Language Disorder Exam 3

Etiology

Underlying medical cause of a symptom or deficit

• Damage to the CNS or PNS

• Results in communication, cognition, language, and behavior deficits: Determined by site and severity of damage

Etiologies of neurogenic communication disorders

Stroke

Traumatic Brain Injury (TBI)

Surgical trauma

Degenerative disorders

Infectious diseases

Idiopathic etiology

deficits or symptoms that are of an unknown or obscure origin

CNS (Central Nervous System)

brain and spinal cord

Peripheral Nervous System (PNS)

all the other pieces of the nervous system

Stroke

AKA: cerebrovascular accident (CVA)

• Can occur within any area of the brain or brainstem.

• Brain tissue is permanently destroyed or temporarily does not function due to decreased or absent blood supply to affected brain tissue

Strokes are the ___ leading cause of death in the U.S

4th

brain consumes ____ of oxygen taken in by the body and can survive six to eight minutes without oxygen

20%

____ seconds without blood circulation causes unconsciousness

5-8

____ minutes produces irreversible brain damage

6-8

Anoxia

complete lack of oxygen to the cell

Hypoxia

partial lack of oxygen to a cell

T/F: Strokes cause death more in women than men

True

factors that increase likelihood of strokes

Tobacco use, physical inactivity, atrial fibrillation, high blood

pressure

Main Types of Strokes

Ischemic stroke

Hemorrhagic stroke

Ischemic Strokes are caused by _____

a blockage of a blood vessel supplying the brain

most strokes are _____

ischemic

Ischemic Stroke Onset Symptoms

Loss of strength/sensation on one side of body

Problems with speech and language

Changes in vision and balance

ischemic core/infarct

the area of dead tissue following the stroke; tissue necrosis

tissue necrosis

death of cells; irreversible.

ischemic Penumbra

Surrounding the ischemic core

This area of the brain is damaged but has received enough blood to stay alive

damage can typically be reversed if medical attention is received within 2 to 4 hours of onset of the stroke.

types of ischemic strokes

Thrombotic or embolic

transient ischemic attack

Thrombotic Stroke (Thrombosis)

Occurs when:

• A thrombus forms

• Interrupts blood flow within the brain

Thrombus

blood clot that forms inside a blood vessel and remains attached to the vessel wall (usually due to atherosclerosis)

Atherosclerosis

chronic disease

Buildup of fatty materials that accumulated slowly on the walls of arteries

Narrows the arteries

May restrict blood supply to the artery

Embolic Stroke (Embolism)

Occurs when a blood clot or other debris travels through the bloodstream and suddenly blocks an artery in the brain

Cuts off blood circulation to a part of the brain

Embolus

A mass traveling through the circulatory system

Lodges in a blood vessel in the brain

A thrombus can become an embolus if…

a piece of the thrombus breaks off, travels, and lodges within a vessel to interrupt circulation within the brain

Hemorrhagic Stroke

Occurs when:

• A blood vessel within the brain ruptures

• Blood spills into the brain

• Deprives a part of the brain of blood flow

Hemorrhagic Strokes usually occur in those who:

Have high blood pressure, which is called hypertension

Are engaged in high periods of physical activity

Have a history of hemorrhagic stroke

Experience alcohol abuse

Two primary kinds of hemorrhagic strokes

Subarachnoid

Intracerebral

Subarachnoid

bleeding between the surface of the cerebrum and arachnoid membrane in the subarachnoid space

Intracerebral

bleeding occurs within the brain itself

Hemorrhagic Stroke symptoms

Severe headache, nausea, and vomiting

Three mechanisms of damage that may occur in Hemorrhagic Strokes

Blood supply to a portion of the brain has been interrupted due to a burst/broken blood vessel

Blood spilling out into the brain tissue where it does not belong causes damage

Intracranial pressure increases due to the continued release of blood into the brain or between the surface of the brain and the cranium

Transient Ischemic Attack (TIA)

“mini stroke”

Small ischemia in the brain that resolves itself within 24 hours

• Symptoms include: Mild motor and cognitive deficits that go away after the blood clot is resolved

• Does not cause permanent deficits unless TIAs are recurring

• May be a warning sign of a larger oncoming stroke

BE FAST Stroke signs

Balance

Eyes

Face

Arms

Speech

Time

Aneurysm

Abnormal stretching or ballooning out of the wall of a blood vessel due to:

• Disease or hereditary factors

• Hypertension and atherosclerosis

Usually occurs in the Circle of Willis

Symptoms of Aneurysm

Severe headache, nausea, vomiting, blurred vision, sensitivity to light, seizures, loss of consciousness

Traumatic Brain Injury (TBI)

Serious and life-threatening brain damage

Result of an external and forceful event

• NOT due to disease, stroke, seizure, surgery

Immediate impact ranges from mild concussion to coma to death

Common TBI Causes

Falls, motor vehicle accidents (MVA), violent assault, being struck by an object

TBI Symptoms

Language and cognitive deficits are varied and complex

—> Depends on what areas of the brain were damaged/to what extent

• slowed mental processing speed

• attention deficits (sustain, divided, selective attention)

