Behaviour Disorder Following ACA Obstruction

7/30/2019 Behaviour Disorder Following ACA Obstruction

1/30

Isnawan Widyayanto

BEHAVIOR DISORDER FOLLOWINGANTERIOR CEREBRAL ARTERYOBSTRUCTION


2/30

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


3/30


4/30


5/30

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.


6/30

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.


7/30

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


8/30

ANATOMY :CEREBRALCIRCULATION


9/30


10/30

Blood flow to the brain


11/30


12/30


13/30


14/30

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.


15/30


16/30

FRONTAL LOBE


17/30

FRONTAL LOBE


18/30

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.


19/30

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


20/30

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.


21/30

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


22/30

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.


23/30

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).


24/30

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.


25/30

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


26/30

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.


27/30

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


28/30


29/30

TERIMA KASIH


30/30

Behaviour Disorder Following ACA Obstruction

Documents

Transcript of Behaviour Disorder Following ACA Obstruction