Exam 1 - CN (subcortical & unusual aphasias) Flashcards
(77 cards)
1
Q
general layers of the brain
A
- cortex (grey matter)
- white matter
- basal ganglia & thalamus
- brainstem
2
Q
extrathalamic
A
basal ganglia
3
Q
thalamic
A
thalamus
4
Q
relay center
A
thalamus
5
Q
specific basal ganglia structures
A
- caudate nucleus
- internal capsule
- globus pallidus
- putamen
- corpus striatum
- substantia nigra
- lentiform nucleus
- red nucleus claustrum
- amygdala
6
Q
general location of basal ganglia
A
between cortex & brainstem
7
Q
function of basal ganglia
A
regulating motor function & muscle tone
8
Q
general location of thalamus:
A
sits on top of brainstem
9
Q
function of thalamus
A
integrates info from all of the senses, except smell & sends info to the cortex
10
Q
subcortical regions
A
- basal ganglia
- thalamus
11
Q
extrathalamic damage
A
(basal ganglia)
1. Parkinson’s disease
2. Huntington’s disease
12
Q
thalamic damage
A
thalamic syndrome
13
Q
mortality rate is high with damage to this region
A
thalamic
14
Q
thalamic syndrome
A
increased or decreased threshold for sensation, somatosensory issues (touch temp pain)
15
Q
left side subcortical lesions: white matter only
A
usually not an aphasia
16
Q
left side subcortical lesions: basal ganglia only
A
damage must be extensive to produce an aphasia
17
Q
left side subcortical lesions: basal ganglia + white matter
A
when aphasia like symptoms are typically observed
18
Q
most common left side subcortical lesions
A
basal ganglia + white matter
19
Q
basal ganglia + white matter damage
A
- anterior syndrome
- posterior syndrome
20
Q
anterior syndrome
A
basal ganglia + white matter
1. can be confused with broca’s/TCM
21
Q
- hemiplegia
- slow, dysarthric speech w/ good phrase length & prosody
- good comprehension
- good repetition
- poor oral reading
- poor writing
- poor naming
A
anterior syndrome
22
Q
- hemiplegia
- fluent speech w/out dysarthria
- poor comprehension
- good single word but poor sentence repetition
- poor naming
- poor reading & writing
A
posterior syndrome
23
Q
posterior syndrome
A
basal ganglia + white matter
can be confused with wernicke’s/TCS
24
Q
left side subcortical lesion: thalamic
A
sometimes confused with TCS aphasia
25
- hemiplegia
- hemisensory loss
- alteration in level of consciousness
- right visual field defect
- initial mutism, but improve to be verbose
- paraphasias, usually semantic
- hypophonic jargon output
- severe anomia
- good comprehension
- logorrhea
- reduced spontaneous meaningful, verbal output
- preserved repetition
thalamic lesion
26
hypophonic
talking quietly
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hemiplegia is more severe with
subcortical aphasia bc of the role w/ the basal ganglia
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motor neuron pathways run next to the
thalamus
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dysarthria is more frequent with
subcortical lesions
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mutism occurs more frequently with
subcortical lesions (most frequently seen with thalamic lesions)
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voice & prosody problems occurs more frequently with
subcortical lesions
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paraphasias occur in ___________ but not in _____________ for ___________ aphasias
speech; repetition: subcortical
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____________ paraphasias occur most frequently w/ subcortical aphasias
semantic
34
arguments FOR subcortical damage being an aphasia type
1. abrupt onset
2. acquired impairment of language
3. symptoms can be associated with lesion site
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arguments AGAINST subcortical damage being an aphasia type
1. language deficits are mild compared to motor speech deficits
2. language problems are more transient than in cortical aphasias, especially w/ thalamic damage
36
transient
temporary
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auditory agnosia
difficulty recognizing auditory stimuli, although the same stimuli may be recognized in other modalities, even though hearing sensitivity is adequate
38
possible types of auditory agnosia
1. amusia
2. auditory sound
3. pure word deafness
39
amusia
without music
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auditory sound agnosia
cannot attach meaning to auditory stimuli (non-speech sounds)
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pure word deafness
cannot recognize speech sounds
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visual agnosia
impairment in the recognition of visual stimuli despite adequate visual sensitivity
43
possible types of visual agnosia
1. prosopagnosia
2. autopagnosia
3. visual object agnosia
44
prosopagnosia
difficulty recognizing familiar faces
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autopagnosia
difficulty recognizing body parts
46
visual object agnosia
difficulty recognizing actual or pictured objects
47
alexia
acquired reading deficit (input)
48
agraphia
acquired writing deficit (output)
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difficulties decoding written text
alexia
50
PPA
primary progressive aphasia
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PPA: primary
impairment is prominent in a single domain (language) with relative sparing of other domains early on (e.g., motor)
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PPA: progressive
the impairment will get worse over time since it is caused by a neurodegenerative disease
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PPA: aphasia
a language impairment
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diagnostic criteria of PPA:
1. min of 2 yrs of language decline
2. prominent language deficits
3. preservation of other mental functions
4. independence in ADLs
5. absence of apathy, disinhibition, forgetfulness of recent events, or visuospatial impairment
6. exclusion of other causes of aphasia
7. SLP & neuropsychological assessments concur w/ neurological exam
55
umbrella of neurodegenerative syndromes
dementia
56
condition, not diagnosis
dementia
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clinical neurodegenerative dementia syndromes
1. alzheimer's dementia
2. posterior cortical atrophy syndrome
3. PPA
4. behavioral variant frontotemporal dementia
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Alzheimer's dementia
amnestic dementia
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posterior cortical atrophy syndrome
visuospatial dementia
occipital lobe
60
PPA type of dementia
aphasic dementia
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behavioral variant frontotemporal dementia
(FTD)
aphasic dementia
right side
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diagnosis of PPA:
1. Hx from pt. & family + current meds
2. neurological exam
3. neuropsychological testing
4. lab measures (blood tests, neuroimaging MRI, PET, LP)
63
PPA: pt typically reports that onset is
insidious (gradual)
64
PPA: pt. often presents many months/yrs after
onset of language difficulty
65
PPA: pt. usually notices problem before
SO
66
PPA: complaints are similar to
stroke-induced aphasia
67
PPA: pt. rarely denies deficit; is usually the one to
seek Dx & Tx
68
PPA: common feelings
frustration
reactive depression
69
PPA: clinical syndrome
progressive aphasia w/ relative sparing of other cognitive domains
70
PPA: neuroanatomic features
relatively focal atrophy w/in the left hemisphere language network
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PPA: neuropathologic features
features associated w/ PPA are variable
72
3 types of PPA
1. semantic variant
2. logopenic variant
3. nonfluent/ agrammatic variant
73
semantic variant PPA
PPA-S
similar to wernicke's
preserved grammar
impaired word comprehension
74
logopenic variant PPA
PPA-L
similar to conduction or anomic aphasia
preserved grammar & word comprehension
impaired word finding/ retrieval & repetition
75
nonfluent/agrammatic PPA
PPA-G
similar to broca's
impaired grammar
preserved word comprehension
76
PPA is a moving target:
1. heterogeneity in progression rates and emergence of symptoms
2. subtyping may not be feasible in the severe stages
77
PPA long-term prognosis
1. after a time of 5-20 yrs after onset, other areas of the brain become affected
2. along w/ language deficits, individual may demonstrate difficulty w/: memory, spatial abilities, attention, personality
3. frustration & behavioral changes are common
4. may compromise life-sustaining functions (e.g., swallowing)
