Understanding The Brain: The Neurobiology of

Everyday Life

In Memory of Wayne Berkeley (1940-2011)By: Susan Berkeley (Trinidad & Tobago)

Lecturer: Prof. Peggy MasonProject Due Date: July 20th, 2014

Hi all fellow MOOCersI am Susan Berkeley;

INTRODUCTION

I have decided to do my project on my brother-in-law, Wayne Berkeley.

Sadly, Wayne passed away, just over three (3) years ago, but it is only now, having done this course, offered by the University of Chicago and Coursera, and facilitated by Prof. Peggy Mason, that I am able to fully comprehend what took place in his body and what caused him to experience the disabilities that he did.

We live in Trinidad & Tobago – a small twin island country, situated in the southern Caribbean. Our country has become famous for the cultural festival of ‘Carnival’ which takes place annually and has attracted many people worldwide.

Wayne, who was right-handed, was a designer by profession. He received numerous awards for his works of art, more specifically for his Carnival costumes, which were worn during the parades and competitions.

We shall take a deeper look into what happened to Wayne, neurologically.

Wayne Berkeley – Just prior to his stroke of 2000

The National Library and Information System Authority (NALIS) remembers Wayne Berkeley for his outstanding contribution to Trinidad and Tobago Carnival.

The national community will miss the high standard of work with which Wayne has been associated. His Carnival designs represent the glory and spirit of Trinidad and Tobago Carnival.

We thank him for choosing NALIS to house his drawings of costume designs. The collection spans the period 1966 to 2000. It comprises 58 collections of work with over 1000 pieces.

We invite you to view the Wayne Berkeley Collection online at www.nalis.gov.tt

Excerpts from Trinidad & Tobago National Library and Information System (Nalis) Authority

Just a few of Wayne’s Drawings

A couple more designs

Actual Costume productions worn by masqueraders

More Costumes

Wayne Berkeley, designer by profession, and someone who had travelled the world, was for all intents and purposes, a healthy 5 ft 10 ins tall individual . . . . or so we thought. On February 17th, 2000 Wayne suffered what was described by his doctors as a ‘massive’ stroke to his left cerebral hemisphere, severely affecting his Right side. It was devastating to the family, as well as to his employees, to his patrons, and to the whole country in general. Of course it was even more devastating to Wayne, especially with this taking place at the peak of production for the ‘new millenium’s (year 2000) Carnival Band.

Wayne was Right handed.

For the first three (3) days after the initial onset, Wayne was unable to speak, walk, and was barely able to sit up in bed. His mouth was twisted, and he was unable to write. He could not mouth his words, and had little control over his tongue. We were told that we needed to ‘wait and see’ what improvement, if any would take place over the next week.

Wayne Berkeley – a bit of Patient History

Site of initial problem

After 5 days, we began to see improvement in mobility, although very slight. Wayne was able to say a few words, ones which did not necessitate much movement of his tongue. He was able to sit propped up in bed, but could not fully support his upper body.

While the actual radiology reports from the year 2000 are no longer available for input, we were told that Wayne had suffered a very bad stroke to the LEFT side of his brain, due to a blood clot in his Left Carotid artery. This artery also showed atherosclerosis. As a result his RIGHT side was severely affected. His speech was also greatly affected. After a two-week period, Wayne recovered a small amount of ability on his right side, but was unable to use either is Right leg, or his Right arm. He was bound to a wheelchair for several months, but set his mind to recovery, and never let up with his physio or speech therapy. After almost a year of undaunted perseverance, Wayne was able to walk (albeit with a limp), drive, and speak to the point where those who knew him were able to easily understand what he said.

He pursued his designing using his LEFT arm, as the left side of his body had been relatively unaffected.

Patient History continued

While his CT Scan and MRI reports are no longer available, from what we have learnt, I can conclude that:

1. Blood clot in the Left Carotid Artery would have cut off the blood supply to that side of his brain. Since it had taken more than ½ hour to get to the hospital, that part of the brain would have been starved of Oxygen and may neurons would have died.

