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A 61 year old male piano teacher with a long history of alcohol abuse was…
A 61 year old male piano teacher with a long history of alcohol abuse was admitted to the hospital due to a stroke. He cannot speak, use his right hand and arm or walk without assistance following the stroke. His wife asks if he will get better so he can play the piano again. She also wants to know if his inability to speak indicates that he has lost his mental faculties.
Downstream Effects
What to tell Wife about husbands mental Faculties
The left side of his brain was definitely severely effected by the stroke
He might not be able to play with his right hand anymore, but yes with his right
His mental faculties are not entirely gone, but it depends on which particular parts of his brain were directly effected
Honestly he might be able to play a little bit again in the future, stranger things have happened
His muscle memory was not directly effected as much as his primary motor cortex and broca's area, so there is a possibility he could relearn how to play with one hand
Determining factors if conditions worsen or improve over time
If the husband sticks to the treatment assigned to him by the hospital
If the husband is willing to quit his alcohol abuse and turn his life around
If he goes through stroke rehabilitation to help him relearn lost skills
If he makes heart and brain conscious life decisions (change in diet, reducing stress, managing blood pressure/cholesterol, etc.)
Immediate Effect of Stroke
Sudden numbness/weakness in one side of his face/body
Sudden confusion, trouble speaking, or understanding speech
Sudden trouble seeing in one or both eyes
Sudden difficulty walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
What will happen if he continues to drink heavily
He is raising his chance of stroke yet again, and next time he might not be able to be saved or remember anything
Alcohol causes brain cell repair to stop, so his history of abuse might hinder his chances of recovering/waking up
Background Information
Functions of the parts/regions of the brain
Saggital
Epithalamus
Connects the limbic system to other parts of the brain
Secretes melatonin
Regulates motor pathways of emotions
Helps promote sleep and circadian rhythm
Hypothalamus
Link the nervous system to the endocrine system via the pituitary gland
Releases growth hormone
Releases Dopamine
Releases Oxytocin
Mood related hormones are found and sent along here
Thalamus
A large mass of gray matter in the dorsal part of the diencephalon of the brain
Relays sensory signals
Sends motor signals to the cerebral cortex
Helps regulate sleep, consciousness and alertness
Corpus Callosum
Integrates motor, sensory, and cognitive performances between the cerebral cortex on one side of the brain to the same region on the other side
Ventricles
Ventricles that communicate with each other, there are 4 located throughout the brain
Filled with cerebrospinal fluid, which helps to protect the brain from injury and transport nutrients and waste
Mammilary Body
Important for recollective memory
Supports spatial memory
Diencephalon
Major relay system for signals
Regulation of autonomic functions
Control of the endocrine system
LImbic System
Emotional/visceral brain (LIZARD BRAIN)
Consists of all the below structures
Midbrain
Serves important functions in motor movement
Particularly movements of the eye and auditory visual processing
Dorsal
Left Cerebral Hemisphere
Controls langauge and logical centers of the brain, as well as the right side of the body
Medial Longitudinal Fissure
"Line" down the center of the brain, separating the brain into the left and right hemispheres
Right Cerebral Hemisphere
Controls emotional interpretation and creativity centers of the brain as well as the left side of the body
Lateral
Temporal Lobe
Wernicke's Area
Responsible for the comprehension of speech
Auditory Cortex
Understanding Language
Behavior
Memory
Hearing
Central Sulcus
Prominent landmark of the brain separating the parietal and frontal lobes
Separates primary motor cortex from primary somatosensory cortex
Parietal Lobe
Sensory Cortex
Knowing Right from Left
Sensation
Processing Language and Math
Body Orientation
Interprets visual information
Input
Frontal Lobe
Broca's Area
Production of Speech
Motor Cortex
Problem Solving
Emotional Traits
Reasoning (judgement)
Speaking
Voluntary Motor Activity
Output
Occipital Lobe
Visual Cortex
Vision
Color Perception
Depth Perception
Face Recognition
Memory Formation
Olfactory Bulb
Located in the forebrain
Receives neural input about odors detected by cells in the nasal cavity
Cerebellum
Coordination and control of voluntary movement
Fine muscle control
Balance
"Muscle Memory"
Olfactory Tract
Connects the olfactory bulb to multiple areas within the center of the brain
Optic Chiasm
An X-shaped space, located in the forebrain, directly in front of the hypothalamus
The left and right optic nerves intersect at the chiasm
Pituitary Gland
A part of the endocrine system
Main function is to secrete hormones into your bloodstream
Hormones can affect other organs and glands, especially your: thyroid
