SLHS 539 Final Exam

What artery supplies blood to the occipital lobes?

PCA

Which artery supplies blood to the medial aspects of the cortex?

ACA

Which artery supplies blood to the cortical areas involved in speech and language?

MCA

A patients experiences a stroke involving their left ACA. What symptoms are they most likely to experience?

Right foot/leg motor weakness and/or sensory loss

A patient experiences a stroke involving their right PCA. What symptoms are they most likely to experience?

left visual field deficits

A patients experiences a stroke involving their left MCA superior division. What symptoms are they most likely to experience?

Right face/hand/arm motor weakness and/or sensory loss

Deficits in language production and/or speech(i.e. Broca's aphasia)

A patient is experiencing a rare condition known as locked in syndrome due to a stroke. Where is the most likely location of this stroke?

basilar artery

Which type of stroke involves a blood clot that blocks the flow of blood to the brain?

ischemic stroke

Which of the following are possible causes of a hemorrhagic stroke?

aneurysm rupture and AVM rupture

According to a CT scan, a patients suffered a hemorrhagic stroke. What are some steps the medical team might take to stop bleeding in the patients brain and reduce pressure from the accumulation of blood in the brain

Take patient off any blood thinners they are on

administer medications to reduce blood pressure

perform a craniotomy

Which of the following can be seen across most(if not all) aphasia typologies?

anomia

What is anomia?

word finding difficulties

A patient is diagnosed with aphasia. They demonstrate agrammatic halting speech and impaired repetition. However their comprehension is relatively good. What type of aphasia do they most likely have?

Broca's aphasia

A patient is diagnosed with aphasia. They demonstrate fluent speech and good comprehension. However, their repetition skills are impaired?What type of aphasia do they most likely have?

Conduction aphasia

A patient is diagnosed with aphasia. They demonstrate fluent but empty speech. Their comprehension and repetition skills are markedly impaired. What type of aphasia do they most likely have?

Wernicke's aphasia

A patient is diagnosed with mild aphasia. Their most notable symptom is difficulty with finding the names of everyday objects. What type of aphasia do they most likely have?

Anomic

A patient is diagnosed with aphasia due to a stroke. Their MRI revealed a lesion spreading in the white matter underneath brodmann areas 44 and 45. Which of the following symptoms most closely match this lesion location?

Nonfluent agrammatic and anomic verbal output

Early on in their stroke recovery, Susan's speech was fluent and her aphasia was characterized by pronounced deficits in comprehension and repetition. Later in their stroke recovery journey, Susan's comprehension showed improvement but they still had a lasting deficit in repetition.

Wernicke's to conduction

True or false: Neglect is associated with perceptual impairment

false

Patients with RHD have problems understanding which type of meaning?

connotative

Which of the following RHD related symptoms can directly affect reading and writing skills?

left hemispatial neglect

Which of the following may be difficult to understand for someone with RHD?

The weather has been chilly

Break a leg!

Can I borrow your car?

Break a leg

True or false: Individuals with RHD typically show deficits in processing linguistic prosody

false

Chronic Traumatic Encephalopathy can lead to all of the following except...

hemiplegia

Which parts of the brain are more often damaged in TBI?

Orbiofrontal and anterior temporal

True or False: TBI rates are higher in females than males for adults older than 75 years old

false

What can cause diffuse axonal injury?

falling off a motorcycle

Individuals with acquired sociopathy typically have damage in which brain region?

orbitofrontal cortex

Severe TBI is characterized by

LOC for longer than 6 hours

In PPA, atrophy starting in the anterior temporal lobe is linked to

semantic dementia

A 79 year old man who was diagnosed with frontotemporal dementia was seen by an SLP who noted the following:

Impaired repetition, intermittent word finding hesitations, phonemic paraphasias, circumlocutions, intact single word comprehension, relatively fluent production, intact syntax

This is most likely...

Logopenic progressive aphasia

The apathetic variant of FTD is characterized by neurodegeneration starting in which brain region?

medial frontal cortex

Semantic dementia is characterized by what?

breakdown in conceptual knowledge

Which is the main artery responsible for blood supply to the perisylvian cortex?

