Localization

Cortex

Dominant

• Wernicke: actual coding/decoding of language for brain. Aphasia can understand things except language.

  • Repetition: bad

  • Comprehension test: bad. Can't decode in brain. 1, 2, 3 step commands (show 3 fingers with right hand)

  • Fluency: intact

  • Naming: bad. Semantic paraphasia: semantic. Meant to say marker but says something else (phonetic paraphasia: words that sounds similar 'parker' instead of 'marker')

• Transcortical sensory aphasia, supramarginal gyrus: intact repetition, affected comprehension, fluency intact, naming bad

• Arcuate fasciculus, angular gyrus, conductive aphasia: repetition bad, comprehension good, fluency good, naming bad

• Broca: repetition bad, comprehension good, fluency bad, naming bad

• Transcortical motor aphasia, premotor: repetition good, comprehension good, fluency bad, naming bad

• Alexia without agraphia: occipital, PCA, impaired visual stimulus to Wernicke's

• Cortical sensation: only in cortex, not subcortex. Write in hands. Put objects in hands. 2 point discriminations

• Frontal eye fields: Moves eyes contralateral. Eyes move towards affected side. Case: right weakness, eyes move to left.

  • Seizures: Increased FEF, eyes move towards opposite of seizure. Case: right weakness, eyes move right

• Apraxia: frontal/parietal lesion cause loss of macros of daily functioning (e.g. light a match)

	Repetition	Comprehension	Fluency	Naming
Wernicke	-	-	+	-
Supramarginal	+	-	+	-
Arcuate	-	+	+	-
Broca	-	+	-	-
Premotor	+	+	-	-

Non dominant

• Receptive aprosody: loss of understanding of non verbal language (monotonous speech)

• Hemineglect: looks to one side, lying on one side of bed and leaning towards one side, doesn't respond on one side, doesn't recognize own hand

  • vision: can use blink reflex to differentiate from hemianopsia

  • sensory: loss of sensory on side of lesion

Cerebellum

Midbrain

• CN 3 palsy, contralateral hemiparesis, tremor/dystonia from red nucleus lesion

• compressive lesion: blown pupil

• ischemic lesion: normal pupil

Pons

• bulbar nerves: dysarthria if dorsal pons lesion, CN 6/7 if ventral pons

Medulla

• lateral: 5, spinothalamic, sympathetic tract, vestibular

  • ipsilateral face, contralateral sensory loss, vertigo (most common)/ataxia, ipsilateral horners (lights off to see difference)