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” aphasia Word output per minute high Content 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 PRESERVED Repetition IMPAIRED Non-fluent, slow agrammatical, telegraphic speech, “expressive aphasia” DOMINANT posterior lateral frontal lobe BRO(KEN) Production!

Classic Aphasias – Broca’s  Don’t confuse with – APHEMIA Non-fluent speech apraxia Occasional mutism But…. ABLE TO WRITE Broca’s can’t write!

Classic Aphasias – Wernicke’s  Wernicke’s Comprehension IMPAIRED Repetition IMPAIRED FLUENT Anosognosia (patient unaware) “Receptive” Aphasia Superior posterior gyrus of temporal lobe

Classic Aphasias – Conduction  Conduction Aphasia Comprehension INTACT Repetition IMPAIRED Phonemic paraphasic errors Arcuate Fasiculus (dominant parietal)

Transcortical Aphasias  REPETITION INTACT I’m Alive!

Non-Classical – Transcortical Sensory  Transcortical Sensory Aphasia Similar to Wernicke’s BUT…. Repetition INTACT Comprehension IMPAIRED Echolalia (unsolicited repetition of other’s) Alzheimer’s! Temporal-parietal area

Non-Classical – Transcortical Motor  Transcortical Motor Aphasia Like Broca’s’ BUT… Repetition INTACT Comprehension INTACT Non-fluent, slow Supplementary 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) Aphasia Associated 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 hemianopsia Deficit of word BUT NOT letter reading  Gerstmann Syndrome 1. Alexia + Agraphia 2. Finger agnosia 3. Acalculia 4. Left-right disorientation Left (DOMINANT) inferior parietal lobe including supramarginal and angular gyri

Cortical Syndromes Remember POOR GERSTMANN His INFERIOR PARents LEFT at a young age As a result, he is a TERRIBLE student Can’t do math, read or write, tell left from right The 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  Prosopagnosia Inability to recognize people from face Bilateral lesions of fusiform (occipitotemporal) gyri

Cortical Structures

 Fornix Memory formation Damaged with transcollosal surgery / colloid cyst MAIN efferent (output pathway) from hippocampus traveling 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 OC Involved with anticipating rewards Gambling, substance abuse, addiction “If I keep gambling, I will ACCUMB(ULATE) wealth!”