Stroke Case Study
Pathophysiology:
In the present case study, the patient is a 61-year-old male named Mr. Black. Mr. Black has presented at the Emergency Room with symptoms of stroke. Further investigation revealed a Middle Cerebral Artery (MCA) distribution stroke with substantially impacted physical function on the left side of his body. The patient also showed signs of impeded speech and reasoning abilities. According to Slater (2013), "middle cerebral artery stroke describes the sudden onset of focal neurologic deficit resulting from brain infarction or ischemia in the territory supplied by the middle cerebral artery (MCA)." (Slater, p. 1) Evidence suggests that the major contributor the Mr. Black's condition has been his chronic hypertension. Whereas many of his vital signs indicate relatively normal functionality at the time leading up to his episode, Mr. Black's blood pressure is registered at a decidedly hypertensive rate of 150/80. At 90 beats per minute, Mr. Black's pulse rate falls on the higher end of the normal function spectrum. Additionally, his respiratory rate of 20 breaths per minute also trends on the elevated end though not excessively so.
Additional consideration must be given to the presence of certain lifestyle conditions that will have contributed to Mr. Black's susceptibility to the stroke. Though Mr. Black has no family history of heart disease or stroke, his wife would report that the patient habitually smoked roughly a pack of cigarettes a day. There is a close correlation between cigarette smoking and a wide battery of serious health concerns. According to the National Stroke Association (NSA), "smoking doubles the risk for stroke when compared to a nonsmoker. It reduces the amount of oxygen in the blood, causing the heart to work harder and allowing blood clots to form more easily. Smoking also increases the amount of build-up in the arteries, which may block the flow of blood to the brain, causing a stroke." (NSA, p. 1)
In Mr. Black's case, the fact that he persisted in this habit even after beginning a hypertensive medication course ten years prior to the presenting incident would substantially undermine the effectiveness of his treatment. This case is strengthened by an otherwise normalcy in the patient's blood levels, brain imaging as...
Ultimately, it may be deduced that the cigarette smoking habit contributed directly to the patient's chronic hypertension and ultimately led to the stroke resulting in Mr. Black's current hospitalization.
Explain the pathogenesis that leads to the structural and functional changes resulting from Mr. Black's stroke.
Using CT-scan imaging, we can determine to some degree the structural and functional changes that are occurring in Mr. Black's brain. Within just a few hours of the initial incident, this allows us to project the likely range of long-term neurological damage that might be resultant from the stroke. In the case of Mr. Black, the scan would reveal early ischemic changes in the left hemisphere on his brain. This suggest occlusion has occurred which has prevented the brain from properly distributing oxygen to its left hemisphere. According to Slater, "the MCA supplies most of the outer convex brain surface, nearly all the basal ganglia, and the posterior and anterior internal capsules. Infarcts that occur within the vast distribution of this vessel lead to diverse neurologic sequelae." (Slater, p. 1)
For Mr. Black, an infarction has resulted in the prevention of distribution to the left-hemisphere with evidence of potentially long-term and irreversible neurological impairment. The consequences of this clotting include a dramatic impingement on the subject's motor control as well as his speech and reasoning abilities.
Explain how two of Mr. Black's clinical manifestations are related to the structural and functional changes caused by the stroke.
Two of the most immediately evident clinical manifestations are Mr. Black's complete loss of bodily function and control on his right side and his loss of comprehensive ability. Though Mr. Black retains the ability of speech and consciousness, he remains disoriented and incapable of responding to questions with recognition or understanding. These clinical manifestations denote that the early ischemic changes (EIC) revealed by the CT-scan are connected directly to an imposing neurological impairment.
The structural implications of these impairments are described in the text by Tocco (2011). Here, the author explains that the middle cerebral artery,…
