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Chief Complaint -Patient had a stroke -Lost ability to speak & some…
Chief Complaint
-Patient had a stroke
-Lost ability to speak & some motility
Possible Direct Upstream Causes
-Loss of oxygen supply to the brain
(2 possible ways)
Possible Indirect Upstream Causes
-Alcohol abuse
-High Blood Pressure (due to alcohol abuse)
-Poor Brain Health (due to alcohol abuse)
Ischemic
brain's blood vessels become narrowed or blocked completely
Hemorrhagic
Blood vessel in brain leaks/ ruptures
The Brain
4 Regions of the Brain
-Cerebrum
-Diencephalon
-Brainstem
-Cerebellum
Brain Anatomy
Outer Surface
Gyri
- folds
Sulci
- shallow depressions
Fissures
- deeper grooves
Common Directional Terms
Rostral
- anterior (toward nose)
Caudal
-posterior (toward tail)
Two Tissue Areas of Brain and Spinal Cord
Gray Matter
Color from motor & interneuron cell bodies, dendrites and unmyelinated axons
White Matter
color from myelin on axons
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Cerebrum
Location of conscious thought processes & origin of all complex intellectual functions
-2 halves (left & right hemispheres)
-difficult to assign precise function to specific region
-Innervation
Cerebral Lateralization
functional differences between hemispheres
Lobes of Cerebrum
-Frontal
-Parietal
-Temporal
-Occipital
-Insula
Functional Areas of Cerebrum
Motor Areas
control voluntary motor function & are housed within frontal lobes
Primary Motor Cortex
-in precentral gyrus of lobe
Motor Speech Area
-(Broca Area)
-inferolateral portion of left frontal lobe
Frontal Eye Field
-superior surface of middle frontal gyrus
Sensory Areas
Primary Somatosensory Cortex
-receives somatic sensory info
-Within postcentral gyrus of parietal lobe
Primary Visual Cortex
-Within occipital lobe
-Receives/processes incoming visual info.
Primary Auditory Cortex
-Within temporal lobe
-Receives/processes auditory info.
Primary Olfactory Cortex
Within temporal lobe
-provides awareness of smells
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Association Areas
process & interpret data or coordinate motor response
Premotor Cortex
-responsible for coordinating skilled motor activities
-Within frontal lobe
Somatosensory Association Area
-Allows for identification of objects w/o seeing them
-Within parietal lobe
Visual Association Area
-Within occipital area
-helps identify things we see
Auditory Association Area
-within temporal lobe
-Stores memory of sound heard in the past
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Cerebral Lateralization
Categorical Hemisphere
Specialized for language abilities
-contains Wernicke area & motor speech area
Representational Hemisphere
-seat of imagination, artistic skill, pattern perception
Cerebral Nuclei
paired masses of gray matter buried within white matter in basal cerebral hemispheres
--help regulate motor output
-diseases of nuclei often associated with involuntary movements
Diencephalon
Epithalamus
forms partial posterior roof of diencephalon & covers 3rd ventricle
Pineal Gland
-endocrine gland, secretes melatonin
-helps regulate day/night cycles (circadian rhythym)
Thalamus
paired oval masses of gray matter on lateral walls of 3rd ventricle
Functions
-principal & final relay point for incoming sensory info., processed & projected to primary somatosensory cortex
-Info. filter
Hypothalamus
anteroinferior region of diencephalon
Infundibulum
thin stalk from hypothalamus to pituitary gland
Functions:
-master control of:
1.autonomic nervous sytem
endocrine system
-regulation of body temp
Brainstem
connects cerebrum, diencephalon & cerebellum to spinal cord
from superior to inferior:
-midbrain
-pons
medulla oblongota
Brain Injury
Traumatic Brain Injury
Acute brain damage, result of trauma
Concussion
Temporary loss of consciousness after blow to head
Contusion
Bruising of brain due to trauma c dc
Second Impact Syndrome
-Receiving 2nd injury prior to resolution of 1st trauma
-Severe brain swelling
Anencephaly
without brain
Spina Bifida
failure to close caudal portion of neural tube
Arcurate Tracts
-Short association tracts connecting neighboring gyri within same lobe
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Structures that Protect & Isolate Brain
Cranium
- Provides rigid support
Meninges
- surround & partition
Cerebrospinal Fluid
- cushions
Blood- Brain Barrier
- prevents entry of harmful materials
Meninges (3 layers)
Pia Mater
-Innermost of cranial meninges
-Thin layer: loose areolar connective tissue
-Tightly lines brain
Arachnoid Mater
-External to Pia Mater
-Partially composed of elastic and collagen fibers
-Trabeculae extend to subarachnoid space
Subdural Space
-potential space between arachnoid and dura mater
-Could be actual space if filled w/ blood/fluid
Dura Mater
tough, dense layer, external to arachnoid mater
Meningeal Layer
