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A 61 year-old male piano teacher with a long history of alcohol abuse…

- - - - Anatomy of the brain,
        
        brain stem: 2.5% of total brain mass
        
        pons
        
        bulging brain stem region
        
        deep projection fibers run longitudinally
        
        part of pathway between higher brain centers and spinal cord
        
        compared of conduction tracts
        
        superficial ventral fibers oriented transversally and dorsally
        
        connect pons bilateral with cerebellum dorsally
        
        relay conversation between motor cortex and cerebellum
        
        medulla oblongata
        
        associated with nerves
        
        hypoglosses nerve
        
        glossopharyngeal nerve
        
        vagus nerve
        
        vestibulocochlear nerve
        
        olives: oval swellings lateral to pyramids
        
        nuclei associated with ascending sensory tracts
        
        nucleus gracilis
        
        nucleus cuneatus
        
        decussation of the pyramids
        
        —> each cerebral hemisphere controls voluntary movements of muscles on opposite side of body
        
        crossover point of fibers forming pyramids
        
        pyramids
        
        longitudinal ridges
        
        midbrain
        
        cerebral aqueduct
        
        run through midbrain
        
        connect 3rd and 4th ventricles
        
        periaqueductal gray matter
        
        involved in pain suppression
        
        links amygdaloid body to sympathetic nervous system
        
        cerebral peduncles
        
        hold up cerebrum
        
        corpora quadrigemina
        
        superior colliculi
        
        visual reflex center
        
        inferior colliculi
        
        auditory relay
        
        act in reflexive responses to sound
        
        cerebrum 83% of brain mass
        
        2 cerebral hemispheres: left and right
        
        cerebral white matter
        
        internal
        
        responsible for communication between cerebral areas, between cerebral cortex and lower CNS centers
        
        projection fibers
        
        association fibers
        
        commissural fibers
        
        allow 2 hemispheres to function as coordinated whole
        
        largest: corpus callosum
        
        basal nuclei or basal ganglia
        
        group of subcorticall nuclei in each hemisphere
        
        involved in control of movement
        
        globus pallidus
        
        caudate nucleus
        
        putamen
        
        play role in cognition and emotion
        
        cerebral cortex of gray matter
        
        executive suite of CNS
        
        each hemisphere concerned w/ sensory and motor function of contralateral side of body
        
        association areas
        
        limbic association area
        
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        posterior association area
        
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        anterior association area
        
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        sensory areas
        
        primary somatosensory cortex
        
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        somatosensory association cortex
        
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        conscious awareness of sensation
        
        visual areas
        
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        olfactory cortex
        
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        auditory areas
        
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        gustatory cortex
        
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        vestibular cortex
        
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        visceral sensory area
        
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        motor areas
        
        function: control voluntary movement
        
        primary motor cortex
        
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        premotor cortex
        
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        Broca’s area
        
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        Frontal eye field
        
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        gyry
        
        elevated ridge of tissue
        
        sulcus
        
        shallow groove
        
        Pareto-occipital sulcus
        
        deep lateral sulcus
        
        central sulcus
        
        fissures
        
        deeper groove
        
        longitudinal fissure
        
        transverse cerebral fissure
        
        lobes
        
        parietal
        
        occipital
        
        fontal
        
        temporal
        
        cerebellum: 11% of total brain mass
        
        folia
        
        transversely oriented pleatlike gyri
        
        hemispheres subdivided by deep fissures
        
        lobes
        
        posterior
        
        flocculonodular lobe
        
        anterior
        
        2 cerebellar hemispheres
        
        connected medially via vermis
        
        several types of neurons
        
        purkinje cells
        
        only cortical neurons that send axons through white matter
        
        activity occurs subconsciously
        
        arbor vitae: tree of life
        
        pattern of white matter resembling branching tree
        
        cerebellar peduncles
        
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        processes fine-tune motor activities
        
        diencephalon
        
        hypothalamus
        
        main visceral control center of body
        
        mammillary bodies
        
        bulge ventrally from hypothalamus
        
        relay station in olfactory pathways
        
        important to body homeostasis
        
        regulate food intake
        
        regulate water balance and thirst
        
        regulate body temperature
        
        initiate physical responses to emotions
        
        regulate sleep-wake cycles
        
        control endocrine system function
        
        control autonomic nervous system
        
        pituitary gland
        
        connected to base via infundibulum
        
        under control of hypothalamus
        
        produces many hormones
        
        epithalamus
        
        pineal gland / body
        
        extend from posterior border
        
        secretes melatonin
        
        helps regulate sleep-wake cycle
        
        posterior commisura forms caudal border
        
        forms roof of 3rd ventricle
        
        thalamus
        
        relay station for information coming into cerebral cortex
        
        mediate sensation, motor activities, cortical arousal, learning , memory
        
        4 ventricules
        
        fourth ventricle
        
        continuous inferiorly with central canal
        
        openings
        
        paired lateral apertures in side walls
        
        median aperture in roof
        
        paired lateral ventricles
        
        separated by septum pellucidum
        
        third ventricles
        
        continuous with 4th ventricles via cerebral aqueduct
        
        communicated with lateral ventricles via inter ventricular foramen
      - spinal cord
    - - brainstem
        
        pons
        
        cooperates with medullary respiratory centers to control respiratory rate and depth
        
        contains nuclei of cranial nerves V and VII
        
        relays information from cerebrum to cerebellum
        
        contains projection fibers
        
        medulla oblongata
        
        relays sensory information to cerebellum via inferior olivary nuclei
        
        contains nuclei of cranial nerves VIII-X and XII
        
        control heart rate, blood vessel diameter, respiratory rate, vomiting, coughing, etc
        
