...patients with acute ischemic stroke. Methods—A survey was undertaken of 280 neurologists from the United States and 270 neurologists from Canada. Brief vignettes were presented for the following 5 scenarios: stroke in evolution, atrial fibrillation-related stroke (A FIB), vertebrobasilar stroke, carotid territory stroke, and multiple transient ischemic attacks. The effect of medicolegal factors was also ascertained. Statistical comparisons were done with chi-squared testing. Results—US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin for patients with stroke in evolution (51% versus 33%, P0.001), vertebrobasilar stroke (30% versus 8%, P0.001), carotid territory stroke (31% versus 4%, P0.001), and multiple transient ischemic attacks (47% versus 9%, P0.001). The vast majority of US and Canadian neurologists would use intravenous heparin for acute stroke patients with A FIB (88% and 84%, respectively). US neurologists more often cited medicolegal factors as a potential influence on the decision-making process than Canadian neurologists (33% versus 10%, P0.001). Conclusions—In several clinical scenarios, US neurologists were significantly more likely than Canadian neurologists to use intravenous heparin. Fears regarding medicolegal consequences may partially explain the treatment disparity. Despite the publication of 4 clinical trials, which have not shown any long-term benefit for patients with acute stroke and A FIB (International...
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...Timely treatment after a stroke is imperative in increasing a patient’s likelihood of survival, as well as sustaining their quality of life. Stroke was once seen as a condition in which little could be done for a patient in the emergency environment; emergency personnel could assess vital signs and maintain airways during transport, whereas in the emergency department (ED) the patient would undergo monitoring until they were recovered enough to receive cognitive and physical therapy. However, with the advent of tissue plasminogen activator (tPA), this dim reality has largely changed. First approved for ischemic strokes by the Food and Drug Administration (FDA) in 1996, tPA works by breaking down blood clots that cause nearly 80% of all stroke...
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...10.1 STROKE This concept was taken from module 10 “Assessment of nervous system”, Sub-topic 3 “common abnormalities and assessment findings of nervous system”. Stroke is a condition of both the nervous and cardio-vascular system. Stroke is a condition of brain damage which results due to shortage of blood supply. The blood supply to the arteries of the brain is reduced leading to brain damage. This result from shortage of blood supply and glucose supply to the brain. In the US it is the fourth leading cause of death. Stroke is also known as cerebro-vascular accident and it is a medical emergency. TYPES OF STROKE There are two main types of stroke namely ischemic stroke and hemorrhagic stroke, though some authors belief that transient...
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...Causes and Effects of Stroke Thesis: To gain better knowledge and understanding of the disease called stroke, one must be familiar with how it is caused, its forms, symptoms, facilitators, how it is diagnosed, treated, and prevented. I. Introduction II. Stroke A. Definition B. Types C. Causes III. Demographics IV. Symptoms V. Diagnosis, Treatment, and Prevention VI. Conclusion Causes and Effects of Stroke Many individuals know or have friends, relatives, loved ones, or someone close to them who have either experienced firsthand or have seen the effects of a stroke, in addition to the toll it takes on the victim and the victim’s life. However, what remains unclear to most families is exactly what the condition is and what causes it. To gain better knowledge and understanding of the disease called stroke, one must be familiar with how it is caused, its forms, symptoms, facilitators, how it is diagnosed, treated, and prevented. By definition, a stroke is a condition where a blood clot or ruptured artery or blood vessel blocks the flow of blood to a specific area of the brain. It is a lack of flowing oxygen and glucose to the brain that leads to the deterioration of brain cells and the start of brain damage, thus resulting in the person developing speech impairment, memory, and movement. There are two main categories in which strokes are classified, ischemic stroke and hemorrhagic stroke. The ischemic stroke is what accounts for...
