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61 year old piano player with a long history of alcohol abuse admitted…

- - - - Cerebrum: is the largest part of the brain composed of right and left hemispheres. It performs higher functions like interpreting touch, vision and hearing, as well as speech, reasoning, emotions, learning, and fine control of movement.
      - Cerebellum: is located under the cerebrum. Its function is to coordinate muscle movements, maintain posture, and balance.
      - Brainstem: acts as a relay center connecting the cerebrum and cerebellum to the spinal cord. It performs many automatic functions such as breathing, heart rate, body temperature, wake and sleep cycles, digestion, sneezing, coughing, vomiting, and swallowing.
    - - They are joined by a bundle of fibers called the corpus callosum that transmits messages from one side to the other. Each hemisphere controls the opposite side of the body. If a stroke occurs on the right side of the brain, your left arm or leg may be weak or paralyzed.
    - - Frontal: Personality, behavior, emotions
        Judgment, planning, problem solving
        Speech: speaking and writing (Broca’s area)
      - Parietal: Language, words , sense of touch, pain,temperature
      - Occipital Interprets vision(color light movement):
    - - surface of the cerebrum
      - The nerve cell bodies color the cortex grey-brown giving it its name – gray matter (Fig. 4). Beneath the cortex are long nerve fibers (axons) that connect brain areas to each other called white matter.
    - - hypothalamus: plays a role in controlling behaviors such as hunger, thirst, sleep, and sexual response. It also regulates body temperature, blood pressure, emotions, and secretion of hormones
      - Pituitary gland:controls other endocrine glands in the body. It secretes hormones that control sexual development, promote bone and muscle growth, and respond to stress.
      - Pineal gland is located behind the third ventricle. It helps regulate the body’s internal clock and circadian rhythms by secreting melatonin. It has some role in sexual development.
      - Thalamus: a role in pain sensation, attention, alertness and memory
      - Basal ganglia:These nuclei work with the cerebellum to coordinate fine motions, such as fingertip movements.
    - - Short-term memory, also called working memory, occurs in the prefrontal cortex. It stores information for about one minute and its capacity is limited to about 7 items
      - Long-term memory is processed in the hippocampus of the temporal lobe and is activated when you want to memorize something for a longer time
      - Skill memory is processed in the cerebellum, which relays information to the basal ganglia. It stores automatic learned memories like tying a shoe, playing an instrument, or riding a bike.
  - - - Even in heavy drinkers, alcohol consumption doesn't kill brain cells. It does, however, damage the ends of neurons, called dendrites, which makes it difficult for neurons to relay messages to one another.
    - - Occasional drinkers: memory impairment, blackout, impaired decision making
      - Heavy drinkers: diminished gray matter in brain, memory loss, loss of attention span
    - - described as a “downer” because it slows down signals sent between neurons
      - automatic brain processes controlled by the cerebellum and cerebral cortex are impaired or slowed (i.e. breathing, balance, processing new information). It also slows GABA neurotransmitters, resulting in slurred speech, lethargic movements, and reduced reaction time.
      - Damage to the hippocampus region (responsible for memory creation) is severely affected by drinking and “blackouts,” leading to short-term memory loss and brain cell death.
      - Repeated blackouts, a clear sign of excessive drinking, can result in permanent damage that inhibits the brain from retaining new memories
  - - - Trouble speaking
      - Paralysis/numbness
      - problem seeing
      - headache
      - trouble walking
    - - Ischemic stroke.
        Most strokes (87%) are ischemic strokes.1 An ischemic stroke happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes blocked
      - Hemorrhagic stroke.
        A hemorrhagic stroke happens when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them.
      - Transient ischemic attack (a warning or “mini-stroke”).
        It is different from the major types of stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.2
- - - - When you have a stroke, the nerves that supply “strength” to different muscle groups can become damaged. The way the nerves are arranged, it’s often just one side.
      - Numbness after stroke is a side effect that can cause complete loss of sensation or a pins-and-needles sensation