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61-yr old male exhibiting paralysis of right arm/hand, inability to speak…

- - - - gray matter:
        gray tissue due to the cell bodies of motor & interneurons being present as well as the absence of myelination on axons of these neurons.
        : located mostly superficial to white matter, making up surface of brain = cerebral cortex
        
        there are some areas of grey matter inside the white matter known as cerebral nuclei which are groups of neuron cell bodies that aid in regulating motor output
        
        disease of the nuclei associated with involuntary movements
      - white matter:
        tissue appears white due to myelin covering neuron axons
        : located deep to gray matter
      - [in the spinal cord, gray matter is deep and surrounded by superficial white matter]
    - - center
        group of CNS neuron cell bodies with a common function
        
        ganglion
        cluster of neuron cell bodies in the PNS
        
        funiculus
        group of tracts in a specific area of the spinal cord
        
        nerve
        bundle of axons extending through the PNS
        
        nerve plexus
        network of nerves at specific locations along the spinal cord
        
        nucleus
        center that displays discrete anatomic boundaries
        
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    - - cranial meninges
        3 layers of connective tissue
        
        FUNCTIONS:
        
        separate & support the delicate brain tissue
        
        enclose and protect the blood vessels that supply the brain
        
        aid in containing and circulating cerebrospinal fluid (CSF)
        
        pia mater
        deepest layer made of
        thin layer of loose areolar connective tissue that anchors to the brain, following the contours of the brains surface
        
        arachnoid mater
        the in-between layer composed partially of collagen and elastic fibers that form arachnoid trabeculae
        
        dura mater
        most superficial cranial meninge that is tough and dense and comprised of 2 layers known as
        meningeal layer & periosteal layer
        
        meningeal layer
        directly superficial to arachnoid mater
        
        periosteal layer
        superficial to meningeal layer.
        forms periosteum on internal surfaces of cranial bones
        
        these 2 layers are mostly fused except for at dural venous sinuses where they separate to form blood-filled cavities that function to drain blood from the brain
        
        epidural space (within dura mater):
        potential space between dura mater and cranial bones containing blood vessels that nourish meninges and cranium.
        can accumulate blood or fluid and become true space
        
        epidural hematoma
        when blood pools into the epidural space due to injury.
        damaging to surrounding tissue and can cause neurological issues or even death
        
        trabeculae extend through subarachnoid space
        which contains CSF
        
        subdural space
        potential space between this layer and the dura mater
        
        subdural hematoma
        hemorrhage in the subdural space.
        can lead to neurological issues.
        
        meningitis
        inflammation of the meninges caused by highly contagious infection.
        
        symptoms:
        
        fever
        
        headache
        
        vomiting
        
        stiff neck
        
        DEADLY if untreated
        
        Vaccines exists for most strains
      - brain ventricles
        cavities within the brain lined with CSF-producing cells called ependymal cells
        
        4 VENTRICLES TOTAL
        
        right and left
        lateral ventricle
        
        within cerebrum
        
        third ventricle
        communicates with both lateral ventricles via
        interventricular foramen
        
        smaller cavity within diencephalon
        
        fourth ventricle
        
        communicates with 3rd ventricle via cerebral aqueduct
        
        opens to subarachnoid space via medial aperture and paired lateral apertures
        
        narrows before merging with central canal of spinal cord
        
        located between the pons and cerebellum
      - cerebrospinal fluid
        (CSF):
        clear, colorless bodily liquid that circulates in the CNS, completely bathing all surfaces. composition is similar to plasma
        
        FUNCTION:
        
        provide buoyancy for the brain (reduces weight and prevents brain collapsing into the foramen magnum)
        
        provides protection as a fluid cushion to delicate neural structures
        
        carries nutrients and chemical messaged TO the brain and carries waste AWAY from the brain to blood vessels.
        
        CIRCULATION OF CSF
        
        produced in the choroid plexus
        
        begins circulation in lateral ventricles then moves to third before passing through the aqueduct to the fourth ventricle
        
        from there, CSF enters the subarachnoid space allowing it to pass into central canal of spinal cord.
        
        flows through subarachnoid space
        
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        each brain ventricle contains
        specialized tissue called
        choroid plexus
        which is composed of
        ependymal cells
        which secrete the CSF
      - blood-brain barrier:
        highly selective, semipermeable border in the CNS separating circulating blood from the brain and its' interstitial fluid
        
        FUNCTION:
        prevention of harmful substances such as drugs and blood waste materials coming into contact with neurons
        
        COMPOSITION:
        
        brain capillaries wrapped in perivascular feet of astrocytes
        
        tight junction between endothelial cells helps to decrease permeability of capillaries.
        