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...Physiological Disorders Nature and diagnosis of physiological Disorders In this assignment I am going to be creating a workbook for level 3 students who study health and social care course which can help them with their studies and support I will be talking about two types of disorders which are Diabetes Mellitus Type 2 and Cerebral Vascular Accident (CVA). P1 Explain the nature of two named physiological disorders. The two types of physiological disorders I am going to be talking about are Diabetes Mellitus Type 2 and Cerebral Vascular Accident (CVA). I’m going to start by naming the physiological disorder with a definition for the both. Diabetes Mellitus Type 2: This type of physiological disorder is the most common form of diabetes. If an individual was to have this type of disorder the body wouldn’t be using insulin properly. This is called insulin resistance, because at first the pancreas would have made extra insulin which would have made up for it. Type 2 diabetes was once known as adult onset or noninsulin dependent Diabetes, this is a very chronic condition for an individual to go through. So anyone having this physiological disorder will have conditions which will affect their body metabolizes sugar. Glucose is very significant source of energy which your body need. If you have type 2 diabetes your body will either resists the effects of insulin this is a hormone which’s help regulate the movements of the sugars which go into your cells, or it doesn’t produce...
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...Brown, MD pirin therapy for reducing the risk of myocardial infarction (MI), stroke, and vascular death among men and women with preexisting cardiovascular disease are well established,1-3 the role of aspirin in primary prevention is less clear. An overview of 5 randomized trials investigating aspirin therapy for the primary prevention of vascular disease found a significant beneficial effect of aspirin therapy on the prevention of a first MI, but no significant effects on the risk of stroke or vascular death.4 Although women were included in only 2 of these studies and accounted for only 20% of the population studied, the US Preventive Services Task Force5 and the American Heart Association6 deemed aspirin therapy effective in decreasing the incidence of coronary heart disease in adults of both sexes who are at increased risk. Subsequently, guidelines from the American Heart Association on the primary prevention of cardiovascular disease in women recommended use of low-dose aspirin therapy in women whose 10-year risk of a first coronary event exceeds 20% and consideration 306 Context Aspirin therapy reduces the risk of cardiovascular disease in adults who are at increased risk. However, it is unclear if women derive the same benefit as men. Objective To determine if the benefits and risks of aspirin treatment in the primary prevention of cardiovascular disease vary by sex. Data Sources and Study Selection MEDLINE and the Cochrane Central Register of Controlled Trials databases...
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...However after undergoing exercises, surgery or therapy it is able to help them repair their brains as well as change their minds and literally change their brains. The process whereby their brains change in response to experience is called neuroplasticity. There are various forms of neuroplasticity such as homologous area adaptation, map expansion, cross-modal reassignment and compensatory masquerade which occur through diverse forms of therapeutic rehabilitation and treatment. Many processes are involved in brain recovery, after an injury or trauma. Neural networks and how they trigger an action potential, neuroplasticity, learning experience and therapy in patient recovery or remission are very important in brain recovery. In this essay, case studies that underwent neuroplasticity due to brain damage will be shown as well as how the treatment they underwent both psychologically and physically ‘changed their brain’. In computer science and associated fields, artificial neural networks are computational models motivated by an animal's central nervous system (in particular the brain) which is competent of machine learning as well as pattern recognition. Artificial neural networks are usually conferred as systems of interconnected "neurons" which can calculate values from inputs (Elsevier, 1988). An action potential is a short-lasting event whereby the electrical membrane potential of a cell quickly rises and falls following a uniform route. Action potentials happen in numerous types...
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...affects a stroke may cause. The causes and symptoms will also be identified along with the various affects a stroke may have on an individual such as physical, emotional, and social impact. Finally, the care and treatments provided will be highlighted and will be referenced throughout according to relevant literature and guidelines such as Infection control, Health and Safety, and various government policies. According to the National Stroke Strategy 2007, a stroke is a condition in which the brain cells suddenly die due to a lack of oxygen. A stroke is often caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain (reference). The two main types of stroke which will be referred to throughout the text are hemorrhagic and Ischemic. National Stroke Strategy (2007) states that ‘an Ischemic stroke accounts for around 87% of all strokes and occurs when a blood clot (thrombus) forms that blocks the blood flow to a certain part of the brain’. When a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus (reference). This wandering clot may then be carried through the bloodstream and to the brain where it can then cause an ischemic stroke. A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and then fills the space between the brain and skull with blood or when a malfunctioning artery in the brain bursts and fills the surrounding tissue with blood. Both Ischemic and Hemorrhagic...