immediately superficial to arachnoid
Periosteal Layer
more superficial layer forms periosteum of cranial bones
Epidural Space
potential space between dura mater and bones of skull
Clinical View
Epidural Hematoma
pool of blood in epidural space of brain
-Brain tissue distorted & compressed
Subdural Hematoma
hemorrhage in subdural space
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Brain Ventricles
cavities within brain derived from neural canal
Lateral Ventricles
(2)
in cerebrum
Third Ventricle
small, thinner cavity in diencephalon
Fourth Ventricle
between pons & cerebellum
CSF
clear, colorless liquid
-circulates in ventricles
Functions
-Buoyancy
-Protection
-Environmenal Stability
Choroid Plexus
forms CSF
specialized tissue in each ventricle
Blood-Brain Barrier
regulates which substances can/can't enter brain's interstitial fluid
-Wrapped by perivascular feet of astrocytes
-Barrier not absolute
Missing or Reduced in 3 Places
Choroid Plexus-
needs to be permeable to produce CSF
Hypothalmus & Pineal Gland
produce hormones requiring access to bloodstream "{
Spinal Cord
Conus Medullaris
tapering end marking end of spinal cord proper
Cauda Equina ( Horse's Tail)
nerve roots projecting inferiorly from cord
Filium Terminale
thin strand of pia mater that helps anchor conus medullaris to coccyx
Posterior Median Sulcus
longitudinal narrow groove on posterior surface
Anterior Median Fissure
longitudinal depression on anterior surface
Cervical Enlargement
large diameter of spinal cord in cervical region
Lumbosacral Enlargement
large diameter in mid-lumbar region
Sectional Anatomy of the Spinal Cord
Gray Matter
inner region made of dendrites & cell bodies of neurons,glial cells, unmyelinated axons
Anterior Horns
contain somatic motor nuclei
-innervate skeletal muscle
Lateral Horns
fund in T1-T2 parts of spinal cord & contain autonomic motor nuclei
-innervate cardiac& smooth muscled and glands
Posterior Horns
contain somatic& visceral sensory nuclei
Gray Commissure
horizontal band of gray matter around central canal which contains unmyelinated axons communicate between left & right gray matter
White Matter
external to gray matter & composed of myelinated axons going to and from brain
Pathways
travel through white matter of spinal cord
-has tract and nucleus
Sensory Pathways
primarily in posterior white matter called ascending pathways b/c sinals from sensory receptors ascend through spinl cord to brain
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Specific Problem #1
Stroke
Possible Direct Downstream Effects
Can cause harm to other systems in the body
Possible Indirect Downstream Effects
Other systems could be permanently affected and cause the individual many struggles
Normal Physiology & Homeostatic Set Points
Motor Cortex
Sends signals/demands through the spinal cord
Movement of limb/ digit happens
Relevant intracellular energy/nutrition/metabolism pathways
Neurons communicate with each other through electrical currents (action potentials) & chemical neurotransmitters
@ synapse, a action potential causes neuron A to release chemical neurotransmitter
neuron a inhibits/excites neuron B fro firing its action potential
Action potential reaches presynaptic terminal
causes neurotranmiter to be released from neuron into the synaptic cleft
After traveling across synaptic cleft, transmitter attaches to neurotransmitter receptors on postsynaptic cleft
Synapses change Action potentials to chemical signals in form of neurotransmitter release
Body receives signals from any/ all sensory organs
Cerebral cortex is the seat of complex thought
One of the many functions of the cerebral cortex is movement
Thalamus relays motor and sensory signals to cerebral cortex and midbrain
Brain acts as a control center.
Alcohol robs blood stream of oxygen
brain needs oxygen to function properly, w/o it can result in speech and behavioral changes
Specific Problem # 2
Inability to Speak
Possible Direct Downstream Effect
Stroke could have caused damage to the left side of the brain
Possible Indirect Downstream Effect
Patient could eventually develop aphasia and would have to learn to speak all over again
Specific Problem #3
Inability to Use Right Hand & Arm
Possible Direct Downstream Effects
Stroke most likely occurred on the left hemisphere of the brain
-Motor cortex of the brain affected
Possible Indirect Downstream Effect
Could cause muscle dystrophia in those certain limbs of the body
Specific Problem #4
Inability to walk w/o Assistance
Possible Direct Downstream Effects
Injury to motor cortex causes inability to move muscles
Possible Direct Downstream Effects
Injury to the motor cortex can diminish muscle tone and control
-Muscles can also lose ability to contract
Effects of Alcohol on the Brain
-
Disturbance of gait
(manner of walking)
-Loss of Balance & Posture
-
Inability to detect Proprioceptive Info.
(inability to close eyes & touch nose)