Week 6 - Language and Strokes

Question 1

Larynx changed

Answer 1

Larynx changed, more sounds, greater vulnerability to choking

Question 2

Language is on what side for more people (laterlization)

Answer 2

Left

Question 3

What happens for language on the right side of the brain

Answer 3

narrative speech, map-reading, prosody, ALSO language

Question 4

Difference between left and right handers

Answer 4

Left handers have less lateralization (might be able to maintain more skills in a stroke)

Left handers make up 10% of populations

Left handers suspected to be smarter

Question 5

Difference between left and right handers

Answer 5

Left handers have less lateralization (might be able to maintain more skills in a stroke)

Left handers make up 10% of populations

Left handers suspected to be smarte

Question 6

Die out of langagues

Answer 6

6,000 languages exist, one language dies every 14 days

Question 7

Aphasia

Answer 7

loss of ability to understand or express speech, caused by brain damage (stroke, TBI)

Question 8

Most common type of stroke to produce aphasia?

Answer 8

L MCA

Question 9

Broca’s Aphasia

Answer 9

Broken, not fluent –> hard time with speech production (broken, not fluid) BUT they can understand fine

Occurs anterior to motor cortex, leads to impaired speech production (think motor, need motor skills to produce language)

Expressive aphasia (condition where a person may understand speech, but they have difficulty speaking fluently themselves)

Worsens with anxiety or pressure demands

Genearlly aware they have it

Question 10

Wernicke’s Aphasia

Answer 10

Fluent –> speak fluently, cannot understand others

Occurs: posterior portion of temporal lobe and by the primary auditory cortex (impaired comprehension, think temporal, can’t process speech)

Receptive aphasia (when someone is able to speak well and use long sentences, but what they say may not make sense)

Impaired language comprehension

Often unaware

**can occur in those who are deaf

Question 11

Receptive vs expressive aphasia

Answer 11

Receptive: Wernicke’s (they can speak fine, but doesn’t make sense)

Expressive: Brocas (can express language, can’t understand)

Question 12

Broca’s vs Wernicke’s area in the brain

Answer 12

Question 13

Other names for strokes

Answer 13

Infarcts (tissue necrosis d/t stroke)

CVA (cerebrovascular accident)

Question 14

Definition of strokes ands rates

Answer 14

occurs when something blocks blood supply to part of the brain or
when a blood vessel in the brain bursts.

Incidence: over 750,000 in US per year (top injury in hospital)

Question 15

Risk Factors of CVDs

Answer 15

Hypertension

Diabetes

Smoking

Obstructive sleep apnea

Obesity

Question 16

Hypertension: risk factors for strokes

Answer 16

• 77% of individuals first strokes have BPs higher than 140/90
• 50% have history of hypertension

Question 17

Diabetes: risk factors for strokes

Answer 17

• 3x increased risk of ischemic strokes
• heightened risk in african americans and whites
• hyperglycemia at stroke onset increase chance of brain damage

Question 18

Smoking: risk factors for strokes

Answer 18

Increase heart rate and blood pressure decrease your arterial distensibility (less able your arteries are able to construct and un-restrict)

Secondhand smoke means equal risk

Question 19

Obstructive sleep apnea: risk factors for strokes

Answer 19

Prevalance in stroke patients: 60%

Independently increases risk by 4x

linked to other factors

CPAP and BiPAP reduce risk

Question 20

Obesity: risk factors for strokes

Answer 20

Abdonminal obesity > greate than total body obesity

linked ot multiple other risk factors

Question 21

Stroke types

Answer 21

Ischemic: obstructs flow of blood

Hemorrhagic: caused by bleeding in the brain

Transient ischemic attack: stroke that lasts only a few minutes
- 1/3 will eventually have a stroke

Question 22

Rates of ischemic vs hemorrhagic

Answer 22

88% Ischemic; 12% Hemorrhagic

Question 23

Brain scan Ischemic and Hemorrhagic

Answer 23

*remember, left is right and right is left.

