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)

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