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...3 patients with massive symptomatic dolichoectatcic aterties and their management as well as a review of the current literature. Cases Case 1 is a 74 year old male with hypertension and ischemic heart disease presented with a sudden onset slurring of speech. This was accompanied by a left upper motor neuron 7th nerve, dysarthia and right sided hemiplegia (MRC grade 4). Computed tomography (CT) of his brain showcased a massive dolichoectatic vertebrobasilar artery with calcification(Figure 1) and an MRI of the brain provided further delineation of the abnormality and revealed the restricted deffusion in the left midbrain and pons consistent with an ischemic stroke (Figure 2). Figure 1. ectatic calcified basilar artery Figure 2. DWI hyperintensity, pontine infarct Case 2 is a 68 year old chinese male with hyperlipidemia, presented with left sided face numbness which progressively got worse. a CT was done for further evaluation. This showed a markedly ectatic calcified basilar artery (Figure 3). An MRI brain was done for further investigation, which showed an ectatic basilar artery indenting the right side of the anterior pons (Figure 4). The neurological deficits resulted from a mass effect on the underling trigeminal nucleus in the pons. Figure 3. End-on calcified basilar artery Figure 4, indentation of pons Case 3 is a 72 year old Chinese female with giddiness and left hemiplegia and right facial droop. She was admitted...
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...Case Study on Neural Function This is the second case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Both are due at the beginning of class on Tuesday, November 18, 2014. Case 1 M.G. is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104º F, lethargy, headache, and stiff neck. Laboratory analysis of a spinal tap demonstrates increased white blood cells in the cerebrospinal fluid (CSF). Discussion Questions 1. What is the most likely cause of M.G.’s signs and symptoms? What is the origin and pathogenesis? What other laboratory findings would be consistent with this etiology? * Meningitis is the likey cause. Usually a bacterial infection. 2. What are common complications of this disorder, and how would one assess for their occurrence? 3. What is the usual treatment for this disorder? Case 2 J.S. is a 72-year-old woman with a long history of atherosclerosis. One afternoon, her grandson found her sitting in a chair staring blankly into...
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...Narrative Report - Left sided hemiparesis due to an ischemic stroke by Clifford Choi on Saturday, December 3, 2011 at 12:47am · I thank my mentors in neurology, integrative medicine, and my patient for his determination to overcome this. He is an atheist but believed in me and himself. The patient reports full recovery. Here is his letter 4 months later. He has given permission to publish the report. He is back to work, travelling, driving, and has no known deficits. 80% of ischemic strokes survive the stroke, but it is uncertain how many fully recover 100% function. _________________________________________________ Dear Dr. Clifford Choi, I tried to call the number you once gave me, but they told at the hospital SEIMC that you were not working there anymore. Anyway I just wanted to touch base and say hello to you and thank you and the colleagues you had at the hospital. The recovery has been very amazing. I was last week at this intensive rehabilitation (or so it was called) session at the _________ University hospital. I was supposed to be there the whole week, but they said that I’m actually in too good shape to gain anything from this anymore, so I left Wednesday morning. I’m allowed to drive now, and officially I will be back to work on August 26th. I can call you, if you want. But then I would need your phone number. The world is a small place, so maybe we some day run into each other. You never know. Best regards, patient x The report below was submitted...
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...Case Study 1 Nichelle Torres Pathophysiology Session 4 Case Study Case 1 (Chapter 14: Concepts of Neurologic Dysfunction & Chapter 15: Alterations in Neurologic Function) J .S. is a 72-year-old woman with a long history of atherosclerosis (hardening of the arteries). One afternoon, her grandson found her sitting in a chair staring blankly into space. She was tilting toward the right, drooling, and had been incontinent of urine. She was able to focus her eyes on him when he spoke to her, but she was unable to verbalize a response. She was transported to the local hospital and diagnosed with cerebrovascular accident (stroke). Discussion Questions : 1.)What questions could be asked of J. S.'s family to help determine the cause of her stroke as thrombotic, embolic, or hemorrhagic (i.e., questions to assess risk factors for each type of stroke)? * The family may be asked if J.S. is a smoker, or if there is a history of hypertension or diabetes. 2.)Based on the scenario described above, which brain hemisphere (left or right) suffered the ischemic damage? What other manifestations of this stroke location would likely be apparent? *Given the information above, the left hemisphere would be affected because a stroke is contra lateral. The fact that she is drooling and incontinent may suggest damage to the brain stem. 3.)What medical therapies might be used to manage this stroke and/or to prevent another one? *...
