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STROKE! Diagnosis & Recovery (Admitted to hospital after suffering…
STROKE! Diagnosis & Recovery
Admitted to hospital after suffering stroke
61-year-old male piano teacher; long history of alcohol abuse
Cannot speak (
aphasia
)
Patient cannot communicate, namely stroke's timeline or personal history. Chance of recovery within hours or days; some communication impairments are permanent
Speech and language therapist highly recommended for recovery. Wife must provide details and serve as interpreter in meantime
Inability to walk without assistance
May result in falls; balance and coordination impaired, subsequent injury likely
Physical therapy, cardiovascular activity and practicing shifting of bodily weight recommended to accelerate healing process
Loss of motor function in
right
hand and arm; impaired mental faculties
Patient cannot play piano as before; cognitive abilities hindered
Neuroplasticity may permit brain to form new neural pathways...with patient's participation. Arm rehabilitation, range of motion & passive exercises will help re-link mind to muscle; may regain ability to play piano fluently
Anatomy of Brain
I. CEREBRUM
Largest, most superior part of brain. Composed of mirrored left and right hemispheres; each receives info and controls the contralateral body part, or "hemifield." Cerebrum's functional areas perform higher functions:
Primary motor cortex - Voluntary movement
Premotor cortex - Coordinates voluntary movement
Primary somatosensory cortex - Sensation, proprioception
Sensory assoc. areas - Integrates sensory info
Visual assoc. areas - Higher vision processing
Primary visual cortex - Vision
Wernicke's area - Language comprehension
Auditory assoc. areas
Primary auditory cortex - Hearing
Limbic assoc. cortex - Emotions, learning & memory
Olfactory cortex - Sense of smell
Broca's area - Speech formation
Prefrontal association areas - Ideas and planning for voluntary movement, thoughts, personality
Lobi Cerebri
Frontal lobe
- Problem solving, judgment, personality, behavior, emotions; intelligence, concentration, self-awareness; motor function; speaking and writing (Broca's area)
Parietal lobe
- Sense of touch, pain, temperature; interprets language and words; interprets signals from vision, hearing, motor and sensory; spatial/visual perception
Occipital lobe
- Visual processing of color, light and movement
Temporal lobe
- Memory; hearing, understanding language (Wernicke's area)
II. CEREBELLUM:
Inferior to cerebrum. Functions to sequence, coordinate and learn fine muscle movements, maintain posture, position and balance. Continuously updates information regarding sequence of desired muscle contractions and rate of movement. Known as the "little brain."
III. BRAINSTEM:
Beneath cerebellum, between spinal cord and superior brain regions. Breathing, sleep and basic functions controlled here. Areas include:
Medulla Oblongata
- Autonomic visceral regulation for cardiovascular, respiratory & digestive activities
Pons
- Relays somatic and visceral motor info to thalamus
Midbrain
- Processes visual and auditory data; maintains consciousness
What is a stroke?
Strokes also known as cerebrovascular accident (CVA). Defined as sudden death of brain cells due to oxygen deficiency, blockage of blood flow or arterial rupture to brain. In all cases, brain's blood supply inadequate, which causes stroke.
Strokes diagnosed by scanning brain with CAT or MRI scans. Without treatment, blood-deprived brain cells are quickly damaged or die. Brain injury, serious disability or death may occur.
Why do stroke symptoms/outcomes differ so much by the patient?
Symptoms of stroke vary widely from person to person. Various factors weigh in, including type, severity, location and how many strokes the person has had. A stroke can affect any area of the brain, each causing different symptoms. Damage to any given area brings about its own symptoms, resulting in distinct disabilities.
A stroke that takes place in the cerebrum can result in impairment of one or more of the following, immediately following the stroke or well after it's over:
Movement and sensation
Speech and language
Eating and swallowing
Vision
Cognitive ability (thinking, reasoning, decision making, judgment, memory)
Coordination, perception, orientation to surroundings
Emotional control
Incontinence
Sexual ability
Notes to the patient's wife:
Alcohol abuse compounds risk of stroke significantly. Liver damage can cause liver to stop making clotting agents, leading to cerebral hemorraging
Alcohol can spike blood pressure and lead to atrial fibrillation (irregular heartbeat, 5x risk of stroke) and hemorrhagic stroke
Husband's recovery depends on stroke's type and severity, getting medical assistance, committing to therapy and amending his lifestyle
Location, based on symptoms: Motor cortex of left cerebral hemisphere