Term
| disconnection syndrome that causes the inability to read |
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Definition
| lesion in the white matter (arcuate fasciculus) disconnects the network connections between visual cortex and the language processing areas |
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Term
| Broca's area (Brodmann's areas) |
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Definition
44 and 45
adjacent areas = 9, 46 and 47 and more broadly 6, 8, and 10 |
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Term
| Wernicke's area (Brodmann's areas) |
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Definition
22
Adjacent areas = 37, 39 and 40 |
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Term
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Definition
| subcortical white matter that connects Wernicke's and Broca's areas along the intervening peri-Sylvian cortex |
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Term
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Definition
| defect in language processing caused by dysfunction of the dominant cerebral hemisphere |
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Term
| Most common cause of Broca's aphasia |
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Definition
| infarct of the left middle cerebral artery superior division |
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Term
| Symptoms of Broca's aphasia |
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Definition
decreased fluency or spontaneous speech
phrase length of less than 5 words and 1. sentences that contain more content 2. words than functional words
3. prosody is lacking in patients
4. naming difficulties
5. repetition is impaired
6. comprehension of syntactical dependent structures is affected ("the lion was killed by the tiger, who is dead?")
7. dyarthria
8. Reading and writing are slow and effortful (reading comprehension is spared)
9. frustration and depression |
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Term
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Definition
normal melodious intonation of speech that conveys the meaning of sentence structure
**lacks in Broca's aphasia |
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Term
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Definition
inability to perform tasks when asked even though the request is understood and they are willing to do the task
**inability to formulate the correct movement sequence and can be caused by lesions in many locations |
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Term
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Definition
large lesion that involves much of the dominant frontal lobe
begins with global aphasia and the diminishes to Broca's aphasia |
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Term
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Definition
caused by a smaller lesion and is confined to the region of the frontal operculum, including Broca's area
starts with Broca's aphasia and recovers to mild decreased fluency and some naming difficulties |
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Term
| most common cause of Wernicke's aphasia |
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Definition
| infarct in the left middle cerebral artery inferior division |
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Term
| symptoms of Wernicke's aphasia |
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Definition
1. impaired comprehension (do not respond appropriately to questions and do not follow commands)
2. speech that is empty, meaningless, and full of nonsensical paraphasic errors
3. naming is impaired
4. impaired repetition (because it is disconnected from Broca's)
5. Reading and writing deficits are similar to speech problems
6. contralateral visual field cut (especially RUQ) due to involvement of the optic radiation
7. Apraxia
8. anosognosia
9. Angry or paranoid behavior |
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Term
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Definition
| pt is unaware of their condition |
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Term
| important symptoms of global aphasia |
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Definition
1. impaired fluency
2. impaired comprehension
3. impaired repetition
infarct of both superior and inferior MCA |
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Term
| important symptoms of conduction aphasia |
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Definition
1. normal fluency
2. normal comprehension
3. impaired repetition
4. speech is fluent, although paraphasic errors are common
5. naming is often impaired
infarct or lesion in the peri-sylvian area that interrupts the arcuate faciculus or supramarginal gyrus |
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Term
| symptoms of transcortical aphasias |
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Definition
resemble Broca's and Wernicke's aphasias but repetition is spared
**usually caused by watershed infarcts = spare Broca's and Wernicke's and their interconnections, but damage other language areas of the frontal or temporoparietal corticies
**common in subcortical lesions of basal ganglia or thalamus or in recovery from other aphasia syndromes |
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Term
| symptoms of transcortical motor aphasia |
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Definition
1. impaired fluency
2. normal comprehension
3. normal repetition
caused by ACA-MCA watershed infarcts
destroys connections to other regions of the frontal lobe that are needed for Broca's area to function in language formation, but Broca's and Wernicke's areas are intact so repetition is spared |
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Term
| symptoms of transcortical sensory aphasia |
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Definition
1. normal fluency
2. impaired comprehension
3. normal repetition
Caused by MCA-PCA watershed infarcts
connections from Wernicke's to the parietal and temporal lobes are damaged but peri-sylvian area is left intact (sparing repetition) |
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Term
| symptoms of mixed transcortical aphasia |
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Definition
1. impaired fluency
2. impaired comprehension
3. normal repetition
**also called isolation of the language areas
caused by combined MCA-ACA and MCA-PCA watershed infarcts as well as subcortical lesions |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| In patients with aphasia, _______ is invariably present |
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Definition
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Term
| when is agraphia without aphasia seen? |
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Definition
| in lesion of the inferior parietal lobule of the language-dominant hemisphere |
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Term
| When is alexia without agraphia seen? |
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Definition
| in lesions of the dominant occipital cortex that extend to the posterior corpus callosum = usually a PCA infarct |
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Term
| When does alexia with agraphia occur? |
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Definition
in lesions of the dominant inferior parietal lobule in the region of the angular gyrus
**aphasia is sometimes absent or may consist of only mild dysnomia |
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Term
