Causes of Language Disorders (W2) Flashcards
1
Q
What causes Aphasia and other Language Disorders?
A
Caused by damage to the brain
- Stroke (Cerebrovascular Accident - CVA)
- Tumor
- Seizure
- Traumatic Brain Injury
- Infection (Encephalitis & Meningitis)
- Progressive Neurological Disease
- Anoxia/Hypoxia
- Dementias
- Neurological Diseases
2
Q
Stroke (aka: brain attack)
A
Results from cutting off vital BLOOD FLOW & OXYGEN to the brain
- The brain cells can live for about 3-6 minutes without oxygen and then start to die
3
Q
Hemorrhagic Stroke
A
Occurs when a blood vessel in the brain breaks leaking blood into the brain.
- 13% of all strokes
- Responsible for more than 30% of all stroke deaths
- Includes AVM (Rachel)
4
Q
Ischemic Stroke
A
Occurs when arteries are blocked by blood clots or by gradual build-up of plaque and other fatty deposits.
- 87% of all strokes
- Thrombosis (blood clot in blood vessel) & Embolic (blockage of an artery)
5
Q
Ischemic Cascade
A
Interruption of blood supply causes lack of oxygen & glucose to brain cells resulting in cell damage and death.
- Damaged brain tissue swells
- Blood flow throughout the brain is decrease and/or disrupted (depends on where stroke occurred)
- Chemical imbalances results in neurotransmitters and neurotoxins being released throughout the brain
6
Q
Transneuronal Degeneration
A
Death of neurons resulting from the disruption of input from or output to other nearby neurons.
7
Q
Diaschisis
A
Loss of function and electrical activity due to cerebral lesions in areas remote from the lesion by neuronally connected to it
8
Q
Risk Factors for Stroke
A
- High Blood Pressure
- Diabetes
- High Cholesterol (Coronary Artery Disease)
- Atrial Fibrillation (Irregular heart rhythm)
- Smoking
- Alcohol & Illegal Drug use (can raise BP too)
- Obesity
- Sickle Cell Anemia (Blood cells not normal shape, they can get caught up and clot blood vessels)
- Vasculitis (Disorder of the vascular system)
- Bleeding Disorders (medications too)
- Women taking BC pills (over 35 increased clot risk)
- Age, Race, & Ethnicity (Black and older more risk)
9
Q
Symptoms of a Stroke
A
SUDDEN numbness or weakness of face, arm, or leg - especially on one side of the body (hemiparesis).
SUDDEN confusion, trouble speaking or understanding
SUDDEN trouble seeing in one or both eyes
SUDDEN trouble walking, dizziness, loss of balance or coordination
SUDDEN severe headache with no know cause
- Call 911 immediately if you or someone you are with has any of these symptoms
- Note the time you experienced your first symptom. This information is important to your healthcare provider and can affect treatment decisions
10
Q
Symptoms of a Stroke - FAST
A
F = FACE ; ask the person to smile. Does 1 side of the face droop? (weakness on 1 side of face) A = ARMS ; ask the person to raise both arms. Does one arm drift downward? S = SPEECH ; ask the person to repeat a simple sentence. Does the speech sound slurred or strange? T = TIME ; If you observe any of these signs (independently or together), call 911 immediately
11
Q
Transient Ischemic Attack (TIA)
A
Like a stroke producing similar symptoms, but usually lasting only a few minutes and causing no permanent damage.
- Small and temporary disruption of blood flow to the brain
- Often called a “mini stroke” a TIA may be a warning
- About 1 in 3 people who have a transient ischemic attack eventually have a stroke, with about half occurring within a year after the TIA
- A TIA can serve both as a warning and an opportunity to take steps to prevent it (Diabetes? Am I taking my meds?)
- Hospitals still treat TIA like a stroke (CT scans etc.)
12
Q
Treatment of Stroke
A
Surgical Clot Removal: Surgeon goes through vessel to retrieve clot. (or surgery to stop bleeding)
Thrombolytics: Drugs help reestablish blood flow to the brain by dissolving the clots (aka: blood thinners)
tPA - Tissue Plasminogen Activator: tPA is an enzyme found naturally in the body that converts, or activates, plasminogen into another enzyme to dissolve a blood clot. Must be given within a 3-4 hour window. Risk includes brain hemorrhage.
