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A 61 year-old male piano teacher with a long history of alcohol abuse was…

- - - - Aphasia
        
        Damage to left parietal and temporal lobes - Broca's area
    - - Hemiplegia
        
        Damage to left side of brain
    - - Damage to frontal lobes, somatic motor cortex, premotor cortex
- - - - Form superior part of brain, makes up 83% of brain mass
      - Surface markings
        
        Gyri: ridges
        
        Sulci: shallow grooves
        
        Fissures: deep grooves
      - Sulci divide each hemisphere into 5 lobes
        
        Frontal
        
        Under the frontal bone
        
        Parietal
        
        Under the parietal bones
        
        Temporal
        
        Under the temporal bones
        
        Occipital
        
        Under the occipital bone
        
        Insular
        
        Centrally located under the other 4 lobes
      - Each hemisphere has 3 regions
        
        Cerebral cortex: gray matter, superficial
        
        “executive suite” of brain
        
        Site of conscious mind: awareness, sensory perception, voluntary motor initiation, communication, memory storage, understanding
        
        Thin (2–4 mm) superficial layer of gray matter
        
        Composed of neuron cell bodies, dendrites, glial cells, and blood vessels, but no axons
        
        40% of mass of brain
        
        3 types of functional areas
        
        Motor areas: control voluntary movement
        
        Located in frontal lobe, control voluntary movement
        
        Primary motor cortex: precentral gyrus
        
        Premotor cortex: anterior to precentral gyrus
        
        Broca’s area: anterior to inferior premotor area
        
        Frontal eye field: within and anterior to premotor cortex; superior to Broca’s area
        
        Sensory areas: conscious awareness of sensation
        
        Occur in parietal, insular, temporal, and occipital lobes
        
        Eight main areas
        
        primary somatosensory cortex
        
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        somatosensory association cortex
        
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        visual areas
        
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        auditory areas
        
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        vestibular cortex
        
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        olfactory cortex
        
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        gustatory cortex
        
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        visceral sensory area
        
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        Association areas: integrate diverse information
        
        Receive inputs from multiple sensory areas
        
        Send outputs to multiple areas
        
        Allows us to give meaning to information received, store in memory, tie to previous experience, and decide on actions
        
        Sensations, thoughts, emotions become conscious: makes us who we are
        
        3 parts
        
        anterior association area
        
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        posterior association area
        
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        limbic association area
        
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        White matter: internal
        
        Responsible for communication between cerebral areas, and between cortex and lower CNS
        
        Consists of myelinated fibers bundled into large tracts
        
        Classified according to direction they run
        
        Association: horizontal running fibers that connect different parts of same hemisphere
        
        Commissural: horizontal fibers that connect gray matter of two hemispheres
        
        Projection: vertical fibers that connect hemispheres with lower brain or spinal cord
        
        Basal nuclei: deep within white matter
        
        Function:
        
        Influence muscle movements
        
        Play role in cognition and emotion
        
        Regulate intensity of slow or stereotyped movements
        
        Filter out incorrect/inappropriate responses
        
        Inhibit antagonistic/unnecessary movements
    - - Consists of three paired gray-matter structures:
        
        Thalamus
        
        Bilateral egg-shaped nuclei that form superolateral walls of third ventricle
        
        Makes up 80% of diencephalon
        
        Bilateral nuclei connected by interthalamic adhesion (intermediate mass)
        
        Acts to mediate sensation, motor activities, cortical arousal, learning, and memory
        
        Hypothalamus
        
        Located below thalamus
        
        Forms cap over brain stem and forms inferolateral walls of third ventricle
        
        Vital to homeostasis
        
        Controls autonomic nervous system
        
        Initiates physical responses to emotions
        
        Regulates body temperature: sweating or shivering
        
        Regulates hunger and satiety in response to nutrient blood levels or hormones
        
        Regulates water balance and thirst
        
        Regulates sleep-wake cycles
        
        Controls endocrine system functions such as:
        
        Secretions of anterior pituitary gland
        
        Production of posterior pituitary hormones
        
        Epithalamus
        
        Most dorsal portion of diencephalon
        
        Forms roof of third ventricle
        
        Contains pineal gland (body)
    - - Midbrain
      - Pons
      - Medulla
      - Controls automatic behaviors necessary for survival
    - - 11% of brain mass
      - Located dorsal to pons and medulla
      - Processes input from cortex, brain stem, and sensory receptors to provide precise, coordinated movements of skeletal muscles
      - Also plays a major role in balance
    - - Brain stem has addition gray matter nuclei scattered within white matter
      - Cerebrum and cerebellum have outer layer of gray matter called "cortex" and scattered areas of gray matter amid white matter
    - - Chambers that are continuous to each other and to central canal of spinal cord, filled with cerebrospinal fluid
  - - - Over continued use, brain adapts by responding more dramatically to neurotransmitters
    - - Neurotoxicity
      - Brain shrinkage
      - Physical dependency and addiction
  - - - Loss of blood flow typically caused by either a clot or a bleed
    - - Cause - clot or bleed
      - Area of brain effected
      - Severity of stroke
      - Time between stroke occurring and medical attention
- - - - If damage is limited to language centers, he may have full mental faculty
    - - Depends on multiple factors
        
        Severity of stroke, success or rehabilitation, promptness of treatment, etc.
  - - - Severity of stroke
      - Severity of symptoms
    - - Mood
      - Treatment compliance