry sensory impulses from the organs toward the brain.

    Mixed nerves - sensory + motor nerves.
  42. Nervous System
    PNS - all cranial and spinal nerves that connect the brain to the spine and other structures.

    Cranial nerves (12) - cranium - they emerge from the brain and innervate the larynx, tongue, pharynx and muscles of the face, neck and head.  The Cranial nerves are important for phonation, voice, and speech.  Not important in language comprehension, but in speech production.

    CNS - nerves of the spinal cord and the brain.  The brain is most important organ for language, comprehension, formulation and expression.
  43. PNS - 12 Cranial Nerves

    On Old Olympus Towering Tops A Fat Ass German Viewed Aging Hops
    • I - Olfactory-Smell                      Sensory
    • II - Optic-Vision                            Motor
    • III - Oculomotor-eye movement   Motor
    • IV - Trochlear-eye movement       Motor
    • V - Trigeminal-                             Mixed
    •      face                                       Sensory
    •      jaw                                         Motor
    • VI - Abducens-eye movement      Motor
    • VII - Facial-                                  Mixed
    •      tongue                                  Sensory
    •      face                                        Motor
    • VIII-Vestibular/Acoustic              Sensory
    •      hearing & balance
    • IX - Glossopharyngeal                 Mixed
    •      tongue & pharynx                 Sensory
    •      pharynx only                         Motor 
    • X-Vagus-very important nerve    Mixed
    •      larynx, resp, cardiac & GI sys
    • XI-Accessory - shoulder, arm       Motor
    •      & throat movement
    • XII-Hypoglossal                          Motor
    •      Mostly tongue movements
  44. Cerebral Blood Supply
    A person loses consciousness within 10 seconds of blood interruption to the brain.

    Electrical activity of the brain ceases after 20 seconds of blood interruption.

    The brain will be permanently damaged within 4-6 minutes of interruption of blood supply.

    Middle cerebral artery supplies blood to the areas concerned with sensory and motor functions, speech and language and hearing functions (Broca's and Wernicke's). Damage to the middle cerebral artery is a frequent cause of stroke and aphasia.
  45. Cognitivism
    The belief that aphasia impairs cognition, those affected with aphasia do not have purposive/propositional speech.
  46. Neurology
    Medical discipline concerned with Aphasia.
  47. Glial Cells
    AKA neuroglia/glue. Nonneural cells, they do not send or receive messages but provide a structural framework for the neural cells and are essential for normal functioning of the nervous system by helping maintain neural metabolic activity.

    CNS Glial cells are classified as astrocytes, oligodendrocytes, microglia.

    PNS Glial cells are classified as satellite and Schwann cells.
  48. Astrocytes
    Help create the blood-brain barrier. Most common site of malignant tumors within the brain.
  49. Microglia
    Make up about 10% of glial cells and are at rest during health but become active upon brain injury.  When activated they secrete a variety of chemical substances, some may be toxic and may lead to cerebral inflammation and opening of the blood-brain barrier.
  50. The Brain
    The most important organ for language comprehension, formulation, and expression.
  51. CNS - structures relevant to a study of Neurogenic language disorders
    • Spinal cord
    • Brainstem
    • Cerebellum
    • Cerebrum
  52. Spinal cord
    The main structure with which the brain keeps in touch with the rest of the body.
  53. Brainstem
    Medulla - controls autonomic functions: digestion, breathing (affecting speech), blood pressure, and heart rate.

    Pons - is a bridge to the hemispheres of the cerebellum. The pons is concerned with hearing and balance; some cranial nerves (trigeminal, facial) originate here.  Transmits info relative to movement from the cerebral hemispheres to cerebellum.

    Midbrain - controls many sensory and motor functions, including eye movements, postural relfexes, and coord of visual and auditory reflexes.  Cranial nerves III and IV originate here.
  54. Cerebellum
    Part of the motor system. Coordinates actions to produce smooth and rhythmic movements, including those involved in speech.  Cerebellum associated with ataxic dysarthria - dominant articulatory and prosodic problems.
  55. Thalamus
    Largest of the diencephalon structures.  Thalamus integrates sensory experiences and relays them to cortical areas.  Also receives info about motor impulses from basal ganglia and cerebellum and relays these to motor areas of the cortex.