MCA

A patient experiences a blockage to the superior division of their left MCA. Assuming the patient is left hemisphere dominant for language processing and production what are the most prominent symptoms that this patient might experience?

right face, hand, and/or arm motor weakness

Right face, hand, and/or arm sensory loss

Deficits in language production and/or speech(ie Broca's apahsia)

A patient experiences a blockage to the inferior division of their left MCA. Assuming the patient is left hemisphere dominant for language processing and production what are the most prominent speech and/or language difficulties that this patient might experience ?

Primarily deficits in language comprehension(ie Wernickes aphasia)

A patient experiences a blockage to their right ACA. what are the most prominent symptoms that this patient might experience?

left leg motor weakness

left leg sensory loss

A patient experiences a blockage to their Left PCA. what are the most prominent symptoms that this patient might experience?

right visual field deficits

What does the "F" stand for in the BE FAST acronym?

face

What are the two arteries that branch off of the common cartoid artery?

the internal carotid artery and the external carotid artery

In which type of MRI sequence does CSF appear black?

T1

What are the main two categories of stroke?

Ischemic and hemorrhagic

Early on in their stroke recovery, Shreya's aphasia was characterized by severe deficits across all domains of language including speaking, comprehension, reading, and writing. later on in their stroke recovery journey, Shreya's comprehension showed improvement but they still had predominant deficits in speaking, word finding, reading, and writing where their speech was characterized as effortful and sparse.

How would you categorize their aphasia early on and later in their stroke recovery journey?

Global aphasia that evolved into Broca's

Phonagnosia is a disorder that can occur after RHD. What is it characterized by?

inability to recognize peoples voices

hemispatial neglect can affect language abilities such as

reading

Aprosodia caused by RHD is

specific to emotional prosody

true or false: a cerebrovascular accident is a type of TBI

false

What degenerative disease involves the accumulation of the tau protein?

alzheimers

Which brain regions are more often affected following coup and contra-coup in TBI?

temporal lobe and frontal lobe

A woman arrives to the hospital after having fallen off a bicycle and hit her head. The person accompanying her said she lost consciousness for a few seconds after the fall and was disoriented for a few minutes afterward. What type of TBI do you think she suffered?

Mild TBI

A former rugby player complains to his doctor that he is feeling depressed, has mood swings, and difficulties to focus on something. Which type of scan would the doctor recommend?

PET scan

Which type of protein builds up in the brain to form Pick bodies in FTD?

Tau proteins

The disinhibited variant of bvFTD is generally associated with a degeneration of which part of the cortex?

orbito frontal cortex

True or false: Primary progressive aphasia is a variant of bvFTD or Pick's disease

false

Which type of aphasia does the fluent primary progressive aphasia roughly correspond to?

Wernickes

The common carotids branch into...

the external and internal carotid

The internal carotid and vertebral arteries supply...

the brain and upper part of the spinal cord

External carotid arteries supply...

the head and dura

On the right side of the body, the brachiocephalic artery splits into

the right subclavian and the right common carotid artery.

On the left side of the body, the left subclavian and left common carotid artery comes directly off the...

aortic arch

Circle of Willis

Vertebral arteries join at the brainstem to form the single basilar artery.

Anterior and posterior blood supplies join.

Right and left blood supplies join.

The Circle of Willis provides a safety mechanism: if one of the arteries gets blocked, the Circle will still provide the brain with blood.

Blood brain barrier

Tight control over the brain environment: nutrients can come in but foreign substances are kept out.

Protects the brain from 'foreign substances' in the blood that may injure the brain.

Protects the brain from hormones and neurotransmitters in the rest of the body.

Maintains a constant environment for the brain.

Anterior cerebral artery (ACA)

Supplies blood to the medial cortex, including the medial aspect of the motor and sensory strip.

Also supplies blood to some parts of the frontal lobe and striatum (basal ganglia).

Posterior cerebral artery (PCA)

Supplies blood to the temporal and occipital lobes of both hemispheres

Middle cerebral artery (MCA)

Superior division of the MCA supplies cortical areas involved in speech, swallowing, and language production, including Broca's area.

Inferior division of the MCA also supplies cortical areas involved in language comprehension and hearing, including Wernicke's area, Heschl's gyrus, and the angular gyrus.

The MCA also supplies most of the deep cerebrum and striatum (basal ganglia).