Ischemic you are seeing dead cells, H you are seeing blood (blood shows white on scans)

Question 24

Two types of ischemic strokes

Answer 24

thrombus: is a blood clot in blood vessels

embolus: a piece of material that
breaks off and is carried through the bloodstream until it reaches an artery too small to pass through

Question 25

initial damage done by ischemic stroke

Answer 25

Initial Damage in Ischemic stroke d/t Glutamate Ecotoxicity *CELL DEATH* Immediate cause of neuron death is the presence of excessive amounts of glutamate. - Decreased O2 leads = Neural membranes become depolarized = ↑ Glutamate - NMDA Receptors become over-stimulated - Inflammation attracts microglia - Microglia attracts WBC that attach to the region - this all leads to *cell death*

Question 26

Non-modifiable risk factors

Answer 26

age race family history

Question 27

Circle of Willis

Answer 27

where the internal carotid arteries branch into smaller arteries that supply oxygenated blood to over 80% of the cerebrum.

Question 28

Three main brain arteries

Answer 28

anterior cerebral artery middle cerebral artery posterior cerebral artery

Question 29

Middle Cerebral Artery (MCA) Stroke -- General

Answer 29

90% of strokes largest of the brain arteries supplies most of the outer surface of the frontal, parietal, temporal lobes and the basal ganglia --> INCLUDING pre-central (sensory) and post-central (mortor) gyrus

Question 30

MCA Stroke Symptoms

Answer 30

Contralateral weaknesses and sensory loss in *upper extremities* --> remember: left effects right Loss of visual field Left MCA stroke: speech deficits - brocas - wernickes Right MCA stroke: neglect and poor movitation - flat prosody - ex. neglect of left side, won't notice if left art stuck in door

Question 31

Anterior cerebral artery (ACA) stroke -- general

Answer 31

Less common (left ACA more common than R ACA) Feeds deep structures in brain, frontal, parietal, corupus callosum, and bottom of cerebrum

Question 32

Anterior cerebral artery (ACA) stroke -- symptoms

Answer 32

Contralateral motry and sensory loss in *lower extremeties* poor gait and coordination (clumsy) slowed initiation (abulia) --> takes longer to do things flat affect urinary incontinence

Question 33

ACA vs MCA strokes

Answer 33

ACA: contralateral lower extremity deficits MCA: contralateral upper extremity and face deficits

Question 34

Posterior cerebral artery (PCA) stroke

Answer 34

5-10% of strokes occipital Symptoms: - impaires consciousness - nausea/vomiting - ataxia (poor motor coordination) - vision changes - nystagmus (eyes shifting)

Question 35

Arteriovenous malformations (AVMs)

Answer 35

Most common in TIAs Tangle of arteries and veins without connecting capillaries Aquired through inborn genetic mutation followed by secondary mutation (1-2% of strokes) Variable size (2mm to cm) Damage: - compression of neighboring structures - stealing of blood flow from surrounding regions Presentation: - sx onset between 10-40 - intracranial hemorrhage most common presentation

Question 36

Post stroke depression treatment

Answer 36

Early psychopharmacologic treatment is KEY

Question 37

Psychiatric Considerations Post-Stroke: Depression

Answer 37

GET THEM ON MEDS, therapy not enough - Post stroke depression = 1/3 of survivors - 6x ↑ risk of depression 2-3 years post stroke - More common in L frontal and basal ganglia strokes - adversely effects functional recovery - ↑ Risk Factors = Premorbid depression & Social isolation post stroke

Question 38

Psychiatric Considerations Post-Stroke: Anxiety

Answer 38

1/4 meet GAD criteria post stroke less common

Question 39

Psychiatric Considerations Post-Stroke: Psychosis

Answer 39

- More common in right-temporo-parietal-occipito area lesions, seizures, and subcortical atrophy - Pseudobulbar Affect (episodes of sudden uncontrollable and inappropriate laughing or crying) = 10-15% post stroke patients - Hypomanic symptoms = 1%

Question 40

If you suspect a stroke, BE FAST **This is on quiz**

Answer 40

Question 41

What can you administer to help stroke (why important to be fast)

Answer 41

Tissue Plasminogen (tPA) can be administered within 4.5 hours - helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment - After that time, has hemorrhagic effect