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160 Cards in this Set
- Front
- Back
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What fraction of the cortex do we understand?
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one third
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Show the blood supple to the cortex (ACA, MCA, and PCA)
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What is the blood supply to the lateral part of each hemisphere?
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MCA
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Show the blood supply to the medial cerebral hemisphere.
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What is special about the central sulcus? How can you identify it?
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It is the only sulus to go all the way to the medial side of the cerebral hemisphere
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Show which parts of the motor cotex supply corticobulbar/cranial nerves vs corticospinal.
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WHat is the major blood supply to the somatosensory and motor cortex?
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middle cerebral artery
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What sensations and movements would you lose in a left MCA infarct? Show it.
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Right side motor and sensation from the arms up.
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What blood vessel would knock off the function of the rest of the homunculi? SHow it's territory!
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The ACA resp for anterior 3/5 of the medial part of the hemisphere.
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So which two arteries affect the motor and sensory homunculi?
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ACA and MCA
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Do the cranial nerves get contralateral innervation? Is there an exception?
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No, they get bilateral! except fot the facial nerve
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Define and show the boundaries of the prefrontal cortex.
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In green. It is the excess area that is past the motor cortexes in the frontal lobe
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NOW WE TALK ABOUT DOMINANT HEMISPHERES!
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YAY!
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Are we talking about left and right in this next section or dominant and nondominant?
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dominant and nondominant
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Can you still be left brain dominant if you are left handed? Statistic?
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Yes, 60% of let handed people are left brain dominant.
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Can the nondominant also play a role in speech? Describe the difference.
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Yes, but not as strongly.
nondominant: prosody- create and understand emotional tone dominant: language- create and understand speech |
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Which capability do dogs have more of?
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prosody
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What does it mean if we are right handed?
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The UMN's coming from the left are more skilled.
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Compare dominant and nondominant in their different abilities for math.
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dominant- can manipulate numbers and do calculations
nondominant- can organize numbers in rows |
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Compare dominant and nondominant in their different abilities for motor tasks and spatial awareness.
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dominant- skilled motor formation
nondominant- spatial awareness and analysis |
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What is a word for skilled motor formation (like writing)?
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praxis
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Compare dominant and nondominant in their different abilities for musical ability.
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dominant- more active in train musicians
nondominant- more active in untrained musicians |
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So what are you trying to shift about your musical center by training musically?
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trying to shift it to the dominant side
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Compare dominant and nondominant in their different abilities for sense of direction.
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dominant- can follow set of written directions in sequnce
nondominant- being able to generally sense where you are spatially |
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NOW WE TALK ABOUT SPEECH CENTERS!
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WERNIIIIE
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Which side of the brain are broca's and wernicke's area on?
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the dominant side.
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What functional areas are broca's vs wernicke's area by?
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broca's- by the vocal motor cortex
Wernicke's- the auditory cortex |
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Which two functional cortexes are near Wernicke's area?
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visual written and auditory
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What is the name for the written comprehension cortex called?
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the angular gyrus
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Why is angulate gyrus called what it is?
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It makes an angle where the sylvian fissure ends
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What area is the angular gyrus near? Why is this advantageous?
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the visual cortex so you can comprehend what you see written down
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Show wernicke's area with it's two related areas that will feed it info.
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Which is the largest lobe by far?
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frontal
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What is held in the frontal lobe besides the frontal eye field and Broca's?
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We don't exactly know, but it contains our personality and learned experiences
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What is the number for the angular gyrus/written comprehension center?
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39
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Show the angular gyrus
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what vessel supplies all the language centers?
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the MCA on the dominant side
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Give the table of stats for which side is dominant for which handedness
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What is area 4?
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primary motor cortex
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What are areas 3, 1, and 2?
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Somatosensory cortex
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What is area 44 and 45? Mnemonic?
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Broca's\
Tom Broca was 44 and 45 throughout his peak |
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What number is the frontal eye field? Mnemonic?
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8
looks like a pair of glasses |
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Give the image with all the brodmann's numbers
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Define apraxia.