2. Given the impairment, I can conclude that he would have had damage to the Forebrain, Left hemisphere. Areas affected would most likely have been – Motor Cortex, given his inability to carry out Voluntary Movement in his Right arm and Right leg and Face, as well as Broca’s area, given that he showed signs of Expressive aphasia.

3. There were no indications of any Brain stem damage, or damage to the Basal Ganglia at that time.

4. There also appeared not to be any damage to the Spinal Cord.5. Atherosclerosis occurs when substances such as fat, cholesterol and other

substances build up in the walls of arteries and form structures called plaques which in turn cause hardening of the arteries. Atherosclerosis is a big contributor to arterial blockage, and therefore strokes

Neurological indications

For almost 10 years, Wayne was able to live a relatively good life, using his left arm for design, almost as good as his right had been, and while not being able to have full use of his Right arm, was actually able to use his right hand for some drawings.

On May 22nd of 2011, Wayne suffered what appeared to be another stroke. While he was able to speak, comprehend, and did not appear to be in any discomfort, except the inability to urinate, but he had generalized weakness in his body and he was unable to stand. During the next few days, though, he apparently suffered a series of new strokes, but recovered enough to be discharged to home.

During the period he was at home, he became bedridden, and was eventually unable to speak. He was declared non-compos mentus on June 7th, 2011 and passed away on June 10th, 2011.

His CT Reports are as follows:

More History

Bilateral peri-ventricular white matter low attenuation consistent with small vessel ischemia, more extensive on the right side.

Chronic left lacunar infarct adjacent to the body of the left lateral ventricle and involving the anterior limb of the left internal capsule.

Sub-centimeter lacunar infarct involving the left lentiform nucleus

Chronic right lacunar infarct also seen in the right lentiform nucleus.

There was no mass effect, mid-line shift or space occupying lesion.

Excerpt from report - CT SCAN BRAIN: May 22nd,2011

Bilateral peri-ventricular areas of low attenuation consistent with chronic microangiopathic ischemia.

More focal hypodense areas noted in the following areas:

Superior Right parietal lobe measuring 16mm X 26mm

Left Cerebellar hemisphere, measuring 25mm X 24mm

Left Corona radiata, measuring 5mm X 25mm Anterior limb of Left internal capsule measuring

14mm Anterior limb of Right internal capsule measuring

16mm.

Excerpt from Report CT SCAN: BRAIN May 26th 2011

Stroke of 2000 -From what we have learnt from this course, it is clear that a blood clot in the carotid artery would have resulted in diminished blood supply to the brain, and if an area of the brain is starved of Oxygen for more than say 5 minutes, the neurons in the area die.

In this case there was damage to the LEFT side of the brain, indicating that the motor cortex would have been damaged – the area which controls motor functions on the Right side of the body.

The physically noted affected areas for Wayne were:◦ Voluntary movement on the Right side of the body, specifically, the arm,

leg, and face. ◦ Speech was also affected, an indication that there was damage to

Broca’s area resulting in expressive (Broca’s) aphasia. He was unable to speak for the first three (3) days.

◦ His comprehension was fully intact, indicating no damage to Wernicke’s area.

◦ After the initial improvement with speech therapy, Wayne never regained any further improvement in his ability to speak, but it was quite evident that his disability had a lot to do with his control, or lack thereof, of his tongue. While he was able to say the word, his enunciation was impaired.

INTERPRETATION

STROKES – 2011

Small vessel ischemia more extensive on the right side, indicating new areas of the brain being affected. Small vessel ischemia can come about as a result of high blood pressure, high cholesterol or diabetes.

Lacunar infarct involving the anterior limb of the left internal capsule.The internal capsule is a white matter structure that carries information past the

basal ganglia, and which separates the caudate nucleus and the thalamus from the lentiform nucleus. The internal capsule contains both ascending and descending axons and is a major route by which the cerebral cortex is connected with the brain stem and spinal cord. Damage to these areas will interrupt communication.

