Neurobiology Project- University of Chicago - Peggy Mason

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

2. Hi all fellow MOOCers
I am Susan Berkeley;

3. 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.

5. 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

10.  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.

12.  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.

13. 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

14.  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:

15.  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.

16.  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.

17. 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.

18. 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.

19.  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.

20.  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!

21. 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.

23. 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

24. THANK
YOU!