getting what it needs to function correctly. With the heart this manifests as pain (angina) and other S&S related to pumping action. With the brain, the S&S very much depend on the part of the brain that has been deprived. Because the brain is so complex, there is no way, in general study, to describe every possible area that can be affected and/or sign and symptom that can show up. So for our course we simplify by organizing the injury as either diffuse – affecting the whole brain more or less equally; or focal – affecting certain areas. Two of those areas are the two sides of the cerebrum—the right hemisphere and the left. Look at your neuro Prep, page 8. This is a bird’s eye view—as if you were looking straight down at a brain. Now also look at page 8 of RRD 8 (three 8’s!)… and see if you can answer these questions: #1. Patient Ren Hoek was hit on the right side of his head during an altercation, sustaining some damage to the right cerebral hemisphere. What S&S would you expect and why (circle your answers on this sheet and check them at the end of this review)? a. When you ask him to smile, Mr. Hoek can only smile on the left side of his face, because the cranial nerve governing that side of his face has been compromised. b. It is likely that Mr. Hoek will be oblivious to anything on the right side of the room, as this is a facet of right hemispheric strokes. c. When you ask Mr. Hoek to smile, he can only smile on the right side of his face, because the cranial nerve has been damaged by cerebral edema. d. Since the parasympathetic properties of the cranial nerve controlling the right pupil can no longer stimulate miosis properly, the pupils may be in fixed mydriasis. e. When in rehab, Mr. Hoek may deny that he has any problems, since insight and intuition are often negatively affected in a right hemispheric injury. #2. Patient Stimpson J. Cat was in the same altercation as Mr. Hoek, but what is most noticeable about Mr. Cat is that his speech is very garbled. What other S&S would you expect and why (circle your answers on this sheet and check them at the end of this review)?? a. Mr. Cat may have some weakness of the right arm and leg because the sensorimotor pathways that journey through left cerebral tissue have been affected by edema from an injury. b. There may be some hemiparesis on the left side below the neck because the sensorimotor pathways that journey through left cerebral tissue have been affected by edema from an injury. c. Droopiness of the left side of the face is likely, since the cranial nerves that have been negatively affected by the left hemispheric injury. d. Mr. Cat will likely need not only speech therapy, but also help with the ability to organize aspects of his life, since abilities of analysis and reasoning usually reside in the left cerebral hemisphere.
Exam Four Review Mydriasis vs miosis: Mydriasis means dilation of the pupil and miosis means constriction. Remember that the pupil is just a hole surrounded by the iris, which responds to parasympathetic and sympathetic stimulation. The iris can cause the pupil to be a wider hole (mydriasis) or shrunken to a smaller hole (miosis).
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