Question

I) A 77-year-old woman was cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms: - paralysis of the right face and arm - loss of sensation to touch on the skin of the right face and arm - inability to answer questions but ability to understand what was said to her - ability to write down her thoughts more easily than to speak them

Questions : 1. Based upon the patient's symptoms, which lobe(s) blood supply is/are distrupted? (Be Specific)

2. Why was she paralyzed in the right face and arm?

3. What is the name of her language disorder, and what caused it?

4. Was this woman's dominant or non-dominant hemisphere damaged?

II) Define the following terms with an explanation/example(s):

a) Aphasia

b) Ataxia

c) Cerebrovascular accident

d) Cerebral palsy

i) Describe the etiology and types of CP?

ii) What treatment options (if any) are available?

Answer 1

Answer:

I )

1) Based on the symptoms of the patient, most probably the blood supply to the frontal lobe is disrupted. The damage to the frontal lobe leads to various symptoms including behavioral problems and motor weakness. Various conditions that are result of frontal lobe damage include stoke,head trauma etc.

2) The paralysis in the right face and arm is mainly due to the damage to her primary motor cortex, which is an area that lies anterior to central sulcus which is in the posterior portion of the frontal lobe. Her loss of sensation might be due to the damage in the primary sensory cortex(post central gyrus)

3) The name of the language disorder is Broca's (Expressive Aphasia). This is as a result of damage to the Broca's area which is in the lateral portion of the frontal lobe. Broca's area is usually involved with higher level of development in the areas of commands which are necessary to find words and for language production. It's damage will cause the vocal expression to be difficult. In question it is mentioned that the patient have difficulties in speech but can can understand what is said to her, this is because in Broca's aphasia the patient have no difficulty in understanding what is said to them but have difficulties in verbalizing it.

4) Since the damage is caused in Frontal lobe, the dominant hemisphere is affected in this patient. The dominant hemisphere usually the areas of brain where the brain controls the ability to speech and mathematical skills, where as the non-dominant hemisphere is more responsible to the ares of brain controlling creativity(art and imagination)

II)

a) Aphasia: Aphasia can be described as an impairment of language affecting mainly the production or the comprehension of speech and their ability to read or write. This is mainly caused due to an injury in the brain mainly from a stroke mainly in older people. Brain injuries resulting in the condition of Aphasia can also arise from a head trauma or brain tumors or from an infection.

Example: Broca's Aphasia, here the speech is reduced and limited due to the short utterances of less than three to four words. Such patient's vocabulary access is also limited and the sound produced by them are laborious and very clumsy.

b) Ataxia: This is a condition where there is a lack of muscle control or the coordination of the voluntary movements. This can affect various different movements and can create difficulties with the eye movements, speech and swallowing. The persistence of this condition usually due to damage to the part of the brain that controls the muscle coordination which is the cerebellum. Many reasons can lead to Ataxia such as alcohol misuse, stroke, tumor, cerebral palsy etc.

Example: Hereditary ataxias: These are that are caused which are hereditary. Such patients are born with a defect in certain gene which abnormal proteins. These abnormal genes can hamper the nerve cells in the cerebellum and the spinal cord and results in their degeneration. Due to either a dominant gener from one parent (autosomal dominant) or recessive gene from each of the parent (autosomal recessive)

c) Cerebrovascular accident: Cerebrovascular accident is condition where there is a sudden death of some of the brain cells. This is due to the lack of oxygen due to the blockage of blood flow into the brain or due to the rupture of an artery which is to brain. This is also referred to as a stroke.

Example:Ischemic stroke: Occurs due to blood clot that blocks the blood vessel and prevents the blood and oxygen to get into the brain. One way this is occurring is an embolic stroke, occurs when the clot forms somewhere in the body and lodging the blood vessels that is to the brain. The other way is a thrombotic stroke when the clot is formed in the blood vessels to the brain.

d) Cerebral palsy: This is described as a group of disorders which mostly affects the movement and the muscle posture and tone. It is mainly due to the damage which occurred to the immature brain as its developed and most often before the birth. The symptoms may appear during preschool or even from infancy. This disorder causes impairment in movement which are associated with the abnormal reflexes, rigidity or floppiness of the limps and the trunk. These people have problem with balancing the eye movements where they are not able to focus.

i) Etiology and types:

causes:

• Gene mutations that can mainly lead to abnormal development
• Maternal infections which mainly affect the developing fetus
• Fetal stroke, which is the  disruption of blood supply mainly to the developing brain
• Traumatic head injury to an infant from a motor vehicle accident or fall
• Lack of oxygen to the brain which is related to difficulty in labor or delivery

Types:

• Spastic (Pyramidal) Cerebral Palsy

• Athetoid (Extrapyramidal or Dyskinetic) Cerebral Palsy

• Ataxic Cerebral Palsy

• Mixed Cerebral Palsy

ii) Diagnosis and Treatment methods:

Diagnosis:

• An electroencephalogram (EEG) can be used to evaluate the electrical activity in the brain.It can be done when someone is showing signs of epilepsy and which results in seizures.
• Blood sample can be taken and tested to rule out the possibility of other disorders such as bleeding disorders.
• Cranial ultrasound which is relatively inexpensive and very quick can be done to get the brain images of the young infants. This method is basically based on using high frequency sound waves.

Treatment:

• Medications

  • Oral anticonvulsants and muscle relaxants aremainly used.

• Surgery

  • Orthopedic surgery can be used for pain relief and to improve the mobility . It is also required for releasing tight muscles or to correct bone abnormalities.

• Assistive aids

  • Aids given are eyeglasses, hearing aids, walking aids,body braces, wheelchairs etc.