        What can diffuse across blood-brain barrier:
        
        lipid-soluble compounds including alcohol and other drugs including some anesthetics
        
        some drugs have the ability to damage the barrier
        
        3 locations with less or no barrier
        
        choroid plexus is more permeable due to it's role in producing CSF
        
        hypothalamus requires access to bloodstream due to role in excreting hormones for circulation
        
        pineal gland requires access to bloodstream due to role in hormone production and circulation
      - cranial bones provide rigid support and protection
    - - cerebrum:
        area of brain responsible for conscious thought process. Also, origin of complex intellectual functions.
        
        diencephalon:
        part of the prosencephalon sandwhiched between inferior regions of the cerebral hemispheres
        
        brainstem:
        
        connects cerebrum, diencephalon & cerebellum to spinal cord
        
        bidirectional passageway
        
        houses autonomic & reflex centers as well as nuclei of many cranial nerves
        
        cerebellum:
        
        produces fine control over muscular actions
        
        aids in muscle memory
        
        helps maintain equilibrium & posture
        
        receives proprioceptive information from muscles & joints
        
        helps maintain awareness of muscle tone & body position
        
        contains cerebellar cortex
        
        cerebellar cortex
        outer gray matter that surrounds internal region of white matter called arbor viate (named for resembling a branching tree)
        
        EFFECTS OF ALCOHOL & DRUGS ON THE CEREBELLUM:
        A.) disturbance of gait- difficulty walking in straight line
        B.) loss of balance- unstable posture
        C.) loss of ability to detect proprioceptive information
        
        3 COMPONENTS
        (superior to inferior)
        midbrain
        pons
        medulla oblongata
        
        COMPONENTS:
        
        epithalamus
        
        thalamus
        
        hypothalamus
        
        epithalamus
        
        forms partial post. roof of diencephalon
        
        covers 3rd ventricle
        
        posterior portion houses pineal gland & habenular nuclei
        
        COMPONENTS:
        pineal gland:
        
        endocrine gland
        
        secretes melatonin
        
        helps regulate circadian rhythm
        
        thalamus
        
        paired oval masses of gray matter
        
        located between anterior commissure and pineal gland
        
        FUNCTIONS:
        
        final relay point for incoming sensory information
        
        processes and projects information to primary somatosensory cortex
        
        filters out unnecessary sensory information
        
        hypothalamus
        
        the anteroinferior region of deincephalon
        
        infundibulum extends from it
        
        FUNCTIONS:
        
        master control of autonomic nervous system
        [heartrate, blood pressure, digestion, respiration etc..]
        
        master control of endocrine system
        [secretes hormones that control pituitary gland activities]
        
        body temperature regulation
        
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        COMPOSITION:
        composed of a right and left cerebral hemispheres that are separated by the longitudinal fissure (only conjoined in a specific few locations)
        
        CHARACTERISTICS:
        
        functional regions overlap and have indistinct boundaries. For some higher functions multiple regions play a role.
        
        RIGHT hemisphere receives stimulus and sends commands to LEFT side of body
        
        LEFT hemisphere receives stimulus and sends commands to RIGHT side of body
        
        cerebral lateralization
        term for the functional differences between the 2 hemispheres
        
        FIVE LOBES OF THE CEREBRUM:
        (4 visible on surface of cerebrum)
        (1 deep)
        
        each has specific cortical regions & areas of association
        
        frontal lobe
        forms anterior part of cerebrum
        (boundaries = central sulcus & lateral sulcus
        
        parietal lobe
        forms superoposterior part of cerebrum
        (boundaries = central sulcus, parieto-occipital sulcus & lateral sulcus
        
        contains mass of nervous tissue posterior to central sulcus called the postcentral gyrus
        
        temporal lobe
        located inferior to lateral sulcus.
        associated with specialty senses of hearing and smelling
        
        occipital lobe
        forms posterior cerebrum
        
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        FUNCTIONAL AREAS OF CEREBRUM
        [ 3 MAIN CATAGORIES]
        
        MOTOR
        
        SENSORY
        
        ASSOCIATION
        
        motor areas
        
        control voluntary motor functions
        
        located within frontal lobes
        
        sensory areas
        
        receive and processes sensory information from sensory organs/structures
        
        association areas
        
        connected to adjacent regions and either: process & interpret data or coordinate motor responses
        
        integrate new sensory inputs with memories
        
        premotor cortex
        
        located within frontal lobe
        
        responsible for coordination of skilled motor activities
        
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        Functional brain region acts like a multi-association area between lobes that integrate information from individual association areas
        
        primary somatosensory cortex
        
        located within postcentral gyrus of parietal lobes
        
        receives somatic sensory information from: proprioceptors, touch, pressure pain & temperature receptors
        
        primary visual cortex
        
        located within occipital lobe
        
        receives and processes incoming visual information
        
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        primary motor cortex
        
