Todd Alderman Lab C
A Case Study of the Central Nervous System
Here is a patient dealing with several different problems. With a very basic diagnostic, we can see that she is a 63 year-old African-American female which means that she is more prone to high blood pressure just based on studies done. Unaware of any medication she is taking, we see her blood pressure to be 139/105. This is above normal and if she is on any medication for this it would be even higher without that medication. After the patient describes her problems, we decide to test her cognitive, motor, and sensory skills to decide what exactly has happened. By this time we have already theorized that our patient is suffering from a stroke based on her complaints and condition of health. The purpose of the tests is to isolate the area of the brain that is affected and how extensive the damage is in order to treat the patient effectively.
In testing, we find total loss of somatic senses on the right side of the jaw, face, and tongue. This tells us that the left side of the cortex is experiencing the bleeding from an artery. She recognizes when things are in her right hand but cannot distinguish what they are without looking at them. This tells is that parts of the primary somatosensory area and the somatosensory association area of the cortex have been damaged. The left side of her body seems to be working properly and both legs, therefore the right side of her brain did not experience the stroke and based on the motor homunculus of the cortex, the bleeding has not been exposed to the top section of the brain but seems to remain just to the left side.
Again, the motor homunculus of the cortex narrows the possible location of the bleeding by our patient displaying non-contracting paralysis of the muscles in the right jaw and face. She shows movements to be hesitant and uncoordinated from the right hand. These two symptoms of paralysis and uncoordinated movements prove the problem exists in the primary motor and pre-motor areas of the cortex. Primary motor damage causes the paralysis and pre-motor causes the uncoordinated movements. She can not move her ring finger but her handwriting is normal. These are explainable because the motor area for her fingers has been affected thus causing the signal to be blocked but her handwriting mainly belongs to wrist and arm action which is located in a slightly different, unaffected area.
She claims that she can no longer play the piano or type which indicates two things. This strengthens our theory that the pre-motor region has been damaged but also shows us how long she has gone untreated for this stroke. It takes time and practice to realize that these qualities have been lost. The longer she waits for treatment, the lower her chances of full recover become.
Spoken and written words are comprehended normally but her speech is severely impaired. This symptom points to damage of the Broca’s speech area. Here we translate sounds into forms of communication.
Based on the following areas of damage: Left side of the cortex (not on the top), Primary Somatosensory and Somatosensory association areas, Primary motor and pre-motor areas, and Broca’s speech area; We can locate the distribution of damage and project and centrally localized source of bleeding. The area highlighted below gives us an idea of the extent and source of the bleeding.
According to the diagram and corresponding vascular systems of the brain, the Middle Cerebral Artery has ruptured and the leakage has emanated from there outward.
Because of the extended time between stroke and treatment, outcome with a full recovery is not a goal to strive for. Our patient has more than likely permanently damaged the neurons of these areas and they can not be repaired or replaced by the body or by modern medicine. She will continue to live her life without piano or speed typing. From now on, her speech will always be impaired but in time will improve slightly by compensation and adaptation from the other side. Otherwise she can learn to use her left hand more dominantly and with the knowledge of her stroke take better precautions in the care of her high blood pressure.