1. A 77-year-old woman was cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms:
- Paralysis of the right face and arm
- Loss of sensation to touch on the skin of the right face and arm
- Inability to answer questions but ability to understand what was said to her
- Ability to write down her thoughts more easily than to speak them
Based upon the patient's symptoms, why was she paralyzed in the right face and arm? What is the name of her language disorder, and what caused it?
A/ The patient's inability to voluntarily move her right face and arm is due to the damage to the face and arm portion of her left primary motor cortex, an area that lies just anterior to the central sulcus in the posterior portion of the frontal lobe. Loss of sensation is due to damage of her primary sensory cortex, an area located in the post central gyrus is a prominent structure in the parietal lobe.
A/ The patient's language disorder is called Broca's, or expressive, aphasia. It is caused by damage to Broca's area in the lateral portion of the frontal lobe. Broca's area is normally involved in higher-level development of the commands necessary for word-finding and language production (which is why it is sometimes called the "motor speech center"). Not surprisingly, it is located just anterior to the area where the vocal muscles are represented on the primary motor cortex. Damage to Broca's area makes vocal expression very difficult to accomplish. The patient has difficulty uttering intended words, often appearing quite frustrated in the process. Speech is telegraphic, with the common omission of smaller words such as "a," "an," and "the." Often, the patient will be able to write down what he/she is trying to say, but cannot verbalize it. Patients with Broca's aphasia have no difficulty understanding what others are saying. This is in contrast to individuals who have had damage to the Wernicke's area and, as a result, suffer from Wernicke's (receptive) aphasia, a condition in which the individual does not understand incoming language.
2. An 81-year-old man and avid reader had a mild stroke from which he eventually recovered. He did have some residual signs and symptoms, however, such as:
Right-sided homonymous hemianopia (i.e. loss of vision on the right half of the visual field in each eye)
Why was this man unable to see the right half of his field of vision? Was there something wrong with his eyes?
A/ Damage to the left primary visual cortex makes it difficult for visual information from the right visual fields of each eye to be processed by the left occipital lobe (note that, like the motor and other sensory tracts, the visual pathways are criss-crossed in the central nervous system). There is nothing wrong with his eyes. Rather, he is suffering from right-sided "cortical blindness."
3. The auditory cortex is located in the
a) Frontal lobe
b) Parietal lobe
c) Temporal lobe
d) Occipital lobe
4. A 7-year-old girl was referred to the neurologist because of unsteadiness. Over the previous 3 months, the child had increasing difficulties with balance and, eventually, with the use of her right arm. The week prior to evaluation, she had developed severe morning headaches associated with nausea and vomiting. Based upon your Anatomy studies, what area of the brain is most likely affected in this patient?
a) Broca’s area
b) Primary sensory cortex
c) Frontal lobe
d) Temporal lobe
e) Occipital lobe
f) Cerebellum
g) Wernicke’s area
h) Corpus callosum
i) Hypothalamus
j) Thalamus
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