        located in precentral gyrus of lobe
        
        control of voluntary skeletal muscles
        
        LEFT primary motor cortex responsible for RIGHT side of body and vice versa (contralaterally)
        
        motor speech area
        
        usually located inferolateral portion of left frontal lobe
        
        controls muscular movements associated with vocalization
        
        frontal eye field
        
        located on superior surface of middle frontal gyrus
        
        regulates eye movements associated with reading and binocular vision
        
        aka: Broca area
        
        CEREBRAL LATERALIZATION:
        hemisphere specialization
        
        categorical hemisphere
        
        specialized for language skills
        
        usually contains Wernicke & motor speech areas
        
        in left hemisphere in majority of population
        
        involved in sequential & analytical reasoning tasks
        
        representational hemisphere
        
        whichever of the 2 cerebral hemispheres is not the categorical hemisphere
        
        responsible for imagination, artistic skill, visiospatial relationships
        
        in right hemisphere in majority of population
  - - - GROSS ANATOMY OF SPINE
        
        conus medullaris:
        tapering end of the spinal cord proper
        
        cauda equina:
        "horses tail"
        nerve roots projecting inferiorly from spinal cord
        
        posterior median sulcus:
        narrow longitudinal groove on posterior surface of spinal cord
        
        anterior median fissure:
        longitudinal depression on anterior surface of spinal cord
        
        cervical enlargement:
        portion of spinal cord in cervical region where diameter is increased due to increase in neurons present for innervation of upper limbs
        
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        contains filum terminale which is a thin strand of pia mater which helps anchor conus medullaris to coccyx
    - - spinal cord meninges
        
        continuous with cranial meninges
        
        layers of connective tissue
        
        encapsulates spinal cord in protective wrapping
        
        helps circulate CSF
      - epidural space
        located between dura mater & inner walls of vertebra. contains connective tissue, blood vessels and fatty tissue. (protection and nutrition)
      - denticulate ligaments
        triangular extensions of pia mater that are attached to dura mater and help suspend & anchor the spinal cord laterally
  - - - higher-order mental functions
        
        include: learning, memory & reasoning
        
        occur within cerebral cortex but involve multiple regions of brain
        
        involves conscious AND unconscious processing
      - cognition
        collective name for mental processes such as: awareness, knowledge, memory, perception & thinking
      - memory
        storage and retrieval of memory requires higher-order mental functions & depends on complex interactions among the brain regions
        
        3 TYPES OF MEMORY
        
        sensory
        
        short-term
        
        long-term
        
        sensory memory
        occurs when brain forms important association based on sensory input from environment & typically lasts only seconds
        
        short-term memory
        follows sensory memory and is generally characterized by limited capacity & brief duration
        [about 7 simple pieces of info for anywhere from a few seconds to a few hours]
        
        long-term memory
        
        can be converted from short-term memory via encoding or memory consolidation.
        
        to do so involves: repetition, association & emotions
        
        can be limitless in time
        
        risk of losing certain memory if not retrieved occasionally
        
        these memories stored mostly in association areas
      - emotions
        emotions are interpreted by the limbic system but their expression is controlled by prefrontal cortex
    - - reticular formation
        
        protrudes vertically through center of midbrain, pons & medulla
        
        loosely organized core of gray matter
        
        center of CONSCIOUSNESS
        
        consciousness
        
        awareness of sensations and ability to voluntarily perform motor activities
        
        involves simultaneous activity of large areas of cortex
        
        there is a spectrum from sleep to alertness
- - - - the longer the brain cells are starved, the more damage that will be done to them, resulting in more severe condition for patient
        
        The regions of the brain being damaged no longer function properly or at all
  - - - cells in regions of the brain whose feeder vessels were damage begin to starve, become damaged and possibly die
        
        along with a lack of blood to the brain cells, the flooding blood creates pressure in the skull which can be very damaging to the brain tissue as well. The brain is being starved in some areas and also compressed
- - - - THE PIANO
        patient appears to be paralyzed only in his right hand and arm, he could learn to play the piano with just the left side but it is also very possible with time and effort for him to be rehabilitated enough to play the piano once more as before
  - - - taking medicines and supplements to prevent clots (daily aspirin etc) and heal liver (milk-thistle etc)
      - following up with therapists to help regain mental and physical abilities
        
        he can create new connections in his brain with practice. this will benefit him emotionally since piano teaching is his job and he most likely enjoys it but also will help strengthen his brain and have physical benefits as well
- - - - this patient cannot speak
        
        this does NOT mean related abilities such as recognizing words, singing and memory will also be impaired because they are not associated with this same area
    - - this patient cannot use RIGHT arm and hand
      - this patient needs assistance to walk