Chapter 8-Neuropathologic and Neuroanatomic Explanations of Aphasia and Related Disorders

About _________________ experience a second or third stroke. About ______________ die as a consequence of a stroke.

200,000; 150,000

Every _______ seconds someone has a stroke.

40

_____________ % of all strokes can be prevented.

80%

-With this type of aphasia, patients usually have right-sided hemiparesis or hemiplegia. -Also known as expressive aphasia -Patients are non-fluent (words come out in single words or groups of two or three) -Patients are laconic (using few words) -Content of written language resembles the content of their speech (use of "and") -Omission of letters in words is common -Patients are able to comprehend spoken and written language better than they speak or write -Patients are aware of their physical and communication impairments and may become frustrated or upset.

Broca's aphasia

-This type of aphasia is caused by damage in the upper temporal lobe and lower parietal lobe. -Impaired repetition and relatively preserved language comprehension. -Difficulty with multisyllabic words. -Fluent speech -Literal paraphasias are present (ex."shooshbruss" for"toothbrush") -Difficulty with reading aloud -Handwriting is good but self-formulated writing may contain spelling errors -Patients are alert, attentive, and task oriented. -They are aware of errors and attempt to repair the errors in speech and writing.

Conduction aphasia

A sudden loss (or change) of function in a portion of the brain connected to adistant, but damaged, brain area. The site of the originally damaged area and of these are connected to each other by neurons.

Diaschisis

-With this type of aphasia, patients retain their ability to repeat what is said despite profound impairment of all other communicative abilities. -Nonfluent -Only speaks when spoken to -Comprehension of spoken language is poor -Cannot name, read, or write -Repetition is good

Mixed Transcortical Aphasia

With this type of aphasia, patients typically have damage in the front half of the language-dominant hemisphere and fissure of Rolando. Patients speak slowly and speech is machine like quality.

Nonfluent aphasia

Speech errors produced by a person with aphasia

Paraphasia

_______________ means prosodic and melodic characteristics of speech.

Speech fluency

This is also known as cerebrovascular accident (CVA), and is the genericterm for brain damage caused by vascular disruptions (loss ofblood supply or bleeding) in the brain. It's also known as a "brain attack"

Stroke

_____________ is the 5th leading cause of death in the U.S.

Stroke

When an artery is occluded by a plug of material accumulating at a fixedlocation:

Thrombotic strokes

-This type of aphasia occurs as a result of damage in the anterior superior frontal lobe in the language-dominant hemisphere. -Reduced speech output, good repetition, and good auditory comprehension. -Poor conversationalists

Transcortical Motor Aphasia

-This type of aphasia is caused by brain damage that spares Wernicke's area, the arcuate fasciculus, and Broca's area. -Repetition skills are good -Speak without being encouraged -Exhibit echolalia -Impairments in comprehension of spoken and written language.

Transcortical sensory aphasia

These are temporary disruptions of cerebral circulation accompanied by rapidly developing sensory disturbance, limb weakness, distorted speech production, visual anomalies, dizziness, confusion, or aphasia which resolve completely within a few minutes to 24 hours

Transient Ischemic Attacks (TIAs)

T/F- About 55,000 more women than men have a stroke each year.

True

T/F- The Southeastern region and lower Mississippi River valley have greater rates of stroke than other U.S. regions.

True

Errors in which an incorrect word unintentionally is substituted for the target word ("knife"for "fork")

Verbal paraphasias

-This type of aphasia is typically caused by damage in the temporal lobe of the language-dominant hemisphere. -Also known as receptive aphasia. -Patients have impaired comprehension of spoken or printed verbal materials. -Fluent aphasia -Exhibit circumlocution

Wernicke's aphasia

Ischemic strokes may be caused by _____________ or _______________.

thrombosis; embolus

An _________________ forms when blood pressure in an artery causes a weakened section of the arterial wall to stretch.

aneurysm

This type of stroke occurs when an artery is blocked and part of the brain loses its blood supply. If the occlusion lasts more than 3 to 5 minutes, death of brain tissue is likely (infarct).

ischemic

Strokes can be _______________ (deprived of blood) or _________________ (caused by bleeding).

ischemic; hemorrhagic

General Effects of Ischemic Stroke

- Within the first few hours after the stroke, neurons deprived of blood supply will die. - Damaged brain tissue swells - Blood flow to both hemispheres diminish. - Diaschisis occurs -Recovery predictions

Aneurysms

-An aneurysm detected before it ruptures may be repaired surgically. -An aneurysm that is leaking may be repaired surgically. -However, a ruptured aneurysm may be impossible to repair. -It may cause severe aphasia. -Could cause death

Paul Broca

-French neurologist in the 1860s -Published a series of papers related to "loss of articulate speech" which is caused by damage to the posterior inferior frontal lobe of the left hemisphere (Broca's area). -Broca's aphasia is a major consequence of damage in Broca's area

Karl Wernike

-German neuropsychiatrist in 1874. -Published a description of"sensory aphasia" caused by lesions in the posterior temporal lobe. -Wernicke's area is considered important for storage and retrieval of the mental representation of words and word meanings and for knowledge and retrieval of grammatic and linguistic rules. -Damage to Wernicke's area often causes Wernicke's aphasia

Phonologic errors in which incorrect sounds replace correct sounds (ex. "shooshbruss" for"toothbrush")

Literal paraphasias

-This type of aphasia Is applied to patients whose only obvious symptom is impaired word retrieval in speech and writing. -Patients with anomic aphasia have spontaneous speech that is fluent and grammatically correct but marred by word retrieval failures.

Anomic Aphasia

This is a label for several syndromes characterized by difficulty carrying out volitional movement sequences in the absence of sensory loss or paralysis sufficient to explain difficulty. It often accompanies aphasia.

Apraxia

When an artery is occluded by material that moves with the blood and blocks the artery:

Embolic strokes

Hemorrhages from the blood vessels in the meninges or on the surface of the brain:

Extracerebral hemorrhages

T/F- 1 in 5 strokes are in people who have had a previous stroke.

False; 1 in 4

With this type of aphasia, patients have damage posterior to the central sulcus in the language-dominant hemisphere. They speak smooth and with little effort. They manipulate speech rate, intonation, and emphatic stress in much the same way as normal speakers do.

Fluent aphasia

-This type of aphasia most often follows occlusion of the trunk of the middle cerebral artery, causing massive damage throughout the perisylvian region. -Exhibit severe language functions. -Comprehension and expressive skills are poor -Reading skills are poor -Some patients answer yes/no questions about family, personal information, and recent experiences but respond at chance levels to all other kinds of spoken material

Global aphasia

This type of stroke is caused by weakness and rupture of a blood vessel wall orby traumatic injury to a blood vessel

Hemorrhagic Stroke (Cerebral Hemorrhage)

Hemorrhages into the brain because the bleeding is in the brain tissue. It is also a cause of aphasia:

Intracerebral hemorrhages

Classification of aphasia groups rely on the following 4 categories:

speech fluency, paraphasia, repetition, and language comprehension

Abrupt weakness or numbness on one side of the body, abrupt impairment of vision, especially in one eye, abrupt difficulty speaking or understanding speech, abrupt episodes of dizziness or falls and abrupt severe headache, especially with any of the others symptoms are all signs of a:

stroke

Aphasia can be caused by several conditions affecting the brain including:

stroke, infection, and brain tumor as well as nutritional deficiency or toxemia