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Download Aphasia and cortical connections
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Kurt Sieloff, MD Overview Speech Terminology Classic Aphasias Non-classical Aphasias Cortical Syndromes Cortical Structures = Extra important / frequently tested Question Which is an example of semantic paraphasia? ○ Gingerjed for gingerbread ○ Leg for foot ○ Non-intelligible gibberish Question A patient presents with an expressive aprosodia and monotone speech, where is the lesion? ○ Non-dominant frontal ○ Non-dominant temporal ○ Dominant frontal ○ Dominant temporal Speech Terminology Paraphasia production of unintended speech ○ typically FLUENT aphasias ○ Phonemic: insertion of syllable papple for apple, gingerjed for gingerbread ○ Neologistic: substitution of gibberish or non- English word ○ Semantic: word related to intended word car for van, tiger for lion, leg for foot Speech Terminology Cont’d Prosody EMOTION! EMPHASIS! TONE! ○ Prosody production: NON-dominant dorsolateral FRONTAL ○ Prosody comprehension: NON-dominant TEMPORAL SIMILAR organization to Broca/Wernicke Speech Terminology Cont’d “Fluent” Aphasia: “Receptive” aphasia Word output per minute high Content per phrase “low” Expect paraphasias Questions Aphemia differs from Broca’s aphasia in that: ○ Speech is fluent ○ Writing is preserved ○ Comprehension is most often impaired ○ All of the above Question Which of the following is typical of Wernicke’s aphasia? ○ Expressive aphasia ○ Echolalia ○ Anosognosia ○ Retained verbal comprehension Classic Aphasias 1.) Broca’s 2.) Wernicke’s 3.) Conduction All have REPETITION IMPAIRED!!!! Classic Aphasias – Broca’s Broca’s: Comprehension PRESERVED Repetition IMPAIRED Non-fluent, slow agrammatical, telegraphic speech, “expressive aphasia” DOMINANT posterior lateral frontal lobe BRO(KEN) Production! Classic Aphasias – Broca’s Don’t confuse with – APHEMIA Non-fluent speech apraxia Occasional mutism But…. ABLE TO WRITE Broca’s can’t write! Classic Aphasias – Wernicke’s Wernicke’s Comprehension IMPAIRED Repetition IMPAIRED FLUENT Anosognosia (patient unaware) “Receptive” Aphasia Superior posterior gyrus of temporal lobe Classic Aphasias – Conduction Conduction Aphasia Comprehension INTACT Repetition IMPAIRED Phonemic paraphasic errors Arcuate Fasiculus (dominant parietal) Transcortical Aphasias REPETITION INTACT REPETITION INTACT REPETITION INTACT REPETITION INTACT I’m Alive! Non-Classical – Transcortical Sensory Transcortical Sensory Aphasia Similar to Wernicke’s BUT…. Repetition INTACT Comprehension IMPAIRED Echolalia (unsolicited repetition of other’s) Alzheimer’s! Temporal-parietal area Non-Classical – Transcortical Motor Transcortical Motor Aphasia Like Broca’s’ BUT… Repetition INTACT Comprehension INTACT Non-fluent, slow Supplementary Motor Area, left anterior superior frontal lobe (purple) Non-Classical Aphasias – Transcortical Repetition PRESERVED Echolalia Water-shed, hypoperfusion, severe carotid stenosis “extraslyvian” areas Other Aphasias Subcortical: basal ganglia, thalamus, internal capsule (aphasia is CORTICAL) Crossed: right-handed with right-hemi aphasia Global: no comprehension, no production Mixed transcortical: repeats but otherwise no comprehension/production Other Aphasias Primary Progressive (non-fluent) Aphasia Associated with CBD, PSP (less FTD) Abnormal microtuble associated tau Question Which is not a component of Gerstmann’s Syndrome ○ Alcalculia ○ Finger Agnosia ○ Prosopagnosia ○ Left-right disorientation Question Prosopagnosia results from injury to: ○ Pulvinar ○ Fusiform gyri ○ Doral lateral thalamus ○ Anterior temporal lobe Cortical Syndromes Alexia w/o agraphia: Often right homonymous hemianopsia Deficit of word BUT NOT letter reading Gerstmann Syndrome 1. Alexia + Agraphia 2. Finger agnosia 3. Acalculia 4. Left-right disorientation Left (DOMINANT) inferior parietal lobe including supramarginal and angular gyri Cortical Syndromes Remember POOR GERSTMANN His INFERIOR PARents LEFT at a young age As a result, he is a TERRIBLE student Can’t do math, read or write, tell left from right The poor kid doesn’t even recognize his own fingers! Cortical Syndromes Asomatognosia deny ownership of limb contralateral to lesion supramarginal gyrus of NON-dominant parietal lobe Prosopagnosia Inability to recognize people from face Bilateral lesions of fusiform (occipitotemporal) gyri Cortical Structures Cortical Structures Fornix Memory formation Damaged with transcollosal surgery / colloid cyst MAIN efferent (output pathway) from hippocampus traveling to the mammilary bodies Cortical Structures Amygdala Anterior temporal Processes “emotional significance” of stimuli including pain, fear Kluver-Bucy bilateral dysfunction, docile/placid MOST prominent efferent = STRIA TERMINALIS Anterior Commmisure Connects temporal lobes Has fibers from olfactory and amygdala Basal Nucleus of Meynert Cholinergic neurons to cortex and amygdala Cortical Structures Orbitofrontal Cortex Injury to lateral OC echopraxia and utilization behavior (OCD OC..Do!) OC ‘syndrome’ socially inappropriate behaviors, poor impulse control, disinhibition Nucleus accumbens (in green) Receives input from limbic and OC Involved with anticipating rewards Gambling, substance abuse, addiction “If I keep gambling, I will ACCUMB(ULATE) wealth!”
