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Case Study: A 61 yr old male is suffering from a stroke. According to the…

- - - - Symptoms
        
        Can't speak
        
        Possible damage to broca's area has been done
        
        Affecting ability to use speech
        
        Can't use his right hand & arm
        
        Possible damage to the left primary motor cortex
        
        Affecting his right arm & hand
        
        Due to lateralization of cortical functioning
        
        Can't walk w/out assistance
        
        Possible damage to premotor cortex
        
        Making it tough to coordinate his movements to walk
      - Direct causes of a stroke
        
        Blood circulation to the brain is reduced
        
        2 Types
        
        Causes of either of these
        
        Atrial fibrillation
        
        Irregular heartbeat leading to blood clots
        
        High blood pressure
        
        2: Hemorrhagic stroke
        
        Def: Internal bleeding in or around brain creating pressure & swelling thus damaging brain tissue
        
        1: Ischemic stroke
        
        Blood clot blocks blood flow to brain
        
        After much O2 in brain is lossed
        
        An enormous amount of glutamate is produced
        
        Causing death of neurons around it
  - - - How this could be a factor contributing to the stroke
        
        2) Atrial fibrillation
        
        Patient is possible at an increased risk of developing cardiovascular problems
        
        This can lead to irregular heat beat which further progresses to blood clots
        
        1) The excess use can raise his blood pressure
        
        This can yield hypertension
        
        Causing a Lacunar ischemic stroke
        
        Blood vessel walls thicken up in response
        
        Not much O2 is getting to them & the vessel can die
        
        Atherosclerosis can also occur in this vessel
        
        This would block them causing a stroke
- - - - Due to excess alcohol not being able to all be processed
        
        This can prevent liver from producing substances to help blood clot
        
        This further puts patient at risk for a hemorrhagic stroke
    - - Ischemic cascade (info from Khan Academy)
        
        W/out blood supply neurons utilize aerobic metabolism due to lack of O2
        
        This hardly produces the energy that the body needs
        
        W/Lactic acid being a byproduct of this, it could disrupt normal acid base balance in the brain
        
        This can cause deterioration of neurons
        
        This causes the Na+ K+ pump to not work effectively
        
        1 more item...
      - Mitochondrial death
        
        All of the toxic chemicals in the cell from ischemic cascade
        
        Mitochondria begin to break down
        
        They then release apoptotic factors (proteins) into cytoplasm
        
        An apoptosis cascade occurs
        
        Cells & neurons all over the body die
        
        1 more item...
      - https://www.youtube.com/watch?v=BBz04rPXuJI
    - - When blood from ruptured vessel leaks it creates pressure in the brain
        
        This irritates other vessels by undergoing vasospasm
        
        Where they close a bit
        
        Thereby causing a secondary stroke
    - - Could cause a vessel to rupture
        
        Thus leading to another stroke & causing more brain damage
  - - - Functional areas of the brain seem to be more affected by the stroke rather than the structural areas
        
        The functional areas affected are involved in mental capacities
        
        Example
        
        The prefrontal cortex does not seem to be affected as far as is known
        
        Therefore, he should still be able to
        
        Solve problems
        
        Use his working memory for object-recall tasks
        
        Areas of brain that seem to be in tact
        
        Temporal lobe
        
        The patient's auditory functions seem to be working
        
        Occipital lobe
        
        The patient seems able to be accessing visual faculties
        
        parietal lobe
        
        The patient has to be able to experience general sensations being he is still responsive in some ways
        
        All of these areas are working together to allow
        
        awareness of localization & his surroundings in space
        
        Recognition of patterns & faces
        
        As for patient's speech
        
        He is able to function well mentally
        
        B/c area affected -> Broca's area
        
        It is responsible for OUTPUT only being that it is in front of the central sulcus
        
        2 more items...
      - As for patient being able to play piano again
        
        He should be able to play with enough practice
        
        Therapy will help him achieve that
        
        He will need to strengthen connections in the left side of brain
        
        Primary motor cortex
        
        For contracting muscles to move his fingers to play
        
        Premotor cortex
        
        For planning the movement in his fingers
    - - Main areas affected
        
        Broca's area
        
        Premotor cortex
        
        Left primary motor cortex
    - - Neuroplasticity
        
        Factors involved in worsened condition
        
        Depression
        
        Possible signs this type is occurring
        
        If patient loses sensation of touch in any part of the right side of body
        
        If patient loses gustatory sensation
        
        If patient begins feeling dizzy or loses balance
        
        If other areas of the right side of patients body begins losing functionality
        
        If patients does not gain functionality in right arm & hand
        
        Patient only practices occasionally or never using his left primary motor cortex, left premotor cortex, & broca's area
        
        Synaptic changes (Chemical)
        
        Very little AP activity occurring
        
        Less neurotransmitters releasing
        
        1 more item...
        
