COD 2 IBN

1. What cause decrease level of consciousness in this patient?

the stimulus of consciousness comes from formatio reticularis in the
brainstem. the stimulus runs into the thalamus and then rises to the
cerebral hemisphere.

The reticularis formation neuron shows a diffuse relationship. The

stimulation of the formation of the midbrain reticularis evokes the
beta waves, the individual becomes awake

The cerebral cortex is the largest part of the central nervous system
in which the cortex plays a role in self-awareness of the environment
or sensory awareness inputs. So the awareness of body shape, where body
parts, body posture and self-awareness are the function of somestetik
association area (area 5 and 7 brodmann) in the superior parietal lobe
extends to the medial surface of the hemisphere

the decrease of consciousness in the patient is caused by the

infarction of right cerebral hemispheres, as we know the existence of
the infak causing disruption of the conscious impulse pathway from the
thalamus to the hemisphere

2. Why Cause of death this patient is Brain herniation? what type of

brain herniation?
Occlusion MCA territoryLarge infarctprogressive and diffuse
cerebral edemacompression vascular and ventricularvertical
and horizontal shift tissue

3. Does this patient need to do decompressive hemicraniectomy?

Please more explain..?

 Decompressive craniectomy is a controversial therapy for malignant middle cerebral artery

(MCA) stroke. Malignant MCA stroke is indicated by:
 MCA territory stroke of >50% on CT
 Perfusion deficit of >66% on CT
 Infarct volume >82 mL within 6 hours of onset (on MRI)
 Infarct volume of >145mL within 14 hours of onset (on MRI)
4. why in this patient, not given anticoagulant (simarc)?