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the inability to perform a movement despite the will and physical capacity to do so
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What would you call disordered movement? Is this the name.
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ataxia and no
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define -praxia
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performance of movements
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What is wrong in a person with apraxia?
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they lack the higher planning centers for movement (premotor or supplementary motor cortex)
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Breakdown agnosia
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a- not
gnosia- knowing not knowing (a sensation) |
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Breakdown astereognosia.
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no knowledge of 3D shapes (stereo)
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What side would you have somatosensory agnosia in if you have the lesion on the left?
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on the right
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What is lesioned in a stereoagnosia?
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the somatosensory association cortex
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So what are the higher cerebral dysfunction associated disorders?
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apraxia and agnosia
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What is an apraxic gait like?
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they can't really take steps on their own but can shuffle a little when pulled
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What is apraxic speech like?
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garbled. can't understand it.
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What sx usually accompanies any kind of aphasia? Why?
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a or dys graphia because all of the same centers are needed as for verbal language
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What is a classic test for aphasia repetition?
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repeat the phrase, "no ifs, ands, or buts"
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What kind of speech would a pt with Broca's aphasia have?
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reduced to monosyllabic speech
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What kind of weakness would a pt with broca's have? Where?
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spastic weakness of lower face and upper limb contralaterally
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Do you process sound bilaterally or unilaterally? How do you know?
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bilaterally. because some cochlear fibers cross in the trapezoid body and some do not
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Who is more frustrated/unaware of their disorder? (b/w)
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unaware or not concerned- wernicke's
frustrated- broca's |
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What do pts with Wernicke's usually attribute their deficit to?
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hearing loss or other people not speaking clearly.
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What sx accompanies b/w aphasia? and mimic the way we tallk?
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agraphia (they write the way their aphsia makes them talk)
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What function is lost with an angular gyrus lesion?
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ability to read
you get alexia |
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breakdown alexia? What common disorder has the same root?
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a- no
lexia- reading dyslexia is impaired reading |
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What region(s) are the math centers? Name and show them.
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40 and 39
(39 in angular gyrus) |
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What is the lesion in Gerstmann syndrome?
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the angular gyrus (brodmann 39)
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What are the 4 sx of Gerstmann Syndrome?
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1. alexia
2. agraphia 3. acalculia 4. finger agnosia |
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explain the alexia
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this is the written comprehension center
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explain the agraphia
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this center is like wernicke's for speech and wernicke's tends to make word salad because it provides the words to say on top of just understanding them
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explain the acalculia
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the math center is in the angular gyrus (as well as in the neighboring brodmann 40)
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explain the finger agnosia
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we probably learned to count on our fingers at an early age so our finger identification is involved in our math center
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explain the disability in finger agnosia
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you ask a person to point to their index finger (usually the right because the center is on the left) and they can't
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.;Where is the lesion in gerstann's?
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dominant parietal lobe
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Will people with Gerstman's know about their deficit?
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probably not. either that or they are not concerned.
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Sum up the affected areas in Gerstmann's syndrome?
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the dominant parietal lobe around the angular gyrus is lesioned. It knocks out the written comprehension and math centers.
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What happens if you have a lesion of the nondominant parietal lobe? Explain the sx.
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unilateral neglect. Pt doesn't take care of the contralateral side because they don't think it belongs to them.
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How did the one lady describe what having unilateral neglect was like?
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it was like she was only paying attention to one side and didn't realize she didn't do the other side till it was pointed out.
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What is the classic test for unilateral neglect?
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drawing a clockface
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Is it possible for them not to be able to see the left side at all? How?
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Yes, if they have enough damage that their visual cortex is also affected
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Show the territories of blood supply again
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What kind of aphasia would a ACA infarct product?
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transcortical motor aphasia
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What syndromes would result from dominant MCA infarction?
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aphasias and Gerstmann's syndrome
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What syndromes would result from nondominant MCA infarction?
Why nondominant? |
unilateral neglect and spatial perception deficits
this side is more specialized for spatial awareness |
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What lobe(s) does the PCA cover?