Lacunar infarct involving the left lentiform nucleus.The lentiform nucleus is a large cone-shaped mass of gray matter within the basal

ganglia. The basal ganglia we have seen is responsible for directing sensory and motor related functions throughout the body and for the smooth coordination of voluntary movement.

Interpretation (continued)

Lacunar infarcts occur when one of the penetrating arteries which provides blood to the brain’s deep structures is occluded. These arteries are small and are uniquely vulnerable. In a lacunar stroke, brain cells in a relatively small area are damaged or killed by lack of Oxygen. The small area is called a lacune. While only a small area of the brain is affected, it can cause significant disability.

Focal hypodense area in the left cerebellar hemisphere. The cerebellum receives much sensory input form many areas like the

joint, muscles, skin, vestibular system, as well as the visual system of the body, and is involved with motor learning and motor execution. It is responsible for proper gait, balance in walking as well as learning new motor skills. Damage to the cerebellum resulted in unsteady gait and the inability to coordinate movement. Wayne was not able to stand steadily during this time. His walking, though assisted, was ‘wobbly’.

During the last week of his life, Wayne suffered extensive memory loss.

Interpretation (continued)

Wayne Berkeley|Mas designer extraordinaire dies at age 70 Friday, June 10, 2011 Posted by Santiwah

Labels: Carnival

Today we have to report the passing of one of Trinidad and Tobago's greatest and legendary Mas designer Mr. Wayne Berkeley. 'Newsday' reported that Mr. Berkeley died at 7:35 pm yesterday at the family home located at Clifford Street in Belmont, Trinidad.

Mr. Berkeley who had suffered a stroke in 2000 died from complications suffered from a third stroke. Mr. Berkeley won nine Band-of-the-Year titles in 1973, 1974, 1980, 1989, 1990, 1991, 1992, 1993 and 1994.

He also designed for other bands after he suffered his first stroke. Trinizagada extends our sincerest condolences to the Berkeley family. Mr. Berkeley, one of our greatest carnival designers will be missed!

One Announcement

I have attempted to display what I have learnt from this course using the example of my brother-in-law, whose disabilities I was quite close to. I would never have been able to comprehend the complex nature of his illness had I not done this course.

While I had no reports from his first stroke, I was fully aware of what he had to go through, as well as what progress he made over the years of physiotherapy. Because of having done this course, I believe I can interpret, to a fairly accurate degree most of what took place in his brain, utilizing what was learnt here. I refer to Week 3 Lectures on topics of Pathways in the Nervous system. Week 4 - Blood Supply, Strokes, Mass effects . Week 8 – Cerebellar, Cerebellar Learning and Basal Ganglia. Week 10 – Memory. Week 4 - A slide which I have stored on every electronic medium I own. This I have reproduced overleaf.

Input From Course

Most Useful Slide

http://pariapublishing.com/2011/07/wayne-berkeleys-costume-design-vol-1/https://www.google.tt/search?q=Wayne+Berkeley+Costumes&client=

https://www.google.tt/search?q=Wayne+Berkeley+Costumes&client=firefox-a&hs=loh&rls=org.mozilla:en

http://library2.nalis.gov.tt/gsdl/cgi-bin/library.cgi?e=p-01000-00---off-0berksa--00-1----0-10-0---0---0direct-10-DC--4-------0-1l--11-en-50---20-about---00-3-1-00-0--4--0--0-0-11-10-0utfZz-8-00&a=d&cl=CL1

http://caribbean-beat.com/issue-2/wayne-berkeley-trinidads-king-carnival#axzz3799MK8Ce

http://www.webmd.com/heart/picture-of-the-carotid-artery

University of Chicago – Understanding the Brain – The Neurobiology of everyday Life – Prof Peggy Mason

Use of Medical Records for the purposes of this project by the kind permission of the Berkeley Family

References

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