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...The Use of Music Therapy on Stroke Victims When normal blood flow to the brain fails, a stroke occurs, there are more than 780,000 strokes every year in the United States causing more serious long-term disabilities than any other disease that number is expected to increase in the coming years. (Know Stroke). While preventing strokes is obviously a goal, the development of successful rehabilitation strategies is equally important. Music therapy has shown promise as a way to help stroke victims recover a variety of lost functionality. In this paper I will be describing the beneficial effects that music has on stroke victims. There are two main types of stroke ischemic and hemorrhagic. Ischemic stroke occurs when blood vessels are blocked, usually by a clot. This accounts for four in five strokes. Hemorrhagic stroke is caused by a broken or leaking blood vessel in the brain (NIH). The effects of a stroke vary by its type, severity and location within the brain. A stroke may affect only one side of the body or part of one side. It can cause cognitive deficits, muscle weakness or paralysis. A stroke in the right half of the brain can cause visuospatial issues, impaired judgment and behavior, along with short-term memory loss. A stroke in the left half of the brain can cause speech and language problems, slow and cautious behavior, as well as memory problems. A stroke in the cerebellum can cause abnormal reflexes, balance problems, and dizziness, nausea, or vomiting (Office on...
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...1. Introduction This assignment is a critique on the study published in The New England Journal of Medicine (NEJM) entitled ‘Homocysteine Lowering and Cardiovascular Events after Acute Myocardial Infarction’ by Bonaa et. al (2006) (also known as The NORVIT study). NEJM’s most recent impact factor was 51.296 (in 2006). NEJM boasts the largest paid circulation among medical journals, with close to 200,000 paying subscribers. It is printed weekly in the United States, Canada, the Netherlands, and Japan, and a range of translated articles reaches approximately 140,000 (New England Journal of Medicine.org, 2006). The NORVIT study was designed as a randomized, controlled, double-blind, intervention study. It included 3,749 men and women who had suffered and acute myocardial infarction within the last 7 days. The rationale behind the study was that high homocysteine levels are considered a risk factor for cardiovascular disease (Bonaa et al, 2006). The aim was to measure how effective lowering blood serum homocysteine levels with B vitamins was in preventing a secondary event. A collaborative meta-analysis published in The Journal of the American Medical Association, states that homocysteine levels are an independent predictor of ischemic heart disease and that studies on disease risk of genetic variants affecting homocysteine may help establish whether homocysteine is causally linked to vascular disease (2002: cited by Bonaa et al, 2006). The meta-analysis suggests that a large...
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...Chronic Angina Case Study Advanced Pathophysiology 2/2/14 1) Basis for diagnosis: Six month history of intermittent chest discomfort, described as lower substernal tightness with numbness of the left upper arm, only during exertion. + exercise stress test with pain and 1.5mm of ST segment depression. Class of Angina: Class 1 Chronic angina is associated with a fixed or stable coronary obstruction that creates a disparity between coronary blood flow and the metabolic demands of the myocardium. It is usually precipitated by situations that increase the metabolic needs of the heart such as physical exertion, cold, and emotional stress and relieved within minutes by rest or nitroglycerin. These symptoms occur repeatedly over time, sometimes months to years. This fixed or stable plaque is commonly associated with chronic angina whereas the unstable plaque is associated with unstable angina and myocardial infarction. It is these unstable plaques that are most prone to abrupt plaque changes, followed by thrombosis, that lead to MI, stroke, and sudden cardiac death. These unstable plaques can be divided into three categories of Acute Coronary Syndrome: Unstable Angina, NSTEMI, and STEMI. The pathophysiology between UA and NSTEMI are similar and include these key features: development of an unstable plaque that ruptures or plaque erosion with superimposed non occlusive thrombosis, an obstruction by spasm, constriction, dysfunction, or adrenergic stimuli, severe narrowing...
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