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61 y/o M with a long history of alcohol abuse was admitted post stroke.…

- - - - Ischemic stroke
        
        Caused by a blood clot blocking blood flow to the brain
        
        The blockage causes cell death from lack of nutrients and oxygen
      - Hemorrhagic stroke
        
        Caused by blood from a weak or burst cell leaking in or around the brain
        
        The leak causing intracranial pressure and causes damage to brain cells and tissue
  - - - Liver damage
      - Atrial fibrillation
      - Hypertension
      - Diabetes
      - These are all conditions the patient might have and increase likelihood of stroke
  - - - The cerebellum
        
        Helps coordinate muscle action and control, fine movement, coordination, and balance.
        
        Since this is being affected he might not be able to play piano again
      - The left cerebral hemisphere
        
        Since each side of the brain controls the opposite side of the body
        
        The stroke affecting this portion caused right sided paresis (weakness)
        
        The frontal lobe that controls movement was affected
        
        The parietal lobe that controls sensation was affected
        
        The frontal lobe is also responsible for reasoning and judgment
        
        This means the ability to do math or to organize, reason, and analyze items are all possibly impaired
        
        This could affect his ability to play piano
        
        The temporal lobe being affected also affects memory
        
        Memory issues more than likely affected his ability to play the piano
        
        His inability to speak stems from the temporal lobe being affected
        
        This is where one of the language centers is and this caused his aphasia (inability to speak)
        
        The occipital lobe is affected affecting his vision
        
        Due to his inability to speak we might not know how much this has been affected
      - Brain stem
        
        His weakness and aphasia could also be because the brain stem was affected
        
        Many of the body's vital "life-support" functions are maintained here. it also helps control nerves involved with eye movement, hearing, speech, chewing, and swallowing.
- - - - There are two main types of strokes
        
        Ischemic
        
        These occur when blood circulation to the brain is blocked and brain tissue dies
        
        The death is a result of the brain not receiving oxygen and nutrients
        
        The most common cause of stroke is a blood clot blocking the cerebral artery
        
        Once the artery is blocked and cell death begins glutamate begins to be released in copious amounts
        
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        Hemorrhagic
        
        Hemorrhagic strokes are usually more severe
        
        A brain aneurysm a ballooned blood vessel can burst or a weak blood vessel leaks
        
        This causes blood to spill into the brain and creates ICP (intracranial pressure) and causes damage to the brain and cell tissues
    - - Symptoms depends on the area of the brain affected
  - - - High blood pressure
        
        Drinking too much alcohol raises blood pressure
        
        High blood pressure abuses blood vessels and can damage them
        
        They can be damaged causing them to leak
        
        This also increases likelihood of plaques causing atherosclerosis
      - Diabetes
        
        Doubles risk for stroke
        
        Alcohol changes the way the body responds to insulin affecting how sugar is regulated in blood
        
        Leading to type 2 diabetes and possibly being overweight which also increases stroke risk
        
        These two can lead to atherosclerosis
        
        Atherosclerosis is a condition characterized by the deposition of fatty tissue and plaques inside of arteries
        
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      - Atrial fibrillation and alcohol
        
        Alcohol abuse can trigger atrial fibrillation
        
        This is a type of irregular heartbeat
        
        Irregular beating of the heart can cause clots to form there
        
        These clots can break off and move up into the brain causing stroke
      - Liver damage due to too much alcohol
        
        can stop the liver from making substances
        
        that help your blood to clot. This can
        
        increase your risk of having a stroke
        
        caused by bleeding in your brain.
    - - Alcohol blocks chemical signals between neurons which causes intoxication and its side effects
        
        After long-term abuse, the brain adapts to the blocked signals by responding more dramatically to neurotransmitters
        
        After becoming sober the brain continues over activating the neurotransmitters, causing withdrawal symptoms that can damage brain cells
        
        This is worsened by drinking binges and sudden withdrawal
        
        Alcohol related damage to the brain can cause
        
        Cognitive impairment
        
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        Memory deficits
        
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        Brain shrinkage
        
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        Neurotoxicity
        
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  - - - Diencephalon
        
        Forms the central core of the forebrain and is surrounded by the cerebral hemispheres
        
        Encloses the third ventricle
        
        Consists of three structures
        
        Hypothalamus
        
        Lies below the thalamus
        
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        Epithalamus
        
        Most dorsal portion of the diencephalon
        
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        Thalamus
        
        Makes up 80% of the diencephalon
        
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      - Brain stem
        
        Located between the cerebrum and spinal cord
        
        Produces automatic behaviors necessary for survival
        
        The brain stem consists of three regions accounting for 2.5% of brain mass
        
        Pons
        
        Located between the midbrain and the medulla oblongata
        
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        Medulla Oblongata
        
        Most inferior part of the brain stem
        
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        Midbrain
        
        Located between the diencephalon and the pons
        
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      - Cerebral hemispheres
        
        The cerebral hemispheres form the superior part of the brain
        
        Account for 83% of brain mass
        
        The hemispheres are separated by the median longitudinal fissure
        
        The transverse cerebral fissure separates the hemispheres from the cerebellum
        
        The cerebral hemispheres can be broken down into three regions or five lobes separated by several sulci
        
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      - Cerebellum
        
        Located dorsal to the pons and medulla
        
        11% of brain mass
        
        Processes inputs and provides precise timing and appropriate patterns of skeletal contraction for smooth coordinated movements
    - - The ventricles are hollow and consist of cerebrospinal fluid and are lined with ependymal cells
        
        There are four ventricles
        
        The lateral ventricles communicate with the narrow third ventricle
        
        The third ventricle lies within the diencephalon
        
        Inside of a channel called the interventricular foramen
        
        The third ventricle is continuous with the fourth ventricle
        
        This is inside of the cerebral aqueduct that runs through the midbrain
        
        It lies dorsal to the pons and superior medulla
        
        The three openings that mark the walls of the fourth ventricle are
        
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        The first two are paired lateral ventricles
        
        These are c-shaped and lie deep within each cerebral hemisphere
        
        They are separated only by a thin median membrane
        
        This membrane is called the septum pellucidum
  - - - Deeper grooves than sulci, separate the cerebral hemispheres from the cerebellum
    - - A fluid filled space surrounding the brain
    - - Shallow grooves in between gyri
    - - Elevated ridges of tissue in the cerebral hemispheres
- - - - He is much less likely to regain full function if he continues drinking
        
        HEavy drinking also increases his risk for another stroke
  - - - Rehabilitation and speech therapy could assist in alleviating the aphasia and paresis
        
        Undamaged neurons can possibly sprout new branches spread into the injured area and take over lost function
        
        This will renew some capabilities