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Definition
| a developmental reading disorder |
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Term
| symptoms of Gerstmann's syndrome |
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Definition
1. agraphia
2. acalcula
3. right-left disorientation
4. finger agnosia
when present with global confusional state or other diffuse disorder, this syndrome is strongly localized to the dominant inferior parietal lobule in the region of the angular gyrus |
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Term
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Definition
severe apraxia of the speech articulatory apparatus, without a language disturbance
**usually caused by a small lesion of the dominant frontal operculum restricted to Broca's area
**pts have normal written language
**also called the "foreign accent syndrome" = effortful, poorly articulated speech |
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Term
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Definition
| aphemia that occurs as a developmental disorder in children often without visual lesions on imaging studies |
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Term
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Definition
bilateral lesions of the primary auditory cortex in Heschl's gyrus
pts are often aware that the sound has occurred but cannot interpret the verbal stimuli |
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Term
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Definition
verbal auditory agnosia
can identify nonverbal sounds but cannot understand any spoken words
pt's can read and write normally unlike in Wernicke's aphasia, and pt can speak normally but cannot understand speech (even their own if played back to them)
lesion = infarct in the auditory area of the dominant hemisphere that extends to the subcortical white matter, cutting off auditory input from the contralateral hemisphere |
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Term
| nonverbal auditory agnosia |
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Definition
pts understand speech but cannon identify nonverbal sounds
lesion = usually located in the nondominant hemisphere |
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Term
| the right hemisphere is more important for __________ in most individuals. |
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Definition
| attentional mechanisms and integrated visual-spatial realization |
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Term
| Which area of the brain is especially important for visual-spacial analysis? |
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Definition
| parietal association cortex (at the junction of the parietal, temporal and occipital lobes) |
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Term
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Definition
| pt erroneously reports the location of a stimulous given to the left side of body as being on the right |
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Term
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Definition
| decreased spontaneous movements of the unilateral limbs and trunk, or decreased eye movements towards the neglected side |
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Term
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Definition
| pt inappropriately moves the normal limb when asked to move the neglected limb |
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Term
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Definition
| limb movements are impaired when the limbs are located in the neglected hemispace |
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Term
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Definition
| pt is aware that they have severe deficits yet show no emotional concern or distress about it |
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Term
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Definition
| patient denies that the left half of their body belongs to them |
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Term
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Definition
overall spatial arrangement
impaired in lesions of the non-dominant hemisphere |
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Term
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Definition
| difficulty comprehending the emotional expression of other's speech |
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Term
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Definition
| difficulty conveying appropriate emotional expression in their own speech |
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Term
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Definition
| patients insist that their friends and family members have all been replaced by identical-looking imposters |
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Term
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Definition
| patients believe that different people are actually the same person who is in disguise |
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Term
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Definition
| patients believe that a person, place or object exists as two identical copies |
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Term
| dorsolateral convexity lesions of the frontal lobes |
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Definition
| tend to produce an apathetic, lifeless, abulic state |
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Term
| ventromedial orbitofrontal lesions |
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Definition
| lead to impulsive, disinhibited behavior and poor judgement |
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Term
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Definition
| more associated with depression-like symtoms |
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Term
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Definition
| more associated with behavioral disturbances resembling mania |
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Term
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Definition
pts are passive and apathetic, exhibiting little spontaneous activity, markedly delayed responses and a tendency to speak briefly or softly
extreme = pt may be totally immobile, akinetic and mute |
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Term
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Definition
| pts exhibit silly behavior, crass jokes, and aggressive behavior |
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Term
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Definition
| patients are given a list of color names printed in colors that are different from the name they represent. Pts are instructed to list the ink colors of the words without reading the words |
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Term
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Definition
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Term
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Definition
| tone is increased, but in a manner in which the patient appears to resist the movements of the examiner in an almost willful fashion |
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Term
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Definition
a primitive reflex seen in infants
examiner can elicit in frontal lobe lesions by stroking the patient's palm |
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Term
