Behaviour Disorder Following ACA Obstruction
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Transcript of Behaviour Disorder Following ACA Obstruction
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Isnawan Widyayanto
BEHAVIOR DISORDER FOLLOWINGANTERIOR CEREBRAL ARTERYOBSTRUCTION
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INTRODUCTION
Pierre Paul Broca (28 June 18249 July 1880)
a Frenchphysician, surgeon, anatom
ist, and anthropologist.
Suggested that certain
regions of the brain wereresponsible for certainfunctions.
His Hypothesis then supported
by John Hughlings Jackson,Carl Wernicke, and Korbinian
Broadmann
http://en.wikipedia.org/wiki/Paul_Brocahttp://en.wikipedia.org/wiki/Francehttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Surgeonhttp://en.wikipedia.org/wiki/Anatomisthttp://en.wikipedia.org/wiki/Anatomisthttp://en.wikipedia.org/wiki/Anthropologisthttp://en.wikipedia.org/wiki/Anthropologisthttp://en.wikipedia.org/wiki/Anatomisthttp://en.wikipedia.org/wiki/Anatomisthttp://en.wikipedia.org/wiki/Surgeonhttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Francehttp://en.wikipedia.org/wiki/Paul_Brocahttp://en.wikipedia.org/wiki/Paul_Broca -
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STROKE
Stroke is a form of cardiovascular diseaseaffecting the blood supply to the brain. Also referred to as
cerebrovasculardisease or apoplexy.
In order to function properly, nerve cells within the brainmust have a continuous supply of blood, oxygen, andglucose (blood sugar).
If this supply is impaired, parts of the brain may stop
functioning temporarily.If the impairment is severe, or lasts long enough, brain
cells die and permanent damage follows.
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Because the movement and functioning ofvarious parts of the body are controlled by these cells,
they are affected also.
The symptoms experienced by the patient will
depend on which part of the brain is
affected.
Thats why important to localize lesion to
determine topical diagnosis.
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Hemorrhagic strokes are caused by bleeding intothe brain or adjacent tissues.
Ischemic strokes are caused by a lack of blood flow tothe brain and account for about 70 percent of all strokes.
There are two broad categories of stroke:
Hemorrhage and Ischemic
Type : - Atherothrombic stroke
- Embolic stroke
- Lacunar stroke
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ANATOMY :CEREBRALCIRCULATION
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Blood flow to the brain
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The territory of the anterior cerebral artery
Includes the whole of the medial aspect of the
frontaland parietallobes, as far back as the parieto-occipital fissure and the subjacent white matter; genu
and anterior four-fifths of the corpus callosum; the
septum lucidum, anterior pillars of the fornix andpart of the anterior commissure; part of the head
of the caudate nucleus, the anterior part of the twoouter segments of the lenticular nucleus, and the
anterior half of the fore-limb of the internal capsule.
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FRONTAL LOBE
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FRONTAL LOBE
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FRONTAL LOBE
The frontal lobes are considered ouremotionalcontrol
center and home to ourpersonality.
There is no other part of the brain where lesions can causesuch a wide variety of symptoms (Kolb & Wishaw, 1990).
The frontal lobes are involved in motorfunction, problem
solving, spontaneity, memory, language,
initiation,judgement, impulse control, and socialand sexualbehavior.
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SYNDROMES OF THE ANTERIOR CEREBRAL ARTERY
CRURAL MONOPLEGIA
(Contralateral lower limb Weakness and Sensory loss)
IDEO-MOTOR APRAXIA/ CALLOSAL APRAXIA
TRANSCORTICAL MOTOR APHASIA
GRASP REFLEX
SNOUT REFLEX
HEMISPATIAL NEGLECT
VISUOCONSTRUCTIVE DISORDER
DISEXECUTIVE SYNDROMES AKINETIC MUTISM
APHATY
ALIEN HAND
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Callosal apraxia (CA)
Often concerns the left hand. It is characterized by an
inability to correctly perform movements to verbal
command with the left hand, contrasting with preserved
right-hand movements.
In most spontaneous cases, CA is caused by infarctions
in the territory of the anterior cerebral artery.
In these cases, the the anterior part of corpus
callosum is damaged.
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Transcortical motor aphasia is characterizedby poor spontaneous speech but good repetition
and comprehension.
There is a variable naming deficit and the written output is
also poor.
The localization of lesions is characteristically in the
superior mesial frontal region or the
supplementary speech area in the dominant hemisphere
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Damage to the medial frontal lobe tends to reduce
initiative, motivation, and spontaneous activity, leading to
abulia or, in the acute stage, akinetic mutism(Nagaratnam et al., 2004).
Different disturbances of speech (mutism, a tendency to
speak in whispers, acquired stuttering)(Hamano et al., 2005; Kakishita et al., 2004)
And motor behavior (perseveration, forced grasp and
groping, compulsive motor behavior, intermanualconflicts, alien hand phenomenon) may occur
independently of lesion side.
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Alien hand phenomenon and loss of bimanualcoordination, involving the right hand, have been
described following left ACA infarcts
(McNabb et al.,1988)
If the infarct extends to the anterior corpus callosum it may
produce disconnection syndromes, the left hand(without access to the left hemisphere verbal information)
becomes agraphic, apraxic to verbal commands and
anomic to tactile stimuli, while the right hand has no such
impairment.However, complete callosal disconnection syndromes are
rarely observed following ACA stroke
(Bogousslavsky and Regli, 1990).
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Hemispatial neglectis generally defined as a failure to detect and orient to
stimuli in the space contralateral to a focal brain lesion
(i.e. the contralesional side), which cannot be explained
by primary sensory or primary motor disturbances, nor
by any general intellectual loss or confusion. Neglect can
be apparent in responses to external stimulation as wellas during spontaneous behavior. Typically, across a
variety of situations and tasks, these patients behave
as if a portion of the contralesional space
did not exist and could not be conceived
any longer.
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DISEXECUTIVE SYNDROMES
The early description of clinical consequences of frontal
damage has documented a large variety of behavioraldisturbances such as:
Abulia, apathy, aspontaneity, akinetic mutism,
pseudodepressive state, lack of drive, poor motivation,inattention, indifference, euphoric state, distractibility,
impulsivity, disinhibition, irritability, restlessness, moria,
pseudopsychopathic state, anosognosia,
indifference,confabulation, and perseveration
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Akinetic mutism
is also called abulia major, and was formerly called
comavigile. Patients with akinetic mutism appear alert
or at least wakeful, because their eyes are open and
they have active gaze movements.
They are mute and immobile, but they are able to follow the
observer or moving objects with their eyes, to whisper a
few monosyllables, and to have slow feeble voluntary
movements under repetitive stimuli.
The patients can answer questions, but otherwise never
voluntarily start speaking.
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ALIEN HAND
A person with alien hand syndrome can feel normalsensation in the hand and leg, but believes that the
hand, while still being a part of their body, behaves in a
manner that is totally distinct from the sufferer's normal
behavior.
They lose the 'sense of agency' associated with the
purposeful movement of the limb while retaining a sense
of 'ownership' of the limb.
They feel that they have no control over themovements of the 'alien' hand, but that,instead, the hand has the capability of acting
autonomously
http://en.wikipedia.org/wiki/Sense_of_agencyhttp://en.wikipedia.org/wiki/Sense_of_agency -
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TERIMA KASIH
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