kurt sieloff, md. overview speech terminology classic aphasias non-classical aphasias cortical...

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!”