- Aspirin
- Reduces deficits from Ischemic Stroke
- If person already on floor and we not sure… this will not work
13
Q
National Institutes of Health Stroke Scale or NIH Stroke Scale (NIHSS)
A
Tool used by healthcare providers to objectively quantify the impairment caused by a stroke (can be used in any Emergency Room.. but now lots of stroke centers)
- Composed of 11 items; each scores a specific ability between 0-4
- For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment
- The individual scores from each item are summed in order to calculate a patient’s total NIHSS score.
- The maximum possible score is 42, minimum score being a 0.
- During the NIHSS, the examiner should NOT coach or help with the assigned task
14
Q
What does the National Institutes of Health Stroke Scale assess?
A
- Level of consciousness
- Best gaze
- Visual
- Facial Palsy
- Motor arm
- Motor Leg
- Limb Ataxia
- Sensory
- Best language
- Dysarthria
- Extinction and Inattention (formally neglect)
Assessed through…
- Picture Naming
- Oral Reading of Words
- Oral Reading of Sentences
… Boston Naming Test: For Aphasia patients
15
Q
Primary Stroke Center
A
A JCAHO (Joint Commition on Accreditation of Hospitals and Health Care Organizations) certification hat recognizes centers that make exceptional efforts to foster better outcomes for stroke care.
- Includes a group of medical professionals who specialize in stroke care and work together to diagnose, treat, and provide early rehabilitation to stroke patients
- A CT or MRI scanner must be available 24 hours of the day
- Access to neurosurgical services (access to a brain surgeon)
- Lab tests of patients with acute stroke must be completed within 45 minutes of being ordered
- A written t-PA (tissue plasminogen activator) protocol must exist in the emergency department.
- The Medical organization must have a declared and established commitment for acute stroke care.
- The hospital must have written acute stroke “clinical pathways”
- An Acute Stroke Team, including a physician and at least one other healthcare professional, must be available around the clock (sometimes even an SLP!).
- Emergency staff must have completed formal training in acute stroke treatments
- There must be a designated stroke center director
- The stroke team must schedule stroke medical education sessions for stroke staff
16
Q
Brain Tumor (What is it?)
A
- Tumors are an abnormal growth of body tissues.
- Tumors can be cancerous (malignant) or noncancerous (benign).
- As a brain tumor grows, it takes up more and more intracranial space and causes compression and destruction of surrounding brain tissue, cranial nerves, and blood vessels
- Symptoms that a patient may experience will depend on the location of the tumor and onset of symptoms may be gradual and progressive
- An estimated 86,970 new cases of primary malignant and non-malignant brain and CNS tumors are expected to be diagnosed in the United States in 2019
17
Q
Meningioma
A
- In Adults
- Most common accounting for 35% of all brain tumors. Nonmalignant (noncancerous), but can be life threatening (wherever they grow).
18
Q
Glioblastoma
A
- In Adults
- Most common and deadliest primary (1st location..did not spread) malignant brain tumor in adults, accounting for 16.3% of all tumors
19
Q
Pilocytic Astrocytoma (low grade)
A
- In children
- Most prevalent brain tumor for children
20
Q
Medulloblastoma (high grade)
A
- In children
- Common Malignant pediatric brain tumor
- Arises in the cerebellum and can infiltrate the entire CNS
21
Q
Brain Tumors treated by…
A
Most commonly treated by surgery, followed by radiation therapy, chemotherapy, or both
- The tumor itself or the treatment (surgery, radiation, chemotherapy) may lead to a communication disorder (speech, language, and/or cognition)
22
Q
Post-chemotherapy cognitive impairment (PCCI)
“Chemo Brain”
A
Cognitive impairment that can result from chemotherapy treatment
- Chemicals = strong.. can kill or affect the bad and healthy cells
- Estimates range from 15-50% of people who undergo chemotherapy experience some level of post-chemotherapy cognitive impairment
Symptoms: difficulty with memory and attention, anomia, difficulty multi-tasking, disorganized, and slower processing
- Difficult to study because cancer patients don’t have cognitive testing before chemotherapy treatment and deficits can be mild.
23
Q
What is a seizure?
A
Sudden disruption of the brain’s normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations
24
Q
Causes of seizures?
A
Epilepsy Brain Tumor Traumatic Brain Injury Infection Stroke Metabolic Dysfunction
- Can affect language, but the extent and nature of the language disturbance varies widely according to the type, severity, and cause of the seizure
25
Generalized Seizures
Involve the entire body (whole body)
26
Partial (focal) Seizures
Electrical disturbance remains in a limited area of the brain.
