Pathophysiologic Cascades in Ischemic Stroke - MyAssignmenthelp.com

Question: Discuss about the Pathophysiologic Cascades in Ischemic Stroke. Answer: Introduction: Stroke refers to the medical condition characterized by poor blood flow to the brain, eventually resulting in death of the brain cells. According to research studies, stroke can be defined as a neurological deficit that occurs due to cerebrovascular incidents, and persists beyond 24 hours (Jauch et al. 2013). At times, such incidents can get interrupted due to death within the time frame. Cerebrovascular accident (CVA) is the medical term commonly used for stroke. Rupture or blockage of a blood vessel results in disruption of blood flow to a part of the brain. This directly creates a deficiency of oxygen in brain cells and leads to their immediate death (Andrade et al. 2012). Hindered blood supply to the neuronal tissues often lead to an extraordinary injury to the brain functions. This essay will focus on a case study of a 75 year-old widow, Ms. Greta Balodis, following her deterioration in health and diagnosis of CVA. Pathophysiology of cerebrovascular accident- Stroke is generally divided into two categories namely, ischemic stroke and hemorrhagic stroke. An analysis of the case study suggests that the patient Greta suffered from a possible ischemic attack in the year 2012. Ischemic stroke generally occurs due to loss of blood supply to a part of the brain, thereby initiating an ischemic cascade. Deprivation oxygen in the brain cells for more than 60- 90 seconds are found to exert damaging effects and irreversible injuries in the patient after three hours. A similar incident probably occurred in the patient where oxygen deprivation led to infarction in her brain (Xing et al. 2012). Furthermore, disruption of blood supply occurs due to narrowing the blood vessel lumen and results in blood flow reduction. This in turn results in blood clot formation in the vessels. Disintegration of atherosclerotic plaques are also found responsible for emboli release. Occurrence of CVA in the patient can be correl ated to embolic infarction that might have occurred due to emboli formation in the heart due to atrial fibrillation (Palm et al. 2012). Research evidences suggest that emboli from the carotid arteries or the heart are found to break off and enter the bloodstream through cerebral circulation, thereby lodging in and blocking the blood vessels in the brain (Bailey et al. 2012). The fact that she suffers from hypertension can also be linked to the pathophysiology of stroke. High blood pressure is found to damage the arteries present throughout the body, thereby creating conditions that result in their bursting or clogging. Such weakened arteries present in the human brain increased the likelihood of the patient to suffer from stroke (Wang et al. 2013). Blockage of blood vessels in the brain resulted in subsequent energy deprivation, which in turn made the brain resort to adopting an anaerobic metabolism pathwayswithin the regions containing affected brain tissues. According to evidences such anaerobic metabolism is found to produce lessATP (Ji et al. 2013). However, this results in accumulation oflactic acid. Depletion of oxygen or glucose in the brain are directly responsible for release of glutamate, the excitatory neurotransmitter. Further pathophysiology mechanism of the CVA suffered by Greta can be linked to producted of reactive oxygen species and oxygen free radicals that damage the endothelium of the blood vessels, and trigger an ischemic cascade (Rodrigo et al. 2013). In addition to causing potential damage to the brain tissues, infarction and ischemia can also be thought responsible for loss of neuronal structural integrity, facilitated by matrix metalloprotease release. On the other hand, hemorrhagic strokes most commonly occur due to ruptured aneurysm, prior ischemic formation, and hypertensive hemorrhage. Previous history of TIA in the patient might have resulted in injury of the brain tissue, thereby leading to their compression from an expanding hematoma (Aggarwal et al. 2012). This pressure is also responsible for disrupting blood supply to the affected parts of the brain, with subsequent infarction. Thus, the blood released from the part where hemorrhage occurred might have created toxic effecrs on vasculature and the brain structure (Zis et al. 2013). Greta was reported to suffer from three fall related incidents in the past six months. This can be established by the fact that seizures are regarded as signs of brain injury and occur due t o sudden disorganization of electrical activity in the brain (Cook et al. 2015). The fact that the patient had previous history of TIA suggests that these might have resulted in the cells emit busts of energy and result in unintentional body movements, and short periods of unconsciousness. Explanation of signs and symptoms- The two common signs and symptoms presented by the patient Greta Balodis include left sided hemiplegia and resolving dysphagia. Hemiplegia refers to a type of paralysis that affects a particular side of the body, often reported to affect one arm and one leg. The symptoms occasionally are found to extend till the torso. Failure of the brain to send, produce or interpret necessary signals, as a subsequent result of any disease or damage to the brain tissues are found to be the underlying factors that govern this condition. Presence of this symptom in the patient can be related to the fact that strokes, transient ischemic attacks and brain aneurysm or hemorrhages are found to directly result in paralysis (Sin and Lee 2013). Insufficient blood supply to parts of the right cerebral hemisphere is found to result in disruption of its function, thereby resulting in left sided hemiplegia in the patient. Most common signs of this condition are associated with difficulty in walking, loss of balance, impaired ability