Neuro SLP: CNs, CVAs, Aphasias

Tracts

100

The _______ corticospinal tract descends from the motor cortex, through the internal capsule, to the medulla, and decussate as pyramids before entering into the spinal cord to the anterior/ventral horns and control fine motor movements.

Lateral

200

Innervation from the _________ corticospinal tract is ipsilateral

anterior

300

Which tract has more fibers? Anterior or lateral corticospinal tract?

Lateral

400

Describe a lesion that would cause impairment of voluntary movement on the same side of the body as the lesion. 

lesion to a fiber tract AFTER or BELOW decussation/crossing

500

Describe the corticobulbar tract that terminates at nuclei for cranial nerve 5. 

Arises from primary motor cortex

Travels through the internal capsule

 Enters brainstem

Terminates at motor nuclei of cranial nerves in brainstem

Pons: V, VI, VII, VIII

Cranial Nerves

100

Which CN might be damaged if I have a patient with a profound impact to articulation and lingual fasciculations? 

Hypoglossal: CN XII

200

Give the name and number of the nerves related to vision/eye movement

II, III, IV, VI

Optic

Oculomotor

Trochlear

Abducens

300

Which CN is responsible for Taste from the anterior 2/3 of the tongue? The posterior 1/3? The root of the tongue?  

VII, Facial 

IX, Glossopharyngeal

X, Vagus

400

Name 4 areas of MOTOR deficit someone with a lesion to CN X might suffer?

Reduced or absent gag reflex

Swallowing deficit

Cricopharyngeus

Failure to elevate soft palate

Nasal regurgitation: loss of food + liquid through nose

Voice disorders

500

Model testing for 2 motor functions each for CN V and XI. 

 Motor: Masseter muscle

Palpation of masseter: from cheek/temporal to lower jaw

Strength of jaw closure: open against resistance

Lateralize jaw in chewing

Lateralize jaw against resistance

sternocleidomastoid:  turn head to 1 side hold it while examiner tries to push back to center

  thrust head forward while examiner resists w hand on forehead

 trapezius muscle: Test: shrug shoulders while examiner presses down on them

CVA

100

Which is the most common type of CVA?

Ischemic

200

Which type of ischemia is temporary but a strong predictor of a stroke

a TIA, transient ischemic attack

300

A ruptured ________ may cause a hemorrhagic stroke. 

aneurysm

400

Define thrombosis and embolism

Blockage due to:

 Thrombus: a blood clot in a blood vessel

* Atherosclerotic plaque:

Hardening in the lining of the artery wall due to

  deposit + accumulation of fatty substance

* Embolism: thrombus breaks free + lodges elsewhere

500

Describe the different types of CVAs and their subtypes, if any. Also discuss where in the brain they might occur. 

Ischemic (Occlusive): 

TIA

Ischemic Attack

Hematoma and Hemorrhagic. 

Subdural, Epidural, Subarachnoid, Intracranial

Aphasia & Motor Speech

100

Describe the impact of a lesion to Broca's area

Nonfluent

Poor Naming

Unable to repeat

Comprehension in tact

200

What is the difference between transcortical motor aphasia and Broca's aphasia? 

Repetition is OK in transcortical motor aphasia

300

In which 3 types of aphasia would comprehension be OK?

Broca's, Transcortical motor, Conduction

400

Which type of dysarthria would be found in someone with Parkinson's disease and what would their speech sound like?

Hypokinetic: 

•Monotone speech (lack of pitch variation)

•Reduced loudness (quiet, muffled voice)

•Rapid speech rate (short rushes of speech)

Difficulty with initiating speech

500

Name and describe 2 different types of dysarthria (besides hypokinetic) including cause (s) and speech quality

Spastic

CVA, TBI

•Spasticity (increased muscle tone)

•Hyperreflexia (exaggerated reflexes)

•Slow, effortful speech

•Strained/strangled vocal quality

Hyperkinetic:

Basal ganglia lesion, GABA

•Involuntary movements of the face, tongue, or respiratory muscles

•Variable speech rate (irregular rhythm)

•Sudden interruptions or pauses in speech

•Voice tremors or harsh voice quality

Flaccid : MG, CN damage 5,7,9,10,12

•Weak, imprecise articulation

•Reduced loudness and breath support

•Possible difficulty swallowing (dysphagia)

Mixed, ALS, MS

•Imparied loudness

•Harsh vocal quality

•Breathy voice

•Articulatory difficulty due to weakness

•Hypernasality

•Excess stress

Ataxic: Cerebellar stroke, degenerative disease

•Difficulty controlling speech rate and rhythm

•Sound “drunken” or imprecise

•Voice may sound harsh or breathy

•Irregular speech rhythm (prosody)

•Slurred speech (imprecise articulation)

•Excessive loudness variation or monotone voice