Introduction

Stroke is described as a common disease, which is as well referred to as CVA (Cerebrovascular Accident). The condition is typified by extraordinary injury of the function of the brain because of hindered supply of blood to the tissues of the brain. Usually, the disease is managed as a medical emergency, which can at times cause the death of a person. The resultant hindrances of blood flow to the tissues of brain limit the brain of sufficient nutrients that as a result makes the brain incapable of carrying out its vibrant activities as a consequence of the incapability of receiving adequate blood (Agbor-Etang & Setaro, 2015; Boorstein 2011).

This paper focuses on the case study of Mrs. Greta Balodis, a 75 year-old widow who has been experiencing deterioration in her health over the past two years incapacitating her normal activities. Sheis diagnosed with right-sided cerebrovascular accident (CVA).

Background Information

Greta presented with headache, drooping of her face and mouth on the side, weakness of her left arm and leg, dizziness and nauseous. She was then diagnosed with Right cerebral vascular accident (CVA) and atrial fibrillation. After spending two weeks in the acute care hospital and six weeks at the specialist stroke rehabilitation, she was discharged with mild residual Left sided hemiplegia and resolving dysphagia. On discharge, she was put on

Aspirin PO 100mg daily
Clopidogrel PO 75mg daily
Digoxin 125mcg PO daily.

Currently she is doing fine. She is on home rehabilitation program receiving regular in-home physiotherapy witha nurse visiting her once a week. She manages to mobilize short distances with a three-pronged stick.

Pathophysiology of Cerebrovascular Accident (Stroke) and How It Affects the Central Nervous System (CNS)

The CNS is often is affected by cardiac conditions or by very similar pathologic processes, which affect the heart. Many diverse heart diseases are capable of producingCNS dysfunction’s signs and symptoms (Mohr et al. 2011). Due to Greta’s presentation and history, definitely he was suffering from an embolic stroke. Cerebral embolism patients typically present with anacute, neurologic deficit. Occasionally, headache may ensue just earlier or togetherwith the development of the deficit. Emboli lodge in the vessels supplying blood to the brain reducing supply of blood. Frequently seizures are the common initial presentation (Mohr 2011). Greta for instance had a history of falls (three in last six months) and TIA in 2012. Often, cerebral embolism ensues during vigorous activity.  Apart from Greta’s arterial fibrillation, other causes of cerebral embolism include MI (Myocardial infarction); Left-ventricular aneurysm; RHD (Rheumatic heart disease); infectious endocarditis; cardiomyopathy; thyrotoxicosis; cardiac cancers; mitral valve prolapse; and CHD (Congenital heart disease) among others.

Pathophysiology of Embolic Stroke

Ischemic stroke is usually is as a result of blood supply to a part of the brain that ultimately stops working. Ischemia is capable of being caused in the brain as a result of thrombotic plaque, which prevents the blood vessels blocking communication via the blood vessel (Gasecki, Karaszewski & Narkiewicz 2016). On the other hand, embolism may result to blockage of blood vessels. Perhaps emboli may be moved from whichever body part and dislocated in a substantial portion of the brain thus stopping blood flow to the brain. Moreover, decreased the supply of blood similar to shock; may lead to a person to CVA. Ischemic stroke is capable of being extremely acute in definite instances. Nonetheless, cryptogenic stroke (unknown type) also leads to a huge percentage of the whole strokes types (Mohr et al. 2011). The etiology of Ischemic strokes is blood clots. Ischemic stroke is of two types: thrombotic and embolic. An embolic CVA takes place at the time a blood clot, which forms somewhere else in the body (embolus), is dislodged and moves to the brain through the circulation. Ultimately, the embolus lodges in vessels and blocks blood the flow resulting to CVA (Campbell2010).

Pathophysiology

Blood clots resulting to embolic CVA can form in any part of human body, but usually originate from the heart or upper chest and neck arteries. Following dislodge the clot moves via the circulation to the brain. However, after entering a small brain vessel, itstuckobstructing the blood flow to the brain (Grotta et al. 2015).