27
Traumatic Brain Injury (TBI)
A form of acquired brain injury, which occurs when a sudden trauma resulting from events outside of the body causes damage to the brain
Can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters the brain tissue.
- 2nd most common cause of sudden onset of Aphasia (1st is stroke)
- Leading Cause of TBI = Falls
- Concussions = mild type of TBI
28
Open Head Injuries (TBI):
Traumatic event causes opening in skull such as the brain is exposed
Ex: Gunshot or other penetrating wounds
29
Closed Head Injuries (TBI):
Exterior bones of cranium remain intact, preventing direct exposure of brain
Ex: Motor vehicle accidents, assaults, sporting accidents, falls
30
Focal Damage (TBI)
Damage involving a small, localized area of brain injuries include contusions (bruises), hematomas (bleeds), & physical destruction of tissue from penetrating object.
Ex: Hit in head with hammer = localized place
Purely focal damage is RARE because extreme force of TBI usually also causes diffuse damage.
31
Diffuse Damage (TBI)
Damage involving multiple parts of the brain
- Includes: Diffuse axonal injuries (tearing of nerve cells) & Brain Swelling
Ex: TBI all over the brain
32
Coup Injury (TBI)
Damage at point of impact
1. Primary impact: The brain strikes the skull on the side of impact
33
Contrecoup (TBI)
Damage in a direct line at the opposite side of the brain
2. Secondary impact: Contrecoup Impact posterior area of skull
34
Acceleration/Deceleration (TBI)
Brain moving around within the cranial vault
35
Rotational Forces (TBI)
Twisting motion which results in Diffuse Axonal Injuries
- "Axons are like taffy.. intact, but if pulled and stretched, then distorted..can't function"
36
Primary Injuries (TBI)
Damage that is complete at the time of the injury
Ex: skull fracture, contusions/bruises, lacerations, hematomas/blood clots, nerve damage.
37
Secondary Brain Injuries for TBI
- Brain swelling (edema)
- Increased pressure inside skull (intracranial pressure)... too much pressure brainstem gets smooshed and then fatal
- Seizures
- Intracranial Infection
- Fever
- Hematoma (bleeding outside of blood vessels)
- Low or high blood pressure
- Hypoxic (increased oxygen)/Anoxic (no oxygen) injury
- Low Sodium
- Anemia
- Too much of too little Carbon Dioxide
- Abnormal blood coagulation
- Cardiac changes
- Respiratory changes
- Nutritional changes (hyper..)
38
Infections
- Bacterial and Viral infections that affect the nervous system can cause language disorders
Most Common Bacterial Infections: Bacterial meningitis & Brain abscesses
Viral Infections: HIV, viral meningitis, herpes, syphilis, West Nile Virus, Covid-19?
Symptoms: Fever, fatigue, headache, stiff neck, cognitive impairment, and can lead to coma
Medical treatment of infection may lead to resolution of symptoms
39
What are some Neurodegenerative Disorders?
- Dementia (Alzheimer's, Multi-Infarct, Frontotemporal)
- Primary Progressive Aphasia
- Parkinson's Disease
- Multiple Sclerosis
- Amyotrophic Lateral Sclerosis (ALS)
40
What is Dementia? List 3 types
Dementia = umbrella term
- It is a clinical syndrome manifested by progressive deterioration of cognitive function, changes in personality and behavior, and impairment of social and psychosocial adaption.
Alzheimer's Disease: Most common form of dementia; Clinically starts with memory disorder followed by language disorder (memory decline)
Multi-Infarct Dementia: 2nd most common dementia; Caused by multiple strokes at both cortical and subcortical levels.
Symptoms are similar to Alzheimer's Dementia, but can be often identified via CT or MRI. (better memory than Alzheimer's)
Frontotemporal Dementia: Affects the frontal and eventually temporal lobes of the brain.
Symptoms include: changes in social and personal behavior
41
Primary Progressive Aphasia (PPA)
Rare neurodegenerative disorder in which a progressive aphasia is present in isolation from other cognitive deficits for at least 2 years.
- Most people with PPA maintain ability to take care of themselves, pursue hobbies, and, in some instances, remain employed
Problem: Disorder of language, and signs and symptoms of other clinical syndromes are not found through tests routinely used to determine the presence of other conditions.