Brain Stem
Medulla Oblongata
helps regulate breathing, heart and blood vessel function, digestion, sneezing, and swallowing
Center for respiration and circulation
Pons
Relays signals from the forebrain to the cerebellum
Helps with sleep, respiration, swallowing, bladder control, hearing, equilibrium, taste, eye movement, facial expressions, facial sensation, and posture
Breathing
Body Temperature
Digestion
Alertness
Sleep
Swallowing
Allows bodily functions to occur reflexively, without thinking about them
Ventral
Infundibulum
Also known as the "pituitary" stalk
A tube-like structure that connects the posterior pituitary to the hypothalamus
Allows for hormones synthesized in hypothalamus to be sent to the posterior pituitary for release into the bloodstream
Entorhinal Cortex
Located in the medial temporal lobe
Functions as a center in a network for memory, navigation and the perception of time
Cranial Nerves
Responsible for a number of functions throughout the body
Directing sense and motor impulses
Equilibrium control
Eye movement
Vision
Hearing
Respiration
Swallowing
Smelling
Facial sensation
Tasting
Differences between Left and Right brain FUNCTIONALLY
2 Hemispheres
Left
Analytical Thought
Logic
Language
Science and Math
Reasoning
Controls
RIGHT
side of body
Right
Creativity
Intuition
Insight
Music Awareness
Emotional Intelligence
Controls
LEFT
side of body
Strokes
Different Types
Intracerebral Hemorrhage
Caused by the sudden rupture of an artery within the brain
Blood is then released into the brain compressing its structures
Subarachnoid Hemorrhage
Also caused by the sudden rupture of an artery
Differs in that the location of the rupture leads to blood filling the space surrounding the brain rather than inside of it.
Ischemic Stroke
Most common type of stroke
Caused by a clot or other type of blockage within an artery in/leading to the brain
A sudden interruption of blood supply to the brain
Strokes occur quickly and require immediate care, so they can also be called "brain attacks"
Effects of a stroke depend on the region of the brain affected and the severity of the injury
Anatomy of the Brain
4 major parts of the brain
Brain Stem
White part at the bottom of the brain, extends into spine
Medulla Oblangata
Pons
Diencephalon
In the center of the brain nestled above brain stem and below cerebrum
Cerebellum
Bulbous part at the back (hind) brain
Cerebrum
Wrinkled part of brain
Divided into two hemispheres (left and right)
Differences between the right and left brain STRUCTURALLY
Left
Speech Center
General Interpretive Center
Controls
RIGHT
side of body
Words, letters and number recognition
Right
Spatial awareness
Controls
LEFT
side of body
Touch Analysis
Face, place, and object recognition
Lobes
Parietal
Sensory Cortex
Temporal
Wernicke's Area
Auditory Cortex
Frontal
Broca's Area
Motor Cortex
Separated from Parietal by central sulcus
Occipital
Visual Cortex
Terms
Gyrus
Gyri
A bulge
Gustatory
Taste
Sulcus
Sulci
A groove
Olfactory
Smell
Auditory
Hearing
Optic
Vision
Effects of alcohol on the brain
Factors that influence alcohol effects on the brain
Age, level of education, gender, genetic background, and family history of alcoholism
Whether they are at risk as a result of prenatal alcohol exposure
Age when drinking first began and how long
Whether he or she is at risk as a result of prenatal alcohol exposure
How much and how often alcohol consumption happens
Blackouts and Memory Lapses
Large quantities of alcohol can cause blackouts or chunks of time the person can not account for
Alcohol produces impairments in memory after only a few drinks
Wernicke–Korsakoff Syndrome
Disease that consists of two separate syndromes, short–lived severe condition called Wernicke’s encephalopathy and a long–lasting and debilitating condition known as Korsakoff’s psychosis
80 percent of alcoholics develop serious brain disorder
Liver cirrhosis
Results from excessive alcohol consumption
Can harm the brain and lead to a potentially fatal brain disorder known as hepatic encephalopathy
Pregnant Drinking
Can lead to deformations in babies brains, called fetal alcohol syndrome or even poison and kill the fetus
Disruption of new brain cell growth/cell death
High doses of alcohol lead to a disruption in the growth of new brain cells
Scientists believe it may be this lack of new growth that results in the long–term deficits found in key areas of the brain
https://pubs.niaaa.nih.gov/publications/aa63/aa63.htm
Upstream Causes
Direct Causes of Strokes
A blockage of an artery inside of the brain
An artery bursting inside of the brain
The blood flow and oxygen and nutrient transport suddenly ceases
Causes of
Specific
Symptoms
The stroke was most likely ischemic (a blockage) and occurred in the left side of his brain
Due to the loss of the right side of his body, and damage to the broca's area, it most likely occured in the frontal lobe
Alcohol abuse effects??
Alcohol abuse can lead to an increased risk of stroke
Alcohol slows down or can completely stop neuron repair, so it might slow down his healing process
Long term abuse made him more susceptible to this happening
