kurt sieloff, md. overview speech terminology classic aphasias non-classical aphasias cortical...
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APHASIAAND CORTICAL CONNECTIONS
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” aphasiaWord output per minute highContent 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 PRESERVEDRepetition IMPAIREDNon-fluent, slowagrammatical, telegraphic speech,
“expressive aphasia”DOMINANT posterior lateral frontal lobe
BRO(KEN) Production!
Classic Aphasias – Broca’s Don’t confuse with – APHEMIA
Non-fluent speech apraxiaOccasional mutism
But….
ABLE TO WRITE
Broca’s can’t write!
Classic Aphasias – Wernicke’s Wernicke’s
Comprehension IMPAIREDRepetition IMPAIREDFLUENTAnosognosia (patient unaware)“Receptive” AphasiaSuperior posterior gyrus of temporal lobe
Classic Aphasias – Conduction Conduction Aphasia
Comprehension INTACTRepetition IMPAIREDPhonemic paraphasic errorsArcuate 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 INTACTComprehension IMPAIREDEcholalia (unsolicited repetition of other’s)Alzheimer’s!Temporal-parietal area
Non-Classical – Transcortical Motor Transcortical Motor Aphasia
Like Broca’s’ BUT…Repetition INTACTComprehension INTACTNon-fluent, slowSupplementary 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)
AphasiaAssociated 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 hemianopsiaDeficit of word BUT NOT letter reading
Gerstmann Syndrome1. Alexia + Agraphia2. Finger agnosia3. Acalculia4. Left-right disorientationLeft (DOMINANT) inferior parietal lobe including
supramarginal and angular gyri
Cortical SyndromesRemember POOR GERSTMANN
His INFERIOR PARents LEFT at a young ageAs a result, he is a TERRIBLE studentCan’t do math, read or write, tell left from rightThe 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
ProsopagnosiaInability to recognize people from faceBilateral lesions of fusiform
(occipitotemporal) gyri
Cortical Structures
Cortical Structures Fornix
Memory formationDamaged with transcollosal surgery / colloid
cystMAIN efferent (output pathway) from
hippocampustraveling 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 OCInvolved with anticipating rewardsGambling, substance abuse, addiction“If I keep gambling, I will ACCUMB(ULATE) wealth!”
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