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61 year old male patient admitted to hospital due to a suffering stroke.…
61 year old male patient admitted to hospital due to a suffering stroke. Patient cannot speak, use right hand and arm, and cannot walk without assistance. Patient has long history of alcohol abuse.
Upstream causes
Indirect causes - Risks leading to strokes include high blood pressure, diabetes, cholesterol, alcohol abuse.
Direct cause - Direct cause of a stroke is loss of or interruption of blood supply to a part of the brain preventing brain tissue from receiving oxygen and nutrients. Brain cells begin to die within minutes.
Background Information
Four adult Brain regions
Cerebral Hemisphere
Executive site of the nervous system , where conscious mind is found
enables the brain to be aware of sensations, communication, memory, understanding, and voluntary movements
Composed of Gray matter ; Neuron cell bodies, dendrites, associated glia and blood vessels. and billions of neurons.
Diencephalon
Thalamus - Relay station for information coming into cerebral cortex , contains large number of nuclei each with a functional specialty, and each projects fibers to and receives fibers for specific region of the cerebral cortex.
Hypothalamus- main visceral control center of the body and vitally important to overall body homeostasis
Epithalamus - location of pineal gland which secretes melatonin and helps regulate the sleep-wake cycle.
Cerebellum
Provides precise timing and appropriate patterns of skeletal muscle contraction for smooth, coordinated movements and agility needed for daily living , occurs subconciously
Brainstem
3 specific areas of the brainstem
Midbrain- contains vertical pillars that hold up the cerebrum, connects with cerebellum, contains nuclei that coordinate head and eye movements and hearing receptors
Pons - composed of conduction tracts , relay "conversations" between the motor cortex and cerebellum, create pathway between higher brain centers and the spinal cord
Medulla oblongata - crucial role as an autonomic reflex center involved in maintaining homeostasis, holds motor nuclei that function in cardiovascular, respiration, sneezing, vommiting, coughing.
Lobes of the Brain
Frontal Lobe - located in the front of the skull
Parietal lobe - located onto of skull
Occipital lobe - Located behind the skull above cerebellum
Temporal lobe - located on temporal bone side
Gray and White matter
Gray matter
consist of short, non myelinated neurons and neuron cell bodies
White matter
mostly myelinated axons with some nonmyelinated axons, primarily in fiber tracts. the dense coating of fatty myelin is what gives white matter its color
Cerebral cortex
The cerebral cortex contains three kinds of functional areas
motor areas
sensory areas
association areas
Each hemisphere is chiefly conceded with the sensory and motor functions of the opposite side of the body.
Motor areas
Primary Motor cortex - located in the precentral gyrus of the frontal lobe of each hemisphere.
Large neurons called Pyramidal cells, in these gyri allows for conscious control of precise or skilled voluntary movements of our skeletal system
Premotor cortex - anterior to the precentral gyrus in the frontal lobe, helps plan movements, sleets and sequences basic motor movements into more complex tasks.
using highly processed sensory information received from other cortical areas, it can control voluntary actions that depend on sensory feedback .
Brocas area - lies anterior to the inferior region of the premotor area.
present in only on the left hemisphere and a special motor speech area that directs the muscles involved in speech production
Sensory areas
Primary somatosensory cortex - post central side of gyrus of the parietal lobe, just posterior of the primary motor cortex
inform the brain of the body position in space
Primary Visual cortex - posterior tip of the occipital lobe, largest cortical sensory area.
It receives visual information that originates on the retina of the eye.
Primary olfactory cortex - medial aspect of the temporal lobe. afferent fibers from smell receptors in the superior nasal cavity send impulses along the olfactory tracts.
Cocnicous awareness of different odors
Gustatory cortex - located in the insult just deep to the temporal lobe
perceiving taste stimuli
Visceral Sensory area - cortex of insult just posterior to the gustatory
involved in conscious perception of visceral sensation
Association areas
Somatosensory Association - lies posterior to the primary somatosensory cortex
integrate sensory inputs relayed to it via the primary somatosensory cortex to produce an understanding of an object being felt, size, texture, and the relationships of its parts
Visual association area - surround the primary visual cortex an covers occipital lobe
Communicating with the primary visual cortex, the area uses past visual experiences to interpret visual stimuli.
Auditory association area - posterior to primary auditory cortex
permits the perception of sounds stimulus. Experience of sound are also stored here.
Multimodal Association areas
Anterior Association area - in the frontal lobe , called the prefrontal cortex, most complicated cortical region of all.
Involved with intellect, complex learning abilities, recall, and personality. Contains working memory, necessary for abstract ideas, judgement, reasoning, persistence, and planning
Posterior Association Area - large region encompassing parts of the temporal, parietal, and occipital lobes.
role in recognizing patterns and faces, localizing us and our surroundings in space, and binding different sensory inputs into coherent whole.
Limbic Association Area - provides emotional impact that makes a scene more important to us.
Types of strokes
Ischemic Stroke
This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow
Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through your bloodstream and lodge in the blood vessels in your brain.
Hemorrhagic Stroke
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels.
causes include uncontrolled blood pressure, diabetes, trauma, protein deposits in blood.
Transient Ischemic attack
is a temporary period of symptoms similar to those you'd have in a stroke. A TIA doesn't cause permanent damage. They're caused by a temporary decrease in blood supply to part of your brain, which may last as little as five minutes.
Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood flow to part of your nervous system.
Lifestyle risk factors
Being overweight or obese
Physical inactivity
Heavy or binge drinking
Use of illegal drugs such as cocaine and methamphetamine
Medical risk factors
High blood pressure
Cigarette smoking or secondhand smoke exposure
High cholesterol
Diabetes
Obstructive sleep apnea
Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation
Personal or family history of stroke, heart attack or transient ischemic attack
Effects of alcohol on the brain
Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol may also interact with other drugs you're takin
symptoms of intoxication, including impulsive behavior, slurred speech, poor memory, and slowed reflexes.
damage the ends of neurons, called dendrites, which makes it difficult for neurons to relay messages to one another.
In addition to pathway damage, brain matter itself is also damaged by heavy alcohol use.
Alcohol has a blood thing effect that can lead to a stroke if reached towards the Brain
Downstream Effects
Execessive Achohol consumption can lead to high blood pressure which can lead to a stroke and can cause damage to brain cells and motor and sensory cortex
A stroke can have outcomes such as damage to the Primary motor cortex leading to the inability to use voluntary muscle movements
A stroke can also effect the Brocas areas which impairs the ability to speak
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected.
Patient may become paralyzed which can lead loss of muscle movements on one side of body or face.
The Patient has experience a Hemorrhagic stroke which is cause by uncontrolled blood pressure due to the excessive alcohol consumption and possibly poor physical and dietary habits
Patient will need to stop alcohol consumption immediately in order to achieve proper recovery and perhaps medications to regulate blood pressure
Patient will likely need assistance in movement and daily life activities due to stroke and the outcome of being paralyzed
Patient will need to withdraw from alcohol all together, and begin taking medications in order to help with recovery of stroke.