61 year old piano player with a long history of alcohol abuse admitted after suffering stroke. Now he can't speak, no use of right hand/arm, walk without help

Background

Downstream

Upstream

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.

Trouble with speaking and understanding


Paralysis or numbness of the face, arm or leg


Trouble with seeing in one or both eyes


Headache


Trouble with walking


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

Alcohol History

Drinking too much alcohol raises your blood pressure. Atrial fibrillation increases your risk of stroke by five times, because it can cause blood clots to form in the heart. If these clots move up into the brain, it can lead to stroke.

Immediate effect

A stroke is a brain attack.The brain controls everything your body does, a stroke will affect the way your body functions. For example, if a stroke damages the part of your brain that controls your right leg, then you may have weakness or numbness in that leg

Cerebellum (top and front of the brain)
Inability to walk and problems with coordination and balance (ataxia), dizziness, vomiting, headache

Brainstem (base of the brain)
Breathing and heart functions, Body temperature control, Balance and coordination, Chewing, swallowing, and speaking

Cerebrum (right and left sides or hemispheres) Movement/sensation, speech/language, Eating/swallowing, vision

Types of strokes

Transient ischemic attack: Anything that temporarily blocks blood flow to your brain causes a TIA. The blood clot and TIA symptoms last for a short period of time.

Ischemic stroke: occurs when a blood clot keeps blood from flowing to your brain. which is a buildup of fatty deposits on the inner lining of a blood vessel.

Hemorrhagic stroke when a blood vessel in your brain ruptures or breaks, spilling blood into the surrounding tissues:

Stroke Symptoms Getting Worse

Doing things differently: Sometimes big changes can affect your body in a big way – and not necessarily for the better

Taking new medication:Sometimes new medication can cause negative side effects

Overworking Yourself:If you ‘go hard’ and do a bunch of things all in one day, then you could experience a regression the next day.

There is usually no pain associated with the symptoms. The symptoms may come and go, go away totally, or get worse over the course of several hours

Drinking alcohol

Alcohol use after recovering from stroke could be dangerous because excessive drinking can raise blood pressure causing heart failure.The area of the brain affected and the extent of the brain injury.

It can cause more damage after a first stroke

Depression is common; strokes affect different people in different ways, depending on the type of stroke

Brain Anatomy

3 main parts

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.

Right/Left part of brain

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.

Lobes of bran

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):

Alcohol in brain

Does alcohol kill brain cells?

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.

How does it impact cognitive ability?

Occasional drinkers: memory impairment, blackout, impaired decision making

Heavy drinkers: diminished gray matter in brain, memory loss, loss of attention span

Brain damage

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

Cortex

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.

Deep Structures

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.

Stroke:occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients

Symptoms:

Trouble speaking

Paralysis/numbness

problem seeing

headache

trouble walking

Main Stroke Types

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

Memory

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.