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Understanding Stroke: Causes, Symptoms, and Treatment
Answered

Mr. Bergen's Case: Observations and Recommendations

What have you learned from their perspectives on the case? Has it changed the way in which you view the case? In what way? Each response post should be a minimum of 75 words.

Classmate 1 k Mr. Bergen presents with a sudden onset of a right lateral facial droop, right lateral arm weakness, and slurred speech. Symptoms began 6 hours ago. No headache, syncope, and no abnormal motor movements. Medical history is hypertension and a myocardial infarction 5 years ago. He has been a lifelong smoker. Mr. Bergen is 72 years old. He takes aspirin daily.

All vitals are within normal range with the exception of blood pressure which is higher than normal range: pulse of 62, blood pressure 135/87, and normal temperature. His neurological and physical exams are normal. Heart rhythm is normal and all lab tests within normal range. I believe Mr. Bergen has had a cerebrovascular accident, also known as a stroke, specifically an ischemic stroke cause by a vessel occlusion due to atherosclerosis. Within minutes of cerebral ischemia, the region of the brain that experienced a loss of blood flow becomes mortally injured and necrosis follows. The necrotic tissue is surrounded by a region of functionally disabled cells due to reduced perfusion but are still metabolically active. These ischemic areas of reduced energy result in depolarization of neurons.

Activation of glutamate receptors results in drastically increased calcium ions while sodium and potassium into the intracellular space, causing edema. The increased calcium ions activate lipases, endonucleases, and proteases. This generates free radicals causing which damages mitochondria, DNA, and membranes which in turn, causes inflammation. Within the damaged area of the brain, neurotransmitters cannot function which causes things like aphasia and lateral weakness. More than 200,000 people have strokes in the United States annually. Survival rates of a stroke are measured age, sex, severity of disability resulting from the CVA. The modified Rankin Scale (mRS) is used to determine life expectancy after a stroke. Women have a higher mortality rate than men which doubles with each decade of age. Approximately 14% of survivors die with 30 days of the stroke and 30% within one year. 62% are readmitted to a hospital with complications.

Treatments for stroke are: Emergency IV medications that need to be delivered within 4.5 hours of initial signs of stroke, emergency endovascular procedures to include medications delivered diretly to the brain or a clot removal with a stent, carotid endarterectomy, angioplasty and stents, surgery to include clot clips placement and endovascular embolization, and blood transfusions. Classmate 2 M Based on Mr. Bergen's age (72), previous heart attack, and the fact that he is a lifelong smoker I think it is likely that he is having a Cerebral Vascular Accident (a stroke). People who smoke are more likely to have heart attacks and strokes. Being the age that he is a stroke wouldn't be too far off base and would make a lot of sense. According to Stanford Health, "The majority of strokes occur in people who are 65 and older" (Stanford Health 2020). The drooping of Mr. Bergen's face is also cause for alarm as this is a very distinguishing symptom when it comes to strokes. During a stroke according to the Mayo Clinic; “… when the blood supply to the part of your brain is interrupted or reduced, preve3nting brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes” (Mayo Clinic 2021). In terms of survival rates; according to SAEBO "The risk of death after 28 days is only 28% however, after one year the rate jumps to 41% and 60% after five years" (Hoffman 2018). This is a sobering fact due to the idea that just because you survive the initial incident, it doesn't mean you're out of the woods by any means. According to the Mayo Clinic some forms of treatment include; Emergency IV medication, emergency endovascular procedures, carotid endarterectomy, angioplasty and stents (Mayo Clinic 2021). Mr. Bergen has a done a great deal of damage to his body through smoking and it would be my recommendation that he quit smoking immediately. Although he cannot reverse the damage that has been done, he can prevent further damage. Unfortunately, Mr. Bergen is of the relative age in which the consequences of smoking start to come out.

Classmate 3 D My initial observations of Mr. Bergen are his age, medical history, his medications he takes daily, and the fact that he is a life long smoker. I believe that noticing these key elements are important to consider before ruling out Mr. Bergen's diagnosis. I do believe that Mr. Bergen has suffered from a stroke, the medical term meaning 'cerebral vascular accident'. A stroke occurs when the blood supply to part of the brain is interrupted or reduced. This prevents brain tissue from obtaining proper oxygen and nutrients. When a stroke occurs, brain cells can die within minutes and treatment is crucial.

It is important to remember that there are 5 warning signs for a stroke:

1) sudden weakness on one side of the body,

2) speech difficulty or confusion,

3) blurred vision,

4) loss of balance, and

5) severe headache without a cause.

The survival rate for someone who has suffered from a stroke is 29%. Treatment options include: emergency endovascular procedures, medications, removing the clot, carotid endarterectomy, angioplasty, and stent placements. The 2 types of cerebral vascular accidents are ischemic strokes and hemorrhagic strokes. Ischemic strokes are more common. This type of stroke is typically caused by a blood clot that blocks a vessel in the brain. The symptoms associated with ischemic strokes are similar to what Mr. Bergen has experienced. Rehabilitation associated with ischemic strokes involves physical therapy.

Hemorrhagic strokes are less common. These type of stokes occur when a blood vessel breaks and bleeds into the brain which eventually leads to an aneurysm. Hemorrhagic strokes roughly create up to 13% of stroke cases and are far more dangerous resulting in death if left untreated. The symptoms for both types of strokes remain the same as well as the type of physical therapy the patient will need.

Make sure to put which classmate you are replying to thanks.

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