PPA may take a number of forms...
1) Appears initially as a disorder of speaking (an articulatory problem), progressing to nearly total inability to speak in its most sever stage, while comprehension remains relatively preserved
2) Begins with impaired word finding and progressive deterioration of naming and comprehension, with relatively preserved articulation.
NO KNOWN TREATMENT FOR THIS DISORDER
42
Parkinson's Disease
Affects predominately dopamine-producing ("dopaminergic") neurons in a specific area of the brain called SUBSTANTIA NIGRA
43
Multiple Sclerosis
A disease of the nervous system that attacks the brain and spinal cord
- (memory and word retrieval difficulty too)
44
Amyotrophic Lateral Sclerosis (ALS)
A progressive nervous system disease which damages nerve cells in the brain and spinal cord that results in loss of muscle control
(Will lose speech...comprehension may be good, but can't use speech... AAC devices)
Although Parkinson's, Multiple Sclerosis, and ALS are diseases that have motor movements of speech affected... language can also be affected.
45
Anoxia
Condition characterized by an absence of oxygen supply to an organ or tissue
Caused by a # of diseases and disorders
- Heart Attack
- Severe Breathing Difficulties (asthma or emphysema)
- Smoke or CO inhalation
- Strangulation
- Near Drowning (CPR you come back.. but still brain damage)
- Etc.
46
Hypoxia
Decreased blood flow to organ
- Blood Pressure levels drop very low and the brain and other organs are deprived of oxygen.
47
Aphasia and other language disorders are caused by damage to the brain from diseases and disorders including?
```
A. Stroke
B. Anoxia
C. Infections
D. Dementia
E. All of the above
```
ANSWER: ALL OF THE ABOVE
48
This type of stroke occurs when arteries are blocked by clots or a gradual buildup of plaque?
Ischemic Stroke
49
All of the following occur during the ischemic cascade of strokes EXCEPT?
A. Interruption of blood supply causes lack of oxygen and glucose to brain cells
B. Blood flow throughout the brain is decreased and/or disrupted
C. Damaged brain tissue swells
D. Increased oxygen flows to the brain
E. Transneuronal degeneration
ANSWER: D. Increased oxygen flows to the brain
50
Risk factors for stroke include all of the following EXCEPT?
```
A. Hypertension
B. Colitis
C. Diabetes
D. Coronary artery disease
E. Atrial fibrillation
```
ANSWER: B. Colitis
51
Symptoms of stroke that occur suddenly include all of the following EXCEPT?
```
A. Numbness or weakness on one side of the body
B. Trouble speaking
C. Difficulty with vision
D. Difficulty hearing
E. Severe headache
```
ANSWER: D. Difficulty with hearing
52
What is a transient ischemic attack?
A. A traumatic brain injury
B. Like a stroke, but causes no permanent damage
C. A warning sign that a stroke may occur
D. Both b and c
E. All of the above
ANSWER: D. Both b and c
53
This possible cause of a language disorder results from abnormal growth of tissue in the brain?
Brain Tumor
54
Treatments for brain tumors include?
Surgery, Radiation, & Chemotherapy
55
A sudden disruption of the brain's normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations is caused by?
Seizure
56
Closed head injuries can be caused by all of the following EXCEPT?
A. Motor vehicle accidents B. Sporting accidents
C. Gunshot wounds
D. Falls
E. Assaults
ANSWER: C. Gunshot Wounds
57
During traumatic brain injuries, generalized damage is more likely to occur than localized damage because of all of the following EXCEPT?
```
A. Damage to a small area of the brain
B. Contra-coup injuries
C. Diffuse axonal injuries
D. Acceleration and deceleration
E. Coup injuries
```
ANSWER: A. Damage to a small area of the brain
58
Examples of viral infections that can affect the brain include?
```
A. Viral meningitis
B. West Nile Virus
C. Covid-19
D. Both a and b
E. All of the above
```
ANSWER: E. All of the above
59
A neurodegenerative disorder in which a progressive aphasia is present in isolation from other cognitive deficits is called?
Primary progressive aphasia
60
Decreased blood flow to an organ or tissue is called?
Hypoxia
61
Neurological diseases that can lead to acquired language disorders include?
```
A. Alzheimer's dementia
B. Parkinson's disease
C. Multiple sclerosis
D. Primary progressive aphasia
E. All of the above
```
ANSWER: E. All of the above
