Question

Mr. Q, age 64 years, developed a severe headache several hours ago that has not responded to acetaminophen. Now his speech is slurred, and his right arm and the right side of his face feel numb. He is very anxious and is transported to the hospital. Mr. Q has a history of smoking and arteriosclerosis, and there is family history of CVA and diabetes. Assessment at the hospital indicated weakness on the right side, including facial asymmetry and a blood pressure of 220/110 Hg mm. A CT scan showed damaged tissue on the left side of the brain, and an angiogram indicated narrowing of the carotid arteries and middle cerebral arteries, with occlusion of the left middle cerebral artery.

Case Study Questions

1. Differentiate the pathophysiology related to CVA/Brain Attack due to thrombus vs. embolus.
2. Appraise the stages in the development of an atheroma.
3. Analyze predisposing factors in this case.
4. Relate Mr. Q’s initial manifestations to the pathological changes. Include a discussion of the patient’s prognosis.
5. Examine the treatments available after first aid for stroke patients.

Answer 1

1. Pathophysiology of CVA due to thrombus vs embolus

• A thrombotic stroke is a type of ischemic stroke.here part of the brain gets injured and gets blocked while in embolic stroke,embolus forms in anitherpart of the body,but moves through the blood to artey in your brain.
• due to any of the risk factors,(both prediposing fatorslike age, gender,herdity etc and also due to precipitation factors like sedentary lifestyle,poor diet,hypertension etc, atherosclerosis is formed which then cause deposits of plaque in the blood vessel walls and thrombosis occurs.Ths lead to the blocage of blood vessels resulting in cerebral hypoperfusion which then give impaired oxygen and nutrient to the brain leads to tissue hypoxia and finally lead to stroke.
• in embolism, due to any of the cases like hypertension, occlusion of the blood vessel occurs, if it is not treated at the beginning itself then the clot which is formed travelsto the brain. then the blood vessel become fragile and blood starts to leak.and ends up with cerebral haemorrhage. If this not manages again te mass of blood forms and grows.and formation of large clots occurs.this leads to compression of the tissues,increased ICP and impaired function and perrfsuin and finally eds up with stroke.

2.stages in the development of an atheroma.

• risk factors such as biochemical imbalance (high LDL) trigger an endothelial activation beyond the normal.Then the LDL enters subendothelially and oxidation occurs. which finally leads to inflammation process. which results as arethoma.
• Therefore this process has 4 steps;
• biochemical imbalance
• and endothelial activation
• oxidation process
• inflammation process

3.predisposing factors in this case are;

• age; risk doubles after 55.patient has 65
• gender (male>females)
• family history (he has family history)
• hypertension (his bp is high)
• smoking habit

4. initial manifestations of this patient shows that blood flow to the left side of the artery has slowed down. that means she is moving to the stage of depleted oxygen which finally ends up with cerebrovascular accidet.

here,eventhough, the patient was transported timely to the hospital his prognosis is going through very bad stage.because he developed middle cerebral artery occlusion. that is the reason why he developed numbness of the right side. So,if properly treated he ca have good prognosis/.

5.Once the patient is given first aid he is immediately shifted to the hospital to ICU.diagnse the type of stroke and based on that the doctor should start the treatment and rehabilaite the patient to prevent the effects of stroke.

in the hospital give a complete medical history and carry out procedure including those like endovascular procedures or surgical treatment and also ake sure that yo have treated te underlying cause as there is chanceof occurrence of one more strke.