Watershed regions are...

regions of the brain where there is an overlap of different artery supplies

Transient ischemic attack (TIA)

Mini stroke - Temporary (transient) disruption of blood flow to the brain.

Symptoms appear similar to a stroke, however deficits resolve on their own within 24 hours (often within a few minutes

Stroke

a more severe and permanent interruption of blood flow, potentially causing lasting brain damage, that may need treatment and intervention to resolve

True or false: Both TIAs and strokes are medical emergencies.

true

What are the two subtypes of ischemic strokes?

thrombotic and embolic

ischemic stroke

a type of stroke that occurs when the flow of blood to the brain is blocked

hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

Which is more common, an ischemic stroke or hemorrhagic?

ischemic

Hemorrhagic stroke types

Epidural and subdural hematomas often caused by head trauma (traumatic brain injury) that results in damage to blood vessels and pooling of blood.

Subarachnoid and intracerebral hemorrhage often caused by high blood pressure, aneurysms, or blood vessel abnormalities (arteriovenous malformation - AVM).

Risk factors associated with ischemia

Hypertension - high blood pressure

Heart disease

Diabetes

High cholesterol

Smoking

Obesity

Inactivity

Genetics

Family History

Age

Race

Broca's aphasia characteristics

nonfluent, relatively good comprehension, impaired repetition

Global aphasia characteristics

nonfluent, impaired comprehension and repetition

transcortical sensory aphasia characteristics

nonfluent, relatively good comprehension, good repetition

Wernicke's aphasia characteristics

fluent, impaired comprehension and repetition

Transcortical sensory aphasia characteristics

fluent, impaired comprehension, good repetition

Conduction Aphasia Characteristics

fluent, good comprehension, impaired repetition

Anomic aphasia (characteristics)

fluent, good comprehension and repetition. Only problem is word finding difficulties

Broca's area region

left frontal lobe of the brain crucial for speech production

Wernickes area region

in the left temporal lobe of the brain crucial for language comprehension

MCA superior division

language production, including Broca's area

MCA inferior division:

language comprehension and hearing, including Wernicke's area, Heschl's gyrus, and the angular gyrus

Transcortical motor aphasia region

Anterior or superior to Broca's area and Supplementary motor area often involved

Conduction aphasia region

Lesion in posterior temporal parietal junction

PNFA region

Atrophy linked to left inferior frontal lobe and anterior insula

Semantic dementia region

Linked to atrophy of anterior temporal lobe

LPA region

Linked to atrophy of temporoparietal junction

Broca's aphasia can evolve into

anomic aphasia

Global aphasia can evolve into

broca's

Wernicke's aphasia can evolve into

conduction or anomic aphasia

True or false: Broca's aphasia can evolve into wernicke's

false

Why does RHD matter?

Many of the 'non-linguistic' deficits have direct impacts on linguistic abilities

Additionally, a number of the deficits are linguistic in nature - or, at least, paralinguistic

Non linguistic deficits that can occur after RHD

Attentional: anosognosia, proprioceptive deficits, left hemispatial neglect

Visuospatial: topographic disorientation, constructional apraxia, prosopagnosia

Auditory: amusia, phonagnosia

Social and emotional: aprosodia, 'emotional agnosia,' pragmatics

Theory of Mind: intention, inference, humor

Discourse: integration, interpretation

linguistic deficits that can occur after RHD

Reading problems, especially the beginnings (left side) of words

Writing and spelling problems

Patients with RH-damage exhibit specific deficits in: processing of metaphors and idiomatic expressions, understanding jokes, making inferences while still maintaining an overall preservation of linguistic ability.

Individuals with RHD tell inappropriate stories/jokes, intrude on personal space, go off on tangents and are overly-talkative

The right hemisphere is responsible for processing affective(emotional) prosody and The left hemisphere is responsible for processing linguistic prosody

What is TBI?

A traumatic brain injury (TBI) is caused by a blow to the head or violent head movement

The term 'TBI' is only applied when there is evidence of total or partial functional disability or psychological impairment, or both.

What is NOT TBI?

Not developmental.

Under Examples of non traumatic brain injuries: Anoxic injuries,Infections of the brain such as meningitis and encephalitis, CVAs,Brain tumors,and Metabolic disorders.