ANATOMY AND PHYSIOLOGY

The middle cerebral artery (MCA) is one of the three major paired arteries that supplies
blood to the cerebrum. The MCA arises from the internal carotid and continues into the lateral
sulcus where it then branches and projects to many parts of the lateral cerebral cortex. It also
supplies blood to the anterior temporal lobes and the insular cortices.

The left and right MCAs rise from trifurcations of the internal carotid arteries and thus
are connected to the anterior cerebral arteries and the posterior communicating arteries, which
connect to the posterior cerebral arteries. The MCAs are not considered a part of the Circle of
Willis.
Areas supplied

Areas supplied by the middle cerebral artery include:

 The bulk of the lateral surface of the hemisphere; except for the superior inch of the
frontal and parietal lobe (anterior cerebral artery), and the inferior part of the temporal
lobe.

 Superior division supplies lateroinferior frontal lobe (location of Broca's area i.e.
language expression)

 Inferior division supplies lateral temporal lobe (location of Wernicke's area i.e. language
comprehension)

 Deep branches supply the basal ganglia as well as the internal capsule
 The brain contains various structures that have a multitude of functions. Below is a list
of major structures of the brain and some of their functions:
Basal Ganglia
· Involved in cognition and voluntary movement
· Diseases related to damages of this area are Parkinson's and Huntington's

Brainstem
· Relays information between the peripheral nerves and spinal cord to the upper
parts of the brain
· Consists of the midbrain, medulla oblongata, and the pons
Broca's Area
· Speech production
· Understanding language

Central Sulcus (Fissure of Rolando)

· Deep grove that separates the parietal and frontal lobes

Cerebellum
· Controls movement coordination
· Maintains balance and equilibrium

Cerebral Cortex
· Outer portion (1.5mm to 5mm) of the cerebrum
· Receives and processes sensory information
· Divided into cerebral cortex lobes

Cerebral Cortex Lobes

· Frontal Lobes -involved with decision-making, problem solving, and planning
· Occipital Lobes -involved with vision and color recognition
· Parietal Lobes - receives and processes sensory information
· Temporal Lobes - involved with emotional responses, memory, and speech

Cerebrum
· Largest portion of the brain
· Consists of folded bulges called gyri that create deep furrows

Corpus Callosum
· Thick band of fibers that connects the left and right brain hemispheres

Cranial Nerves
· Twelve pairs of nerves that originate in the brain, exit the skull, and lead to the
head, neck and torso

Fissure of Sylvius (Lateral Sulcus)

· Deep grove that separates the parietal and temporal lobes

Limbic System Structures

· Amygdala - involved in emotional responses, hormonal secretions, and memory

· Cingulate Gyrus - a fold in the brain involved with sensory input concerning
emotions and the regulation of aggressive behavior
· Fornix - an arching, fibrous band of nerve fibers that connect the hippocampus to
the hypothalamus

· Hippocampus - sends memories out to the appropriate part of the cerebral

hemisphere for long-term storage and retrievs them when necessary

· Hypothalamus - directs a multitude of important functions such as body

temperature, hunger, and homeostasis

· Olfactory Cortex - receives sensory information from the olfactory bulb and is
involved in the identification of odors

· Thalamus - mass of grey matter cells that relay sensory signals to and from the
spinal cord and the cerebrum

Medulla Oblongata
· Lower part of the brainstem that helps to control autonomic functions

Meninges
· Membranes that cover and protect the brain and spinal cord

Olfactory Bulb
· Bulb-shaped end of the olfactory lobe
· Involved in the sense of smell

Pineal Gland
· Endocrine gland involved in biological rhythms
· Secretes the hormone melatonin

Pituitary Gland
· Endocrine gland involved in homeostasis
· Regulates other endocrine glands

Pons
· Relays sensory information between the cerebrum and cerebellum

Reticular Formation
· Nerve fibers located inside the brainstem
· Regulates awareness and sleep

· Substantia Nigra - Helps to control voluntary movement and regualtes mood

· Tectum- the dorsal region of the mesencephalon (mid brain)

· Tegmentum- the ventral region of the mesencephalon (mid brain).

· Ventricular System - connecting system of internal brain cavities filled with

cerebrospinal fluid

· Aqueduct of Sylvius - canal that is located between the third ventricle and the
fourth ventricle

· Choroid Plexus - produces cerebrospinal fluid

· Fourth Ventricle - canal that runs between the pons, medulla oblongata, and the
cerebellum

· Lateral Ventricle - largest of the ventricles and located in both brain hemispheres

· Third Ventricle - provides a pathway for cerebrospinal fluid to flow

· Wernicke's area -region of the brain where spoken language is understood

 DISCHARGE PLANNING

Medications
 Discuss with the patient and watcher the need to comply with home medications.
> This will help the family and the patient to know the importance and advantage in
complying treatment regimen.

