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Aphasia 07

This document discusses language disorders and their neurological underpinnings. It describes: 1. The brain areas involved in language production and comprehension, including Broca's and Wernicke's areas. 2. Common language disorders like aphasia, their symptoms and causes. Disorders discussed include Broca's aphasia, Wernicke's aphasia, conduction aphasia and anomic aphasia. 3. The assessment and treatment of language disorders, as well as factors that influence their prognosis.

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razik89
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202 views34 pages

Aphasia 07

This document discusses language disorders and their neurological underpinnings. It describes: 1. The brain areas involved in language production and comprehension, including Broca's and Wernicke's areas. 2. Common language disorders like aphasia, their symptoms and causes. Disorders discussed include Broca's aphasia, Wernicke's aphasia, conduction aphasia and anomic aphasia. 3. The assessment and treatment of language disorders, as well as factors that influence their prognosis.

Uploaded by

razik89
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Disorders of

language
language
  “The method of human communication,
either spoken or written, consisting of the use
of words in a structured and conventional
way”
(oxford English dictionary)

 distinguishing feature of the human race


Mechanism of language production
 As complex as language itself
Wernicke’s area (22) Broca’s area(44,45)
Comprehend Form articulatory sequences
Initiate response formation Connect words with meaning
by noun & verb assembly appropriate syntax
Give meaning Form final language

Primary motor cortex Motor planning areas in


prefrontal cortex (ar.6)
(ar.4)
Create appt plan for complex
UMN movements of speech by
Initiate primary signals in determining which muscles to
appropriate muscle groups contract & in what sequence

Cranial nerve
nuclei in brainstem
LMN
speech
Lan
Lan Infer gua
gua ior ge
ge pari Prim cue
visu
cues etal ary in
al
in lobu Wer audi aud
cort
visu le nicke tory tory
ex
al (ang ’s cort
(ar.1 stim
field ular area ex
7,18, uli
Rea gyru (ar.4 Hea
19)
ding s) 1,42) d
boo Area spe
k 39
ch
Assessment

 Hearing , mental status (if possible)


 Articulation
 Comprehension (not axial movements)
 Spontaneous speech Fluency, syntax
 Reading
 Writing
 Repetition ( No ifs, buts or ands; British constitution)
 Naming
Language disorders
 APHASIA
 ALEXIA
 AGRAPHIA
 APROSODIA
 APHEMIA
Language disorders
 APHASIA
a) Acquired disorder of language due to brain damage.
b) Aphasia does not include
1. developmental disorders of language
2. dysarthria or dysphonia
3. primary thought disorders (schizophrenia)
4. agnosias, apraxias, acalculia
 ALEXIA
 AGRAPHIA
 APROSODIA
 APHEMIA
causes
 Aphasia- Lesions affecting dominant
hemisphere (left for 90% of right handed &
60% of left handed)
 Aphasia in non dominant- crossed aphasia
 Aprosodia- non dominant hemisphere
 CVA
 Hemorrhage, trauma
 Neoplasm
 Degenerative diseases ( dementia, Alzheimer's)
Aphasia- types
 Wernicke’s (amnestic, nominal, sensory, receptive)
 Broca’s ( motor, expressive)
 Global
 Conduction
 Nonfluent transcortical
 Fluent transcortical
 Isolation
 Anomic
 Pure word deafness
 Sub cortical
 progressive
Wernicke’s aphasia
 Impaired comprehension
 Cant understand written or spoken language
 Reading, writing, repetition, naming impaired
 Perseverations or repetitive utterances
 Agitated mood, violent

 Impaired noun & verb vocabulary


 full of function words
 Paraphasias
semantic (pen for pencil)
phonetic (plenthil for pencil)
 Word substitution
 neologisms
 Word salad, jargon aphasia
 Not to be confused with
 Deafness
 Schizophrenia
 Confusional states
 malingering

 Obeys commands related to axial


movements
Broca's aphasia
 Impaired grammar

 Decreased fluency / output


 Replies in nouns, verbs, YES or NO
 Pause between words
 Word searching
 Comprehension intact

 Except for complex grammatical sentences


 Insight present patient depressed

 Usually some dysarthria (except for music-


melodic intonation therapy)

 Repetition, reading, writing, naming largely


unimpaired esp. for nouns
Global aphasia
 Combination

Conduction aphasia

 Arcuate fasciculus
 Cant convey lexical representations in
Wernicke's to Broca's
 Similar to Wernicke's, but comprehension intact
Nonfluent transcortical(motor)
 Similar to Broca's except for

 lesser repetition impairment


 less agrammatism

 Lesion in watershed zone b/w ACA & MCA


territory disconnect Broca's from prefrontal
Fluent transcortical(Sensory)
 Similar to Wernicke’s except for
 lesser repetition impairment

 Lesion disconnecting Wernicke's from


temporoparietal association areas (watershed
infarcts)
Isolation aphasia

 Combination of transcortical motor & sensory


 Like global aphasia, but with intact repetition
 ECHOLALIA- parrot like

 Patchy large watershed infarct of frontal, temporal,


parietal lobes (ISOLATED language areas)
 CO poisoning
 Extensive neoplasm
Anomic aphasia
 minimal dysfunction
 Vocabulary impaired
 absent nouns, verbs
 Fluent, paraphasic
 Comprehension, insight intact (df. Wernicke's)
 Repetition, reading intact( df. Conduction)
 Sites- middle & inferior temporal gyri
 Most common disorder in head trauma, met
encephalopathy & alzheimers
Pure word deafness

 Lesion in fasciculus connecting auditory


cortex with Wernicke's
 Patient cant understand the language cues in
auditory stimulus
 Can understand other sounds
 Repetition, naming intact
 Often get agitated
 Improve gradually with lip reading
Subcortial aphasia

 Lesion in thalamus, lentiform nucleus

 Suspected in anomic aphasia following


internal capsule stroke.
ALEXIA without agraphia

 Visual equivalent of pure word deafness


 Cant understand language cues in vision
 Visual cortex , splenium
 right hemianopia
 In left hemifield- repetition impaired, but
naming normal
 Color anomia-sometimes
 Transient amnesia
Gerstman’s syndrome

 Area 39
 angular gyrus of inferior parietal lobule

 Alexia
 Acalculia
 Right left confusion
 Finger agnosia
aphemia
 Impaired fluency alone
 Partial lesions of Broca's area

aprosodia
 Loss of melodic stress & intonation
 “He is clever” & “He is clever?”
 Perisylvian areas in right hemisphere
 Confused with depression
Aphasia in IC lesion

 Subcortial aphasia (edema/ extension into


thalamus, lentiform)
 Separate infarcts
 MCA main stem occlusion
Associations
 Broca's (sup. Branch of MCA)
 left Brachial, frontal opercular syndrome (M
& S)
 Gaze preference to lesion (left)
 Right Inferior quadrantic hemianopia
 Gerstman
 Apraxia(dressing, constructional)
 Anisognosia
WERNICKES

 INF BRANCH OFMCA


 Hemi sensory neglect
 Superior quadrantic hemianopia

 An initial global aphasia in CVA may resolve


to Wernicke's , Broca's or conduction
treatment

 Routine CVA management


 Psychosocial support, psychotherapy
 Speech, language therapy
 Experimental
 constraint-induced aphasia therapy (CIAT)
 Memantine, gabapentine, bomociptine
 Melodic intonation therapy
prognosis

 Better- type- Broca's,


cause-CVA

 Worst- type- Wernicke's,


cause- tumor, degenerative

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