aphasia midterm review

Non- Fluent aphasias

• global aphasia

• mixed transcortical aphasia (MTA)

• brocas aphasia

• transcortical motor aphasia (TMA)

brocas aphasia

• Lesion: Left posterior inferior frontal gyrus (BA 44/45), insula, premotor cortex

• Vascular: Superior division of MCA

• Fluency ↓: Effortful, telegraphic, 1–3 words per utterance

• Naming ↓: Severe anomia, especially verbs; literal paraphasias

• Comprehension ↗: Relatively preserved, better than expression

• Repetition ↓: Impaired, especially for long utterances

• Other signs: Apraxia of speech may coexist; frustration, depression, good therapy participation

transcortical motor aphasia (TMA)

• Lesion: Dorsolateral prefrontal cortex, anterior watershed zone (ACA–MCA)

• Fluency ↓: Poor initiation, long latency, “blocked” responses

• Naming ↓: Impaired but better than Broca’s

• Comprehension ↗: Fair to good

• Repetition ↗: Preserved, even for long, complex phrases

• Cue responsiveness: Improves with phonemic/semantic prompts

global aphasia

• Lesion: Massive perisylvian area, trunk of MCA

• All NFCR ↓↓↓↓: Naming, Fluency, Comprehension, Repetition all severely impaired

• Output: May be mute or limited to stereotypies (“no-no-no”, “oh boy”)

• Comprehension: Only basic, personally relevant cues may be understood

• Recovery: May evolve into MTA if repetition begins to recover

mixed transcortical aphasia (MTA)

• Lesion: Watershed zones; perisylvian intact

• Fluency ↓: Echolalic, stereotypic, minimal voluntary speech

• Naming ↓: Poor

• Comprehension ↓: Severely impaired

• Repetition ↗: Strikingly preserved but without comprehension

• Often seen in recovery phase from global aphasia

fluent aphasias

• Wernicke’s aphasia

• Transcortical sensory aphasia (TSA)

• Condition aphasia

• Anomic aphasia

Wernicke’s Aphasia

• Lesion: Posterior superior temporal gyrus (PSTG), inferior division of MCA

• Fluency ↗: Effortless, rapid, prosodic speech

• Naming ↓: Paraphasias (phonemic, semantic), neologisms

• Comprehension ↓↓↓: Severely impaired

• Repetition ↓: Impaired, frequent paraphasic intrusions

• Awareness: Often lacks awareness of errors

Transcortical Sensory Aphasia (TSA)

• Lesion: Posterior watershed region (MCA–PCA)

• Fluency ↗: Fluent but empty content

• Naming ↓: Semantic paraphasias, circumlocutions

• Comprehension ↓: Significantly impaired

• Repetition ↗: Preserved, often echolalic

• Similar to Wernicke’s but with repetition spared

Anomic Aphasia

• Lesion: Variable (angular gyrus, posterior temporal regions)

• Fluency ↗: Normal speech with full syntax

• Naming ↓: Primary symptom, with circumlocutions

• Comprehension ↗: Good

• Repetition ↗: Preserved

• Mildest fluent aphasia; often endpoint of recovery

condition aphasia

• Lesion: Arcuate fasciculus (supramarginal gyrus, posterior parietal)

• Fluency ↗: Fluent but interrupted by self-corrections

• Naming ↓: Phonemic paraphasias

• Comprehension ↗: Fair to good

• Repetition ↓↓↓: Severely impaired, hallmark sign

• High self-awareness; recognizes errors

Repetition spared

• TMA, TSA, MTA

Poor comprehension + fluent speech

• Wernicke or TSA

Nonfluent + preserved repetition

TMA

All functions impaired

• Global aphasia

Naming only problem

Anomic

Fluent speech + poor repetition

Conduction

Motor strip intact

• No hemiparesis in fluent types (esp. Wernicke)

BA 4

• function: primary motor cortex

• nickname: motor strip

• associated disorder: hemiparesis, apraxia

BA 6

• function: premotor cortex

• nickname: motor programming

• associated disorder: apraxia

BA 44/45

• function: inferior frontal gyrus

• nickname: broca’s area

• associated disorder: expressive aphasia

BA 1, 2, 3

• function: postcentral gyrus

• nickname: sensory s trip

• associated disorder: sensory loss

BA 5,7

• function: somatosensory assoc.

• nickname: interpretation of touch

• associated disorder: tactical agnosia

BA 39

• function: angular gyrus

• nickname: semantic integration

• associated disorder: Alexia, aclcullia

BA 40

• function: supra marginal gyrus

• nickname: phonological processing

• associated disorder: conduction aphasia

BA 22

• function: superior temporal gyrus

• nickname: wernicke’s area

• associated disorder: receptive aphasia AB

BA 41/42

• function: Heschl’s gyrus

• nickname: PAC

• associated disorder: Auditory agnosia

BA 17

• function: primary visual cortex

• nickname: PVC

• associated disorder: word blindness

BA 9, 10, 11, 46, 47

• function: prefrontal cortex

• nickname: executive functions

• associated disorder: abulia, preservation

Ischemic stroke

• Blockage of a blood vessel à Brain cells deprived of oxygen/nutrients

• caused by a blood clot

• either thrombotic stroke or embolic stroke

• aka, occlusive stroke

• responsible for 87% of all strokes

• 2 types:

  • 1)thrombotic CVA

    • Stationary thrombus at a location caused by plaque

    • Plaque: fat, chestrol, calcium

    • #1 reason: ‘atherosclerosis’ at a fixed location due to hypercholesterolemia

  • 2)embolic CVA

    • emboli (‘small/traveling blood clots’)

    • Two main sources of embolus development:

      1.breaking free from the thrombus —> thromboembolic CVA,

      2.from the heart or elsewhere in the body —> Embolic CVA (e.g., A-Fib)

Hemorrhagic stroke

• Ruptured arteries à Neurons are deprived of oxygen/nutrients

• Intracerebral hemorrhagic stroke

• Extracerebral HS

• caused by

  • a weakened vessel leading to an artery ruptures

  • The leaking blood accumulates outside of the artery

  • compresses the surrounding brain tissue —> swelling, headache

• either intracerebral hemorrhage (ICH) or subarachnoid hemorrhage

• Make up ~13% of CVA cases

• Higher mortality rate than ischemic type (40% at 1month & 54% at 1 year)

• More common in Asians than Whites: roughly 20-30% of CVA due to HTN, genetic, stress, smoking, alcohol

• 2 types of:

  • ICH

  • SAH