        site of decussation of pyramids
        
        contains projection fibers
        
        relays ascending pathway impulses for skin and propioceptors via nuclei cuneatus and gracilis
        
        midbrain
        
        contains subcortical motor centers
        
        contains nuclei for cranial nerves III and IV
        
        contains visual and auditory reflex centers
        
        contains projection fibers
        
        reticular formation
        
        maintains cerebral cortical alertness
        
        filters out repetitive stimuli
        
        functional system
        
        helps regulate skeletal and visceral muscle activity
        
        cerebellum
        
        provides instructions to cerebral motor cortex and subcortical motor centers
        
        resulting in smooth, coordinated skeletal muscle movements
        
        responsible for balance and posture
        
        processes information from cerebral motor cortex, proprioceptors, visual and equilibrium pathways
        
        diencephalon
        
        hypothalamus
        
        regulates body temperature, food intake, water balance, thirst, biological rhythms + drives
        
        regulates hormonal output of anterior pituitary gland
        
        chief integration center of autonomic nervous system
        
        acts as an endocrine organ, producing posterior pituitary hormones ADH + oxytocin
        
        limbic system
        
        mediates emotional response
        
        involved in memeory processing
        
        functional system
        
        thalamus
        
        relays impulses between cerebral motor cortex and lower motor centers
        
        involved in memory processing
        
        relays sensory impulses to cerebral cortex for interpretation
        
        cerebral hemispheres
        
        cortical gray matter
        
        controls voluntary + skilled skeletal muscle activity
        
        functions in intellectual + emotional processing
        
        localizes + interprets sensory inputs
        
        basal nuclei
        
        subcortical motor centers
        
        help control skeletal muscle movements
        
        lobes
        
        parietal
        
        sensory/ touch
        
        expression of emotion
        
        temporal
        
        interpretation and storage of sounds + smell
        
        understanding speech
        
        frontal
        
        motor control of skeletal muscle
        
        personality
        
        concentration
        
        decision-making
        
        verbal communication
        
        occipital
        
        visual interpretation/ association
    - - blood circulation to brain area is blocked or hemorrhage
        
        delivery of oxygen and nutrients is impaired
        
        blood flow can't reach the region that controls a particular body function,
        
        that part of the body won't work as it should.
        
        several factors
        
        location of the obstruction
        
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        extent of brain tissue affected
        
        brain tissue dies of ischemia
      - common cause: blood clot
      - less frequent : bleeding compressing brain tissue
      - warning signsand symptoms : BE FAST
        
        Eye dropping
        
        Face drooping
        
        Balance
        
        Arm weakness
        
        Speech difficulty
        
        Time to call 911+ time of onset of symptoms
    - - alcohol is depressant of CNS
        
        —> slows activity down.
        
        Poor coordination
        
        Impaired vision
        
        Impaired hearing
        
        Inability to drive effectively
        
        Delayed reaction times
      - Alcohol crosses the blood-brain barrier
        
        —> penetrate the brain
      - interacts with the brain receptors, interfering with the communication between nerve cells, and suppressing excitatory nerve pathway activity.
    - - functional brain systems
        
        reticular formation
        
        states of consciousness and arousal
        
        motor nuclei
        
        somatic motor activities
        
        visceral motor activities
        
        composed of loosely clustered neurons
        
        reticular activating system
        
        maintain alert state of cerebral cortex
        
        filters flood of sensory inputs
        
        limbic system: emotional-visceral brain
        
        parts of rihinencephalon
        
        hippocampus
        
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        dentate gyrus
        
        septal nuclei
        
        parahippocampal gyrus
        
        cingulate gyrus
        
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        parts of diencephalon
        
        hypothalamus
        
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        anterior thalamic nuclei
        
        amygdaloid body
        
        nucleus sitting on tail of caudate nucleus
        
        responds to perceived threats with fear or aggression
        
        role in memory
        
        fornix
        
        and other fibers tracts link limbic system regions together
        
        interacts with prefrontal cortex
    - - meninges
        
        dura mater
        
        most outer layer
        
        anchored to Cristi Galli of ethmoid bone
        
        thick, fibrous
        
        arachnoid mater
        
        thin, forms loose sac around CNS
        
        membranes of connective tissue
        
        pia mater
        
        fine, delicate
        
        lies on CNS tissues
        
        dips into indentations like visceral serous menmbranes
        
        enclose brain, spinal cord and blood vessels
      - cerebrospinal fluid
        
        removes metabolic wastes from interstitial fluid, return them to blood stream
        
        support, cushions, nourish CNS
        
        clear fluid composed of water, gases, electrolytes, small molecules
        
        circulate through ventricles and spinal cord, into subarachnoid space
        
        return to dural venous sinuses via arachnoid granulations
        
        made by ependymal cells from blood plasma in choroid plexus in each ventricle
      - blood brain barrier
        
        block other, water-solubles, potentially harmful substances
        
        everything pass through plasma membrane into endothelial cell and out other side
        
        allow water, essential nutrients, respiratory gases
        
        basement membrane of endothelial cell
        
        contain enzymes destroying chemicals that would activate brain neurons
        
        allow lipid-soluble molecules
        
        consists mainly of tight junctions between endothelial cells of brain’s capillaries
- - - - physical therapy should start as soon as possible to prevent muscle contractures
    - - left hemisphere damage
      - pianio teacher unable to use right hand
  - - - procedural memory
        
        cerebellum
      - teacher can still play piano as long as memory is intact
- - - - alcohol abuse
        
        Drinking too much alcohol can raise blood pressure levels and increase the risk for stroke. It also increases levels of triglycerides in blood that can harden arteries.