Emboli can result from fat globules, air bubbles, or an arterial plaque. However, emboli can as wellarisefrom abnormal heartbeat (for instance atrial fibrillation); a disorderthat the heart fails to beat efficiently, resulting to pooling and clotting of blood (Siniscalchiet al. 2015). Greta’s CVA was as a result of this.

Risk Factors

Persons with heart diseasesare at higher risk of developing embolic stroke. Consistent withGrotta et al. (2015), atrial fibrillation forms 15% of embolic CVAs. Persons with a familialhistory of CVA, or who have before experienced a mini-stroke remain at higher risk(Grotta et al. 2015).Other risk factors are older age (Greta Balodis 75 years old);Hypertension (Greta Balodis is Hypertensive); high cholesterol; diabetes; autoimmune diseases; smoking (Greta Balodis is a passive smoker); and obesity(Jørgense, Nakayama, Raaschou, Pedersen, Houth & Olsen 2015). In short,factors that may have precipitatedGreta’s stroke areprevious history of TIA, hypertension, atrial fibrillation, passive smoking, and obesity (Greta is obese her BMI is 34.96: height 1.55m and weight 84kg).

Management of Stroke

Medical treatment

Anticoagulation; patients with cerebral embolism episode are required to be anti-coagulated primarily with heparin (7-10 days) and later on warfarin provided the predisposing heartdisease lasts. Anti-coagulation should be avoided in patients with infectious and infectious endocarditis or cardiac cancers. TIA’s patientsoftenrespond well from daily aspirin, 650 mg BD; clopidogrel, 75mg OD; or Aggrenox) (Spence & Hammond 2016). Also, TIApatients will have less attack in case they aremanaged with warfarin; nevertheless, warfarin treatmenthasanincreasedbleeding complications’ risk compared to aspirin (Aiyagari & Gorelick 2011). For reduction of risk factors, patients are giventherapy targeted at reducing the risk factors for instance management of hypertension.

Greta Balodis was discharged with Aspirin PO 100mg OD and Clopidogrel PO 75mg OD for TIA and Digoxin 125mcg PO OD to manage hypertension. However, the current medication Atenolol PO 50mg daily is for the management of hypertension and Panadol PO 500mg prn is for the management of pain.

 

 

Pharmacology

Thrombolytic, more precisely, fibrinolytic agents convert captured plasminogen to plasmin as well as binding to clot fibrin leading local fibrinolysis. Alteplase is a t-PA utilized in the management of acute MI, acute pulmonary embolism, and ischemic stroke.  However, aspirin administration prevents prostaglandin synthetase activity that later onbarssynthesis of prostaglandin and prevents the creation of platelet-aggregating thromboxane A2 (Jones & Riazi 2011). Similarly, it works on the hypothalamic heat-regulating centre to diminish fever. On the other hand, Clopidogrel preventsaggregation of platelet and is utilized for the prevention secondary CVA (Gasecki, Karaszewski, & Narkiewicz, 2016). Acetaminophen lessens high temperature by acting on hypothalamic heat-regulating centres directly byraising the body heat dissipation throughsweating and vasodilation.Atenolol, an adrenergic receptor-blocking agent produces dose-related reductions in hypertension without bringing down reflex tachycardia (Aiyagari & Gorelick 2011).

Conclusion

Greta presented with headache, drooping of mouth and eye, dizziness and nausea. Sudden trouble in walking, dizziness occurs as a result of injury to inner-ear nerves.  Similarly, this may cause nausea, wobbliness on the feet, a propensity to turn to one side or the other, or amysterious fall.Headacheresult from due to meningeal stretching or irritation. Greta’s medication as prescribe aboveAspirin PO 100mg OD and Clopidogrel PO 75mg OD for TIA and Digoxin 125mcg PO OD to manage hypertension. However, the current medication Atenolol PO 50mg daily is for the management of hypertension and Panadol PO 500mg prn is for the management of pain.Pharmacokinetics is given above.

 

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