    There is increasing evidence that the thalamus plays some role in speech and language, possibly thalamic aphasia.  Stimulation of left thalamic areas improved acquired stuttering.
  56. Basal ganglia
    Produce important neurotransmitters which help regulate and control movements.  Damage/disease of the basal ganglia deplete neurotransmitters. Ex. Parkinson's and Huntington's.  Patients may exhibit a form of dsyarthria, a motor speech disorder due to loss of muscle tone and muscle weakness.
  57. Cerebral cortex/Cerebrum
    Responsible for all higher brain functions: thinking, logical, abstract, mathematical reasoning: memory, speaking, production of language, creativity, judgment and emotional.
  58. Sulcus/lateral cerebral fissure/sylvian fissure
    Located at the inferior frontal lobe at the base of the brain, a deep fissure starts and moves laterally upward.  Regions surround the fissure are especially involved in speech, language, and hearing.
  59. Primary lobes of brain

    FRONTAL                      OCCIPITAL

    • Frontal - largest of lobes
    • Extremely important for speech and language.  It holds the Broca's area (motor speech) on the left lower, posterior portion.

    Temporal - lowest 1/3 of brain and lies under the temporal bone. Holds primary auditory cortex - hearing - auditory reception and visual auditory association: posteriorly is Wernicke's area in left temporal lobe.  LEFT temporal lobe is significant in comprehension of written and spoken language. Medial part contains hippocampus which mediates memory and learning.

    Occipital - smallest of the lobes, mostly concerned with vision.

    • Parietal - concerned with perception, sensations of touch, pressure, position in space, and body awareness, and integration of sensory experiences. Nondominant hemisphere controls understanding of spatial relations and selective attention. Damage to one side may cause unawareness of objects or persons on the opposite side. Supramarginal and angular gyruses are significant for language.  Damage to supramarginal gyrus may cause agraphia (conduction aphasia).  Damage to angular gyrus can cause naming, reading, and writing difficulties and possibly transcortical sensory aphasia.
  60. Cerebral ventricles (4)
    Located below the corpus collosum and are filled with cerebrospinal fluid.  When the circulation of CSF is blocked it results in hydrocephalus.
  61. Meninges (3)
    Meninges are the covering of the brain and spinal cord.

    • Dura mater - thick outer layer
    • Arachnoid - thin middle layer-adheres to dura mater
    • Pia mater - thin inner layer-adheres to brain surface
  62. Vascular Network
    • Artery
    • Arterioles
    • Capillary
    • Venules
    • Veins
  63. Aorta
    The main artery of the heart.
  64. Middle cerebral artery
    Biggest branch of the internal carotid which supplies the entire lateral surface of the cortex, including major regions of the frontal lobe.  Including major areas concerned with sensory and motor functions and speech, language, and hearing functions (Broca's and Wernicke's). Damage to the artery is frequent cause of stroke and aphasia, contralateral hemiplegia, impaired sense of touch, position, pain, and temperature may result.  Reading and writing deficits may be a part of the symptom complex.
  65. Anterior cerebral artery
    Damage to this artery can cause disruption of the blood to the midsagittal portions of the motor cortex.  Motor symptom disruptions include paralysis of legs and feet.  Also cognitive deficits; impaired reasoning, judgment, concentration (prefrontal lobe symptoms).
  66. Circle of Willis
    Watershed area of the brain where the anterior, middle, and posterior cerebral arteries end their distribution and blood supply.  Interruption of blood supply to the region, specific kinds of aphasia, especially transcortical motor aphasia and transcortical sensory aphasia may result.
  67. Blood Brain Barrier
    Composed of endothelial cells of the cerebral walls with continuous lining and tightly formed junctions - the junctions do not contain intercellular pores so substances can not pass.  While harmful substances are prevented from reaching the neural cells, so are helpful medicines.

    Brain tumors and certain diseases can break down the blood-brain barrier and allow harmful infections to penetrate the cerebral cells.
  68. Neurodiagnostic Methods
    • Post hoc - postmortem
    • Invasive - craniotomy (ex. epileptic focus removal)
    • Inferential -
  69. General Neuropathology of Aphasia
    Brain damage is most immediate or simultaneous cause of aphasia.

    • Genetic predisposition
    • Poor eating habits
    • High blood cholesterol
    • Atheroscleoris
    • An interrupted blood supply
    • Injury to language structures in the brain
  70. Neuropathological elements of aphasia
    • Edema
    • Cellular changes
    • Destruction of glial cells
    • Necrosis of small blood vessels
    • Ischemic penumbra
  71. Aphasia - 4 Categories of Definitions
    • Nontypological - only one kind exists
    • Typological - suggests there are types of Aphasia
    • Cognitive - cognitive impairments
    • Social -