 Explain with them the advantages and disadvantages of strict compliance of

treatment regimen.
> This will ensure and encourage the patient that taking medications will help treat
and prevent recurrence of the disease and for faster recovery.

 Instruct the patient and watcher the right time, right medications, right dosage,
and right route as ordered by the physician.
> This will avoid confusion of the proper drugs that would be taken by the patient.

 Instruct the patient not to skip taking medications and complete the whole course
of medication.
> This will help for an effective action and compliance of the medications and for
faster recovery.

 Remind the patient and watcher the importance of taking consideration of the
foods or other drugs that is contraindicated while taking the medications.
> This will prevent further complications and unnecessary effects to the patient.

 Instruct and warn patients and significant others about the possible effects and
adverse reactions that may occur brought about by taking the medications.
> Side effects and adverse reactions from the medications will sometimes lead
into another occurrence of complication or disease. This will also facilitate
proper medical assistance.

 Remind them to take the drugs properly and taking note of the expiration date
before taking the medication.
> This will ensure good compliance of the medications to be taken and to prevent
accident poisoning.

 Encourage the patient not to take medications not prescribed by the physician.
> Non-prescribed drug may contain antagonistic or synergistic effect.

 Instruct the patient not to stop the medication abruptly or adjust the dosage
without prescription of the physician.
> Stopping the medication abruptly or adjusting the dosage would not take the effect
or action of the medication.
 Instruct the family to properly store and handle the medications so as not to let
children accidentally get hold of it.
> This will prevent accident of drug poisoning.

Exercise/Environment
 Encourage the patient to perform light exercises such as walking and jogging.
>Exercise helps reduce cholesterol levels in the biliary tract, which could help
prevent gallstones.
 Avoid heavy exercises.
> To prevent the risk of tearing the incision site and also to prevent body fatigue.

Treatment
 Explain the purpose of the treatment and why it is continued at home.
> This will help the patient and family to be oriented about the treatment and this will
help her understand about the importance of taking the prescribed drugs for faster
recovery in the disease process. To also make them aware that the treatment is not
only done in the hospital but it should be continued at home.
 Explain to the family the condition of the patient and give them factual
information.
> To have better understanding of the condition of the patient and to make
appropriate action of the disease.
 Direct and instruct the watcher to give the medication or assist the patient
according to the medication regimen.
> Giving the medication and assisting the patient accordingly will have good
compliance of the medications and will give sufficient effect to the patient’s
condition.
 Emphasize the importance of recognizing any sign of unusuality.
> To give appropriate intervention.

Health Teaching/Hygiene
 Encourage and advice the patient and family members to practice proper hand
washing before and after eating.
> Proper hand washing will prevent the spread of microorganisms.
 Instruct patient to do activities of daily living.
> To promote good health and prevent infection. It also increases the sense of
wellness, which is very much needed in the therapeutic process.

Out-Patient Referral
 Encourage patient and family to have a regular check up with their physician
> To monitor health status and conditions. This will help recognize any alterations in
the body.
 Advice patient and family to follow doctor’s order comply with the doctor’s
advice and follow what is stated in the written discharge instruction.
> Following the doctor’s advice and complying will help achieve the success of the
treatment coarse and will help for the immediate recovery of the patient.
 Encourage the patient and the family to immediately report any unusualities
regarding the patient’s condition.
> Signs of unusualities will indicate the occurrence of the disease and reporting it
immediately to the health care providers will immediately give enough attention to
treat the said complaint.

Diet
 Avoid crash diets or a very low intake of calories — less than 800 calories a day.
> Losing weight too quickly is associated with an increased risk of gallstones.

 Choose a low-fat, high-fiber diet that emphasizes fresh fruits, vegetables and
whole grains. Reduce the amount of animal fat, butter, margarine, mayonnaise
and fried foods in daily meal.
> A high-fiber, low-fat diet helps keep bile cholesterol in liquid form. Do not cut out
fats abruptly or eliminate them altogether, as too little fat can also result in gallstone
formation.

 Eat regular meals, 5 or 6 small meals per day.

> This helps to avoid overloading the digestive system and allows the body more
time to digest any fats.