to grasp, muscle fatigue and reduction in movement precision (Sasaki et al. 2013). Therefore, injury to parts of the right hemisphere that controls body movements resulted in Gretas inability to control voluntary movement of the muscles present on the left arm and legs. It can further lead to muscle spasticity and make her more vulnerable to suffering from seizures and subsequent falls. Dysphagia refers to the medical condition that results in difficulty in swallowing food. Greta also reported symptoms of dysphagia, following her stay at the stroke rehabilitation facility. This suggests that the patient takes more time and effort for moving food or any fluids from the mouth to the stomach. This difficulty in swallowing is usually a result of muscular problems. Oral dysphagia or high dysphagia results in weakness of the tongue following experience of a stroke, which in turn creates difficulties in transporting food along the mouth. Lack of oxygen, in specific regions of the brain, results in death of neuronal cells and tissues, due to reduced blood flow (Daniels, Anderson and Willson 2012). Death of cells that are responsible for governing the process of food swallowing can directly lead to this condition. Thus, sudden neurological damage due to cerebrovascular accident might make it difficult for Greta to move food particles into the throat. This would make her gag, choke or cough while swallowing. Her old age can also be considered as a major risk factor for this presenting symptom. Further complications may also arise in the patient such as, pneumonia, aspiration, dehydration and sudden weight loss (Crary et al. 2013). To conclude, it can be stated that previous history of TIA made the patient at an increased likelihood of suffering from cerebrovascular accidents. Thus, strokes are major debilitating and life threatening conditions that occur with little warning. The patient Greta suffered from a CVA due to interruption of blood supply to parts of her brain. This further resulted in paralysis on the left side of her body and subsequent difficulty to swallow food. Thus, in addition to pharmacological intervention, efforts must be taken to restore her mobility. This can be brought about by engaging her in physical therapies and occupational therapy. Support from her daughter and other family members is crucial for providing her a comfortable environment after stroke. This will enhance her overall health and wellbeing and improve her health related quality of life. References Aggarwal, A., Gupta, A., Kumar, S., Baumblatt, J.A., Pauwaa, S., Gallagher, C., Treitman, A., Pappas, P., Tatooles, A. and Bhat, G., 2012. Are blood stream infections associated with an increased risk of hemorrhagic stroke in patients with a left ventricular assist device?.ASAIO Journal,58(5), pp.509-513. Andrade, S.E., Harrold, L.R., Tjia, J., Cutrona, S.L., Saczynski, J.S., Dodd, K.S., Goldberg, R.J. and Gurwitz, J.H., 2012. A systematic review of validated methods for identifying cerebrovascular accident or transient ischemic attack using administrative data.Pharmacoepidemiology and drug safety,21(S1), pp.100-128. Bailey, E.L., Smith, C., Sudlow, C.L. and Wardlaw, J.M., 2012. Pathology of lacunar ischemic stroke in humansa systematic review.Brain Pathology,22(5), pp.583-591. Cook, M., Baker, N., Lanes, S., Bullock, R., Wentworth, C. and Arrighi, H.M., 2015. Incidence of stroke and seizure in Alzheimer's disease dementia.Age and ageing,44(4), pp.695-699. Crary, M.A., Humphrey, J.L., Carnaby-Mann, G., Sambandam, R., Miller, L. and Silliman, S., 2013. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care.Dysphagia,28(1), pp.69-76. Daniels, S.K., Anderson, J.A. and Willson, P.C., 2012. Valid items for screening dysphagia risk in patients with stroke: a systematic review.Stroke,43(3), pp.892-897. Jauch, E.C., Saver, J.L., Adams, H.P., Bruno, A., Demaerschalk, B.M., Khatri, P., McMullan, P.W., Qureshi, A.I., Rosenfield, K., Scott, P.A. and Summers, D.R., 2013. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke,44(3), pp.870-947. Ji, R., Schwamm, L.H., Pervez, M.A. and Singhal, A.B., 2013. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis.JAMA neurology,70(1), pp.51-57. Palm, F., Urbanek, C., Wolf, J., Buggle, F., Kleemann, T., Hennerici, M.G., Inselmann, G., Hagar, M., Safer, A., Becher, H. and Grau, A.J., 2012. Etiology, risk factors and sex differences in ischemic stroke in the Ludwigshafen Stroke Study, a population-based stroke registry.Cerebrovascular diseases,33(1), pp.69-75. Rodrigo, R., Fernndez-Gajardo, R., Gutirrez, R., Manuel Matamala, J., Carrasco, R., Miranda-Merchak, A. and Feuerhake, W., 2013. Oxidative stress and pathophysiology of ischemic stroke: novel therapeutic opportunities.CNS Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS Neurological Disorders),12(5), pp.698-714. Sasaki, N., Mizutani, S., Kakuda, W. and Abo, M., 2013. Comparison of the effects of high-and low-frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke.Journal of stroke and cerebrovascular diseases,22(4), pp.413-418. Sin, H. and Lee, G., 2013. Additional virtual reality training using Xbox Kinect in stroke survivors with hemiplegia.American Journal of Physical Medicine Rehabilitation,92(10), pp.871-880. Wang, Y., Xu, J., Zhao, X., Wang, D., Wang, C., Liu, L., Wang, A., Meng, X., Li, H. and Wang, Y., 2013. Association of hypertension with stroke recurrence depends on ischemic stroke subtype.Stroke,44(5), pp.1232-1237. Xing, C., Arai, K., Lo, E.H. and Hommel, M., 2012. Pathophysiologic cascades in ischemic stroke.International Journal of Stroke,7(5), pp.378-385. Zis, P., Vemmos, K., Spengos, K., Manios, E., Zis, V., Dimopoulos, M.A. and Zakopoulos, N., 2013. Ambulatory blood pressure monitoring in acute stroke: pathophysiology of the time rate of blood pressure variation and association with the 1-year outcome.Blood pressure monitoring,18(2), pp.94-100.