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Aphasia vs dysarthria

Aphasia is higher order inability to speak (language deficit)

Dysarthria is motor inability to speak (movement deficit)


Where are broca's and wernicke's?

In dominant hemisphere (if R handed, your dom hemisphere is L)

Motor speech is Broca - Frontal lobe above sylvian fissure

Associative auditory cortex is Wernicke - temporal below sylvian. Borders parietal too. Behind primary auditory cortex.


Broca's aphasia

1) No fluency

2) Yes comprehension

3) No repetition

Inferior frontal gyrus

Broca is Broken Boca


Wernicke aphasia

1) Yes fluency

2) No comprehension

3) No repetition

Superior temporal gyrus

Wernicke is Wordy but makes not sense. Wernicke is What???


Conduction aphasia

1) Yes fluency

2) Yes comprehension

3) No repetition

Arcuate fasciculus

Can't repeat phrases such as No ifs, ands, or buts


Global aphasia

1) No fluency

2) No comprehension

3) No repetition

AF, Brocas and Wernicke affected


Transcortical motor aphasia

1) No fluency

2) Yes comprehension

3) Yes repetition


Transcortical sensory aphasia

1) Yes fluency

2) No comprehension

3) Yes repetition


Mixed transcortical aphasia

1) No fluency

2) No comprehension

3) Yes repetition

Broca and Wernicke involved. AF spared.


Kluver-Bucy Syndrome

Bilateral amygdala lesion

disinhibited behavior (hyperphagia, hypersexuality, hyperorality)

Associated with HSV1


Frontal lobe lesion

Disinhibition and deficits in concentration, orientation, judgment. May have reemergence of primitive reflexes


Nondominant parietal-temporal cortex lesion

Hemispatial neglect syndrome (agnosia of contralateral side of the world)


lesion to dominant parietal-temporal cortex

Agraphia, acalculia, finger agnosia, L-R disorientation

Gerstmann Syndrome


Lesion to reticular activation system (midbrain)

Reduced levels of arousal and wakefulness (coma)


Mammilary body lesion bilateral

WKS - confusion, ophthalmoplegia, ataxia; memory loss (anterograde and retrograde amnesia), confabulation, personality changes

Associated with thiamine deficiency and excessive EtOH use. Can be precipitated by giving glucose without B1 to a B1 deficient patient

CAN of beer - Confusion, Ataxia, Nystagmus


Basal ganglia lesion

May cause tremor at rest, chorea, athetosis



Cerebellar hemisphere lesion

Intention tremor, limb ataxia, loss of balance; damage to cerebellum leading to ipsilateral deficits. Fall toward side of lesion

Cerebellar hemispheres are laterally located - affect lateral limbs


Cerebellar vermis lesion

Trunctal ataxia, dysarthria

Vermis is centrally located - affected central body


STN lesion

Contralateral hemiballismus


Hippocampus lesion bilateral

Anterograde amnesia - inability to make new memories


Paramedian pontine reticular formation lesion

Eyes look away from side of lesion


Frontal eye field lesion

Eyes look towards lesion


MCA stroke

1) Motor cortex - upper limb and face: Contralateral paralysis of upper limb and face

2) Sensory cortex - upper limb and face: Contralateral loss of sensation of upper limb and face

3) Temporal lobe (Wernicke), Frontal lobe (Broca): Aphasia if in dominant (usually left) hemisphere. Hemineglect if lesion affects nondominant (usually Right) hemisphere


ACA stroke

1) Motor cortex - lower limb: Contralateral paralysis of lower limb

2) Sensory cortex - lower limb: Contralateral loss of sensation of lower limb


Lenticulo-striate artery stroke

Striatum, internal capsule: Contralateral hemiparesis/hemiplegia

Common location of lacunar infarcts secondary to unmanaged HTN


Anterior Spinal Artery stroke

1) Lateral corticospinal tract - Contralateral hemiapresis of upper and lower limbs

2) Medial lemniscus - reduced contralateral proprioception

3) Caudal medulla, hypoglossal nerve - ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)

Stroke is commonly bilateral

Medial Medullary Syndrome - Caused by infarct of paramedian branches of ASA and vertebral arteries


PICA stroke

Lateral medulla - vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle

Vomiting, vertigo, nystagmus; reduced pain and temp senseation from ipsilateral face and contralateral body; DYSPHAGIA, HOARSENESS, lower gag reflex; ipsilateral Horner; ataxia, dysmetria

Lateral Medullary (Wallenburg) Syndrome - Nucleus Ambiguus effects are specific to PICA. Don't PICK A (PICA) HORSE (horseness) that CANT EAT (dysphagia)


AICA stroke

1) Lateral pons - cranial nerve nuclei; vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers

Vomiting, vertigo, nystagmus. PARALYSIS OF FACE. reduced lacrimation, salivation. Reduced taste from anterior two thirds of tongue

Ipsilateral reduced pain and temp of the face, contralateral loss of pain and temp of body

2) Middle and inferior cerebellar peduncles - ataxia, dysmetria

Lateral Pontine Syndrome - facial nucleus effects are specific to AICA lesions. Facial droop means AICA's pooped.


PCA stroke

Occipital cortex, visual cortex - Contralateral hemianopia with macular sparing


Basilar stroke

Pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, PPRF

Preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements

"locked in"