• short-term memory and working memory deficits

• executive functions (problem-solving, reasoning, inhibition

  • affect activities of daily living

Brain Tumor

Neoplasm

Primary tumors

Secondary Tumors

Neoplasm

Abnormal growth of cells in the brain

Serves no purpose to the body

Benign vs Malignant (brain cancer)

• benign can be dangerous if it grows rapidly

Biopsy

Primary Tumor

Brain tumor that originates in the brain

Secondary Tumor

A cancerous tumor that spreads from another part of the body to the brain

Biopsy

surgery to remove a piece of tissue for testing

Malignant brain tumors

These brain tumors are brain cancer

Can grow and spread quickly to other body parts

Treated with surgical removal and radiation

Benign brain tumors

Cannot spread to other parts of the body

Mass effect may occur

Surgical Trauma

Damage to brain tissue that may occur during surgery to the brain

• May result in acquired speech, language, cognitive, and swallowing deficits

• May also cause secondary seizures, additional CVAs, infections, and increased intracranial pressure

Infection

Can damage CNS and PNS

May be viral, fungal, bacterial, parasitic

Impacts cognition, motor, and language

• Depends on site, nature, and damage of infection

Some infections that affect the nervous system

Encephalitis

HIV/AIDS

Syphilis

Poliomyelitis

Encephalitis

Acute infection and inflammation of the brain or spinal cord

• “-itis” = inflammation

Caused by a virus or bacterial infection

Symptoms will reflect the type and location of the infection

HIV/AIDS

se(x)ually transmitted disease

Weakens the immune system

NeuroAIDS, HIV/AIDS dementia

Language is often unaffected

• Mild to severe language deficits have been reported

Neurological symptoms of HIV/AIDS

Inability to learn new information

slowed processing

disfluent speech

impaired recall

reduced attention

Creutzfeldt-Jacob Disease

Degenerative and fatal brain disease caused by a prion

• Prion: tiny abnormal proteins that cause other normal proteins to misfold  → destroy brain cells

As neurons die, the brain develops microscopic holes, giving it a “spongy” like appearance

Affects the CNS

Symptoms of Creutzfeldt-Jacob Disease

Dementia with rapid onset and involuntary movements (balance, myoclonus=muscle jerk)

Personality or Behavioral changes

Speech and Swallowing difficulties

Mayo Clinic

Syphilis

Sexually transmitted disease

Caused by bacteria called spirochetes

Neurosyphilis

Simultaneous HIV and syphilis infections are common

Symptoms of Syphilis

Meningitis

headaches

stiff neck

visual changes

facial weakness

cognitive deficits

motor problems

Neurosyphilis

A version of syphilis that affects the nervous system

Occurs years after initial infection and treatment

Poliomyelitis (Polio)

Virus that attacks motor nerve tracks of the PNS

Primarily infects children

Preventable with a vaccine

Symptoms of Poliomyelitis

Nonsymmetrical paralysis with diminished or absent reflexes

• Inability of PNS to deliver volitional and nonvolitional commands to the muscles

Seizures

Sudden, often periodic, abnormal levels of electrical discharge occurring in the brain

Mild-moderate seizures can produce a slowly accumulating level of brain damage to the affected areas over time

Severe seizures are capable of creating immediate brain damage or even death

• “Quiet Seizures” also possible, common in children

Seizure Causes

Stroke

TBI

tumor

surgical trauma

infections

epilepsy

Seizure Stages

→ Aura Stage

→ Ictus Stage Tonic

→ Ictus Stage Clonic

→ Post-ictal

Aura Stage

Period immediately before the seizure

Warning signs a seizure may occur:

• Headache, déjà vu, panic, nausea, radical mood changes, tingling in limbs, visual abnormalities

Ictus

Main stage of the seizure

Convulsions and loss of consciousness

Post-ictus

Period after the seizure

Post-ictal confusion

• Short-term cognitive deficits

Interictal period

time between seizures

Status epilepticus

Seizures one after the other without an interictal period

Partial Seizures

Pathological electrical overstimulation confined to

a limited region of the brain

• Can create any motor, sensory, or emotional

symptom

Simple partial seizure

Consciousness maintained during seizure

Complex partial seizure

Causes an altered state of consciousness

Generalized Serizures

Affect the entire brain and are associated with total loss of consciousness

• Tonic clonic seizure (grand mal)

• Petit mal (absence attacks)

Tonic clonic seizure (grand mal)

Tonic phase

• Loss of consciousness and body stiffens

Clonic phase

• Body convulses violently

Petit mal (absence attacks)

Loss of awareness for a few seconds

No motor activity, shaking, or convulsing

If a person is experiencing a seizure

• Put nothing in their mouth

• Clear away sharp or dangerous objects

• Turn them on their side

• Put a pillow or something soft under their head

• Stay with the person until the seizure ends or, if in a hospital, the appropriate medical personnel arrive