        Structural changes (new connections forming)
        
        Neuronal pruning occurs
        
        Not much growth seen in dendrites
        
        1 more item...
        
        Factors involved in improvement of condition
        
        Potentiation
        
        Possible signs this type is occurring
        
        Patient gains ability to move around more & walk
        
        Patient gains sensory feeling in hand and arm again & is able to move them again
        
        Patient is able to gain speech back
        
        Patient practices using his left primary motor cortex, left premotor cortex, & broca's area alot & in many different ways to accomplish this
        
        Synaptic changes (Chemical)
        
        Many APs are fired
        
        Releasing more neurotransmitters
        
        1 more item...
        
        Structural changes (new connections forming)
        
        Neuronal sprouting occurs
        
        Many dendrites grow in response
        
        1 more item...
        
        Def: Ability of the brain to rewire
- - - - Folding of brain during development
        
        Neutral tube (Containing central canal)
        
        Primary brain vesicles
        
        Prosencephalon (forebrain)
        
        Secondary vesicles
        
        Telencephalon
        
        1 more item...
        
        Diencephalon
        
        2 more items...
        
        Mesencephalon (Midbrain) BRAIN STEM
        
        Secondary vesicles
        
        Mesencephalon
        
        1 more item...
        
        Rhombencephalon (Hindbrain) BRAIN STEM
        
        Secondary vesicles
        
        Metencephalon
        
        3 more items...
        
        Myelencephalon
        
        2 more items...
  - - - 2 Types
        
        Type 1: Ischemic
        
        Def: Artery blocked by blood clot, reducing blood flow to brain, preventing it from receiving O2 & nutrients to brain tissue
        
        Factors related
        
        Atherosclerosis
        
        Buildup of fatty cholesterol plaque in walls of arteries
        
        Incomplete stroke, NOT PERMANENT
        
        Transient ischemic attacks (TIAs)
        
        Last from 5-50 min
        
        Characterized by
        
        3 more items...
        
        Type 2: Hemorrhagic
        
        Def: When a blood vessel in brain ruptures or leaks
        
        Factors related
        
        Weakness in blood vessel walls (Protein deposits)
        
        Uncontrolled high blood pressure
        
        Other causes from either types
        
        Heart disease
        
        Diabetes
        
        Medications
        
        Excessive alcohol usage
      - Def: Blood circulation to the brain is blocked or reduced
        
        Putting neurons are at risk of death in min
        
        It does this by
        
        After the brain is deprived of O2, it begins to disintegrate, & a magnitude of glutamate is released
        
        Glutamate excites surrounding cells to death
      - Why symptoms differ much in certain patients vs. others
        
        Depending on what type of stroke it is & what area of the brain it affected determines outcome of symptoms
        
        Example
        
        Someone who has troubles speaking after a stroke most likely has had restriction to a blood vessel near broca's area of the cerebrum
    - - Depressant of CNS
      - Process of intoxication
        
        5) Lots of Cl- enters the neurons & cells
        
        This inhibits glutamate (excitatory neurotransmitter)
        
        Thereby depressing responsiveness
        
        By slowing brain processes
        
        This drives in more dopamine & serotonin
        
        1) ethanol, C2H5OH enters stomach
        
        20% is broken down immediately
        
        2) The rest is absorbed in small intestine
        
        Where it is sent through bloodstream
        
        3) It then reaches the brain
        
        Wtih C2H5OH present, GABA (inhibitory neurotransmitter) activity increases
        
        By the C2H5OH acting as a positive allosteric modulator
        
        It binds to a separate receptor than where GABA binds
        
        Increasing the effect when GABA binds
        
        4) This inhibits the signal longer & more often than usual
        
        This occurs all over the brain
        
        Long term effects
        
        Produces opposite effect on the brain
        
        Long term use taps into adaptation response in order to restore equilibrium
        
        The brain decreases GABA & increases glutamate
        
        Therefore more alcohol is needed to obtain an inhibitory effect
        
        Effects
        
        3 more items...
      - Intoxication effects on areas of brain
        
        Prefrontal cortex
        
        Making self control less important to the individual affected
        
        Affects decision making
        
        Affects planning
        
        Affects idea formation
        
        Hippocampus
        
        Making it difficult to learn new material or remember it
        
        Cerebellum
        
        Affecting ability to drive or play instruments
        
        Affects balance
        
        Hypothalamus
        
        Blood pressure often increases
        
        Body temp & heart rate decreases
- - - - Ischemic stroke
        
        Removal of blood clot using a mechanical thrombectomy
        
        Medications often used
        
        Aspirin
        
        Tissue plasminogen activator
      - Hemmorhagic stroke
        
        Medications
        
        If bleeding is excessive
        
        Surgery may be required to drain the blood
      - https://www.youtube.com/watch?v=EY98RInP-A4