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part of the upper parietal and the occipital
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How would a PCA infarct affect the occipital lobe? What is this called and what is spared?
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you would get contralateral lack of visual processsing presenting as homonomous hemianopsia with macular sparing
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Breakdown homonomous hemianopsia
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Homonymous: (having the same name or designation) or standing in the same relation
hemi: half anopsia: blindness |
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What does it look like to have Homonymous hemianopsia from a right PCA lesion?
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can't see the left half of both eye field
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What is macular sparing? Show what it would look like to the pt.
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when the center 5-10 degrees is not affected
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Show the macula. What is here?
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a high concentration of color cone cells
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Why are the macula spared?
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because they have a readily available source of blood supply from the MCA
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What deficit will you get with a dominant PCA infarct on the parietal/occipital lobe junction area?
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alexia without agraphia
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In processing stimuli, What are the 2nd and 3rd areas together called? (analysis and recognition)
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association area
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What is another name for the receiving area? (1st)
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The primary area
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Mnemonic for visual cortex numbers?
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You start to see the world at 17
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Mnemonic for auditory cortex numbers?
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When she hears the noise of sin,
22- Nun 41- Rat 42- Runs |
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WHat info exactly does Broca's area contain?
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the motor programs for saying certain words.
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Do you talk during inspiration or expiration? Why?
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expiration because you are pumping air out of the vocal cords
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What do you call the production of sound?
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phonation
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What is the main structure associated with phonation?
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layrnx (with vocal cords)
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What is articulation then?
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The process of modulation the sound to produce words
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What are the structures associated with artculation? (5)
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1. larynx
2. tongue 3. pharynx 4. lips 5. soft palate |
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Show which cranial nerves control each structure for articulation (assume 9 just goes with 10)
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If articulation needs to be very coordinated, what do the 7, 9, 10, 11, and 12th nuclei have to be heavily connected to?
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the cerebellum and primary motor area assoiated with broca's
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What is a dys-phonia?
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problem with the production of sound
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What are two broad reasons for dysphonias?
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1. psychological
2. physiological |
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Which structures are ultimately affected in dysphonias or aphonias?
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The larynx or the respiratory system
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What is dysarthria?
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trouble articulating
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What are some reasons for dysarthria? (5)
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1. cerebellar dysfunction
2. UMN (corticobulbar) 3. LMN (cranial nerves) 4. NMJ 5. Muscle pathology |
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What would the articulation result of cerebellar dysfunction be? (think drunk people with cerebellar dysfunction in purkinjies)
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slurring of speech due to incoordination of the muscles
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What are the two types of UMN caused dysarthria?
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pyrimidal vs extrapyrimidal
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Give an example of each.
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pyrimidal- spastic dysarthria
extrapyrimidal- parkinsons (unable to start or stop speech well) |
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Give 2 examples of a LMN problem.
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tumpr in the brainstem area.
Bell's palsy |
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Give an example of a NMJ problem. Is this dysphonia or dysarthria?
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myasthenia gravis. It is both
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NOW WE TALK ABOUT DYSPHASIA AND APHASIA
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YAY!
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What areas can be defective in a or dys phasias?
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broca's, wernicke's, or arcuate fasiculus
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Which areas are ok in -phasias?
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all the ones listed for dysarthrias. (5)
plus vision and hearing processing |
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So describe aphasia pathologically.
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There is a problem with the higher language centers that decode and encode language (verbal, written, or signs)
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Just like in any other movement, what two structures need to be consulted before speech is made?
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the basal ganglia and the cerebellum
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Sx for Broca's aphasia
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1. Can't say words
2. Can't repeat words |
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What are some alternate names for Broca's aphasia? (4)
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1. anterior aphasia
2. expressive aphasia 3. nonfluent aphasia 4. mute aphasia |
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Sx for Wernicke's aphasia?
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1. Can't understand speech
2. Can't repeat speech 3. Word salad without knowing it |
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Why don't you recognize that you said the wrong word?
