Aphasia – a reminder.pdf
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This document provides an overview of aphasia and related language disorders. It begins with an example of a patient exhibiting Broca's aphasia by incorrectly identifying the dead animal in a question. The rest of the document covers the historical figures who discovered different types of aphasia, the anatomy of language processing in the brain, clinical assessment of aphasia, and descriptions of specific aphasia types including Broca's, Wernicke's, conduction, and transcortical variants. It also discusses related disorders such as alexia, agraphia, aphemia, and cortical auditory disorders. In summary, the document presents information on the neurological basis and clinical manifestations of different language impairments.
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Aphasia – a reminder.pdf
- 1. Aphasia – a reminder Yasser Alzainy MSc.
- 2. Doctor: “the tiger was killed by the lion. Which one of them is dead?” Aphasic patient: “the lion.” 5/2/2023 PRESENTATION TITLE 2
- 3. Which type of aphasia does this patient have? Answer after the lecture 5/2/2023 PRESENTATION TITLE 3
- 4. Agenda • Historical Note • Anatomy of language processing • Differential diagnosis of language disorders • Bedside language exam • Broca’s aphasia • Wernicke’s aphasia • Simplified Aphasia classification scheme • Other syndromes related to aphasia 5/2/2023 PRESENTATION TITLE 4
- 5. TimeLine Discovered that damage to a specific area of the brain (now known as Broca's area) resulted in language deficits. Pierre Paul Broca Discovered that damage to a different area of the brain (now known as Wernicke's area) resulted in language comprehension deficits. Karl Wernicke Proposed a model of language processing that involved interactions between Broca's and Wernicke's areas, as well as other brain regions. Norman Geschwind Investigated the role of neural oscillations in speech perception and how different brain regions interact during language processing. David Poeppel Investigated the role of different brain regions in syntax processing and language acquisition Angela Friederici Investigated the role of syntax and semantics in language processing, and how these processes are implemented in the brain. Liina Pylkkänen 5/2/2023 PRESENTATION TITLE 5
- 10. Aphasia Aphasia is a defect in language processing cause by dysfunction of the dominant cerebral hemisphere; both spoken and written languages are affected 5/2/2023 PRESENTATION TITLE 10
- 12. Disorders of speech production Dysarthria Aphemia (verbal apraxia) Mutism Auditory disorders Peripheral hearing loss Pure word deafness Cortical deafness Defects in arousal and attention Global confusional state Narcolepsy Psychiatric disorders Schizophrenia Conversion disorder and other somatoform disorders Uncooperative patient Malingering 5/2/2023 PRESENTATION TITLE 12
- 14. Causes of Aphasia • Cerebral contusion • Subdural • Epidural hematoma Head Trauma • Ischemic • Haemorrhagic Vascular event • Ictal • Post-ictal Focal seizures in dominant hemisphere • Brain tumor • Abscess • Toxoplasmosis Mass lesions • Vasculitides • Multiple Sclerosis Inflammatory / Autoimmune • Language delay • Autism Developmental disorders • Progressive non- fluent aphasia • Semantic dementia • Advanced Alzheimer’s disease • Huntington’s disease Degenerative disorders 5/2/2023 PRESENTATION TITLE 14
- 16. 6-Step Bedside Test 1. Spontaneous speech • Fluency • Prosody • Grammar and meaning • Paraphasias • Articulation 2. Naming • Visual confrontation naming • Responsive naming • Objects and parts • Nouns, verbs, proper nouns, colors, etc. 3. Comprehension • Commands, simple to complex • Yes/no questions and multiple choice • Point to objects • Syntax-dependent meaning 4. Repetition • Single words • Simple sentences • Complex sentences 5. Reading • Aloud • Comprehension 6. Writing • Patient’s name • Copy sentence • Spontaneous sentence 5/2/2023 PRESENTATION TITLE 16
- 17. Clinical Vignette 5/2/2023 PRESENTATION TITLE 17 A 65-year-old man presented with mild dysarthria and subtle right upper limb and facial weakness that began 1 hour ago. He had a history of atheromatous disease. What is the NIHSS of this patient? When asked to repeat “The president lives in Washington,” he made phonologic paraphasic errors.