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Definition
shuffling gait in which the pt's feet barely touch the floor
seen in frontal lobe lesions |
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Term
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Definition
| glabellar sign is a primitive reflex where the pt blinks when the examiner taps on his or her head. The pt should blink for the first couple taps but if the blinking continues, it is abnormal = Myerson's reflex; a sign of Parkinson's disease |
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Term
| dorsal pathways of the brain |
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Definition
| project to parieto-occipital association cortex ; answer the question "where"? = analyze motion and spatial relationships between objects, and between the body and visual stimuli |
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Term
| ventral pathways of the brain |
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Definition
| project to the occipitotemporal association cortex; answer the question "what"? = analyze form, with specific regions identifying colors, faces, letters and other visual stimuli |
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Term
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Definition
cortical blindness
caused by bilateral lesions of the primary cortex
pts have complete visual loss on confrontation testing yet they have anosognosia and are completely unaware of the deficit |
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Term
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Definition
pts are unable to recognize people by looking at their faces
commonly caused from a lesion in the occipitotemporal cortex, also known as the fusiform gyrus |
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Term
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Definition
| normal perception stripped of its meaning |
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Term
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Definition
a central disorder of color perception
can be cortical color blindness and is usually caused by lesions in bilateral inferior occipitotemporal cortex
**not the same as color agnosia (color perception is intact--caused by lesions of the primary visual cortex of the dominant hemisphere) |
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Term
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Definition
| objects appear unusually small |
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Term
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Definition
| objects appear unusually big |
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Term
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Definition
| a more general term describing a condition in which objects have distorted shape and size |
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Term
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Definition
previously seen objects reappear periodically
caused by lesions of the visual association cortex or medications such as trazodone |
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Term
| polyopia (cerebral diplopia) |
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Definition
pts see two or more images, respectively, of an object
can be psychiatric in origin or can be seen with occipital lesions, corneal lesions, or cateracts |
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Term
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Definition
gold, red, purple or other unnatural coloring of the visual field
can be seen with certain drugs, such as digitalis toxicity = yellowish halo |
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Term
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Definition
bilateral lesions of the dorsolateral parieto-occipital association cortex
clinical triad of symptoms:
1. simultanagnosia (core abnormality)
2. optic ataxia
3. ocular apraxia
**commonly caused by MCA-PCA watershed infarcts, but can also be caused from hemorrhage, tumors, or dementia with posterior cortical atrophy |
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Term
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Definition
impaired ability to perceive parts of a visual scene as a whole; deficit in visual-spacial binding
core abnormality in Balint's syndrome |
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Term
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Definition
impaired ability to reach for or point to objects in space under visual guidance
**distinguished from cerebellar ataxia because the pt can still point using proprioceptive or auditory clues and can perform smooth movements with their eyes closed |
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Term
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Definition
| difficulty voluntarily directing one's gaze toward objects in the peripheral vision through saccades; pt may need to move their heads to initiate a voluntary redirection of gaze; defect in the visual perception of stimuli |
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Term
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Definition
| quick, simultaneous movements of both eyes in one direction; serve as a mechanism for fixation, rapid eye movement and fast phase of optokinetic nystagmus |
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Term
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Definition
| false localization of objects in visual space |
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Term
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Definition
| inability to perceive moving objects |
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Term
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Definition
| common disorder consisting of a peripheral auditory disorder affecting the tympanic membrane, middle ear ossicles, cochlea, or CN VII |
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Term
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Definition
| pulsatile "whooshing" sounds that can be associated with turbulent flow in arteriovenous malformations, carotid dissection or elevated intracranial pressure |
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Term
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Definition
auditory hallucinations
seen in elderly patients with senorineural deafness |
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Term
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Definition
| visual hallucinations caused by visual loss |
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Term
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Definition
| a sound that is heard once is then heard repeatedly, analogous to palinopsia |
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Term
| musical hallucinations can be caused by _________ |
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Definition
most commonly, seizures
also may be caused from peripheral or pontine tegmentum lesions |
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Term
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Definition
nonspecific term that means simply diffuse brain dysfunction
most common cause of impaired attention |
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Term
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Definition
occurs in the setting of alcohol withdrawal
delirium = acute confusional state in which agitation and hallucinations (auditory, visual and tactile) are prominent |
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