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you can't understand your own words
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Why do you say the wrong word? (2 of my own theories)
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1. your programs for words are intact, but your mental dictionary is out of whack
2. you cannot correct yourself (normal people say wrong words too) |
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What two types of nonsensical speech can someone with Wernicke's say?
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1. word salad (wrong word)
2. neoligisms (make up new words) |
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What are 3 alternative names for wernicke's aphasia?
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1. Posterior aphasia
2. Receptive aphasia 3. Fluent aphasia |
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What do you call it when you are adding unintended words and syllables to your speech?
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paraphasia
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What speech ability is the arcuate fasiculus responsible for?
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repetition
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What is another name for a arcuate fasiculus lesion?
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conduction aphasia
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How common is this aphasia compared to the others?
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much more rare
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What is it like to have conduction aphasia?
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You cannot repeat back things said to you
You have difficulty correct yourself when you mispeak although you recognize it |
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What disability is common between all of the aphasias?
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problem with repetition
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define transcortical
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of or relating to nerve pathways that cross the cerebral cortex of the brain.
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What is the lesion in transcortical motor aphasia? Show it.
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cut off broca's from the rest of the frontal cortex
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What is the sx in transcortical motor aphasia?
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difficulty in saying the things you want to say (frontal to broca disconnection), but with repetition intact
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What is the lesion in transcortical sensory aphasia? Show it.
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What ability is commonly retained in both trancortical motor and sensory aphasia?
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the ability to repeat something because wernicke's broca's area and their connections are intact.
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What is the sx in transcortical sensory aphasia?
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You cannot understand language, but can repeat sounds and written words.
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WHat is mixed transcortical aphasia?
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when it is both motor and sensory
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What is the sx of nominal aphasia?
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you know it is a book for reading, but call it a car.
repetition is intact |
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What is damaged in nominal aphasia supposedly? (mnemonic)
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the posterior part of wericke's. similar to a word salad phenomenon
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What is lesioned in global aphasia?
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everything from broca's to arcuate to wernicke's
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What lesions can imitate Broca's vs Wernicke's aphasia?
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Broca's- anterior BG (caudate head and putamen)
Wernicke's- posterior BG (GPi and e) |
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How can you distinguish BG lesions from broca's and wernicke's aphasia by sx?
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usually broca's and wernicke's will involve neighboring damage as well
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What sx usually present with Broca's? Why?
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contralateral lower face and upper limb weakness because of the nearby motor homunculus
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What sx usually present with Wernicke's? Why?
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contralateral loss of visual processing and 50% hearing loss because of he nearby visual and auditory cortex
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What sx usually present with BG lesions? Why?
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loss of tone and posture because the BG helps pull up these programs to help intended movements
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Describe thalamic aphasia.
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1. You can understand what others are saying
2. Others cannot understand what you are saying |
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Which nucleus of the thalamus is concerned with the sensory system?
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the ventral posterior nucleus
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Which nucleus of the thalamus is concerned with the motor system?
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ventral anterior and intermediate
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Which parts of the thalamus are involved in visual and auditory processing?
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the medial and lateral genticulate bodies
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What are thalamic aphasia pts usually mistaken for?
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psychotic patients
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Define a watershed area.
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the boundary between two blood supplies that is the first to hypoperfuse in low BP
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In a watershed problem, what kind of aphasia could you get?
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any combination of the common ones! they are all close to the watershed line
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What sx do you have when you have a lesion of the corrsponding Broca's area on the nondominant side.
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flat speech
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What disorder is this?
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expressive dysprosody
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Define prosody.
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the rhythm, stress, and intonation of speech
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What is you had a lesion on the nondominant Wernicke's?
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receptive dysprosody- can't understand emotional tone
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Name all 12 types of aphasia/dysphasias.
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1. Broca's 2. Wernicke's 3. TC sensory 4. TC Motor 5. TC mixed 6. Nominal 7. Global 6. Anterior BG 7. Posterior BG 8. Thalamic 9. Watershed 10. Conducting
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did you remember 4 to the floor for primary motor?
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then you need to write **** down!
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