- 19. 5/2/2023 PRESENTATION TITLE 19
- 20. Broca’s aphasia • Caused by lesions affecting Broca's area and adjacent structures in the dominant frontal lobe • Decreased Fluency: o Decreased phrase length (<5 words) o Content words > Function words o Impaired word generation tests (FAS test) 5/2/2023 Aphasia – a reminder 20
- 21. Broca’s aphasia – cont. • Impaired Syntax: Speech is effortful, telegraphic, and agrammatical • Naming: Marked difficulties • Repetition: impaired (disconnection from Wernicke's area) o Esp. phrases with high content of function words • Comprehension is "relatively" intact o Exception is for syntactically dependent structures. 5/2/2023 Aphasia – a reminder 21
- 22. Broca’s aphasia – cont. • Writing and reading aloud: o Slow, effortful, agrammatical • Reading comprehension is often “relatively” spared o Exception: syntactically dependent structures. • Associated features: o Dysarthria o Right hemiparesis o Frustration and depression 5/2/2023 Aphasia – a reminder 22
- 23. Broca’s aphasia patient: “Stroke ... Sunday night... Navy, Army, Airforce ... Sunday night ... Pool (gestures motion for shooting pool) ... pay phone... “I got your girlfriend”. I don’t know ... memo- ries … memories ... shot twice (gestures trigger pull with hand) ... pints of blood (holding his neck area) ... bar ... helpless ... helpless ... rescue ... helicopter ... coma ... heli- copter ... passed out ... helicopter… memories ... drugged up ... drill, drill (points to head) ... drugged up ... Tragedy.” 5/2/2023 Aphasia – a reminder 23
- 25. Wernicke’s aphasia • Caused by lesions affection Wernicke's area and adjacent structures in the dominant temporoparietal lobes • Impaired Comprehension o Do not respond appropriately to questions and follow virtually no commands 5/2/2023 PRESENTATION TITLE 25
- 26. Wernicke’s aphasia – cont. • Impaired Lexicon: Speech is empty, meaningless, and nonsensical • Naming: some difficulties with frequent paraphasic errors o Semantic o Phonemic • Repetition: impaired (disconnection for Broca's area) 5/2/2023 PRESENTATION TITLE 26
- 27. Wernicke’s aphasia – cont. • Writing and reading aloud o Fluent but meaningless • Reading comprehension: impaired • Associated features: o Contralateral (right) upper quadrantanopia o Anosognosia (carry out with conversation despite markedly impaired) o Angry or paranoid behavior 5/2/2023 PRESENTATION TITLE 27
- 28. Wernicke’s aphasia patient: “I’ve been retired since 1972 with /cardimiapesun/ (cardiomyopathy). Ten per cent [of] the people [of] the /catraps/ (cataracts) has the [problem with the] retina. I was in the /bizzet/ (business) of records … /fotegraph/ (phonograph) records … for the /shusta/ (distribution?) … In other words, I was a /eksiev/ (executive). Look, I think it’s /porten/ (important). I can’t [say] /tivelsha/, /diveltsher/(television), uh TV.” 5/2/2023 PRESENTATION TITLE 28
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- 33. Question 5/2/2023 Aphasia – a reminder 33
- 34. What was the type of aphasia in the patient in the first question? • Broca’s Aphasia • Wernicke’s Aphasia 5/2/2023 Aphasia – a reminder 34
- 35. Test Yourself Classify aphasia based on date provided 5/2/2023 Aphasia – a reminder 35
- 36. Intact fluency Intact comprehension Impaired repetition Conductive aphasia 5/2/2023 Aphasia – a reminder 36
- 37. Impaired fluency Intact comprehension Impaired repetition Broca’s aphasia 5/2/2023 Aphasia – a reminder 37
- 38. Impaired fluency Impaired comprehension Intact repetition Mixed transcortical aphasia 5/2/2023 Aphasia – a reminder 38
- 39. Intact fluency Impaired comprehension Impaired repetition Wernicke’s aphasia 5/2/2023 Aphasia – a reminder 39
- 40. Impaired fluency Impaired comprehension Impaired repetition Global aphasia 5/2/2023 Aphasia – a reminder 40
- 41. Impaired fluency Intact comprehension Intact repetition Transcortical motor aphasia 5/2/2023 Aphasia – a reminder 41
- 42. Intact fluency Impaired comprehension Intact repetition Transcortical sensory aphasia 5/2/2023 Aphasia – a reminder 42
- 43. Intact fluency Intact comprehension Intact repetition Nominal aphasia 5/2/2023 Aphasia – a reminder 43
- 44. Recovery from Aphasia Subtle dysnomia Transcortical motor aphasia Broca’s aphasia Global aphasia 5/2/2023 PRESENTATION TITLE 44 Dysnomia Transcortical sensory aphasia Wernicke’s aphasia
- 45. Other syndromes related to aphasia
- 46. Alexia and Agraphia • Impairment in reading / writing caused by deficits in central language processing and not by simple sensory or motor deficits • Tend to parallel the aphasic syndrome for spoken language 5/2/2023 Aphasia – a reminder 46
- 47. Variants • Agraphia without aphasia • Occur in lesion of the inferior parietal lobule of the dominant hemisphere (alone or as a part of Gerstmann's syndrome • Agraphia of the non-dominant hand • Occur in lesions of the corpus callosum (disconnection from language areas) • Alexia without agraphia: • Occur in PCA infarct involving the splenium of the corpus callosum. (can't read what they wrote!) 5/2/2023 Aphasia – a reminder 47
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- 49. Aphemia • Severe apraxia of the speech articulatory apparatus, without a language disturbance. • Caused by a small lesion of the dominant frontal operculum and connection to Broca’s area. • Have normal written language. • Patients with aphemia have effortful, poorly articulated speech sometimes referred to as foreign accent syndrome. 5/2/2023 PRESENTATION TITLE 49
- 51. Cortical Auditory disorders 5/2/2023 PRESENTATION TITLE 51 Can understand speech Cannot understand speech Can identify non-verbal sounds Normal Pure word deafness Cannot identify non-verbal sounds Non-verbal auditory agnosia Cortical deafness
- 52. Cortical Auditory disorders – cont. • Cortical deafness • Bilateral lesions of the primary auditory cortex in Heschl's gyrus • Can read and write normally • Pure word deafness • Lesion of the auditory area of the dominant hemisphere • Speak normally but, cannot understand speech (even their own if its recorded and played back to them). • Nonverbal auditory agnosia • Lesion of the auditory area in the non-dominant hemisphere. 5/2/2023 Aphasia – a reminder 52