Running head: ISCHEMIC STROKE IN A PATIENT WITH HYPERCHOLESTEROLEMIA 1
Ischemic Stroke in a Patient with Hypercholesterolemia
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ISCHEMIC STROKE IN PATIENT WITH HYPERCHOLESTEROLEMIA 2
Ischemic Stroke in a Patient with Hypercholesterolemia
A 63-year-old woman presents to the emergency room with numbness on her left side, difficulty walking, and clumsiness with her left hand. She has had hypercholesterolemia for the past 15 years but recently discontinued her medication because she could not afford it. The patient also reports a brief episode of paresthesia in her left arm three days prior. Upon examination, the woman has normal language and memory skills. She has no left-sided neglect and her vision is normal. She also has normal superficial reflexes including corneal reflex and plantar reflex. She has sensory loss over her left hemibody and left side ataxia as well in fingerto- nose and heel-to-shin testing.
Based on her presentation, the patient appears to have suffered from an ischemic stroke.
According to the American Heart Association, ischemic stroke accounts for 87% of all strokes
(Mozaffarian et al., 2015). Ischemic strokes are caused by a blood clot (thrombus or embolus) in an artery leading to the brain, blocking blood flow to certain regions. She exhibits the following symptoms of stroke according to the NIH Stroke Scale: left-side sensory loss, pronator drift, ataxia, and hemiparesis. She does not, however, exhibit aphasia or facial palsy,
groups of her lower extremities bilaterally. Sensory exam is normal to pin prick and light touch
She does have a history of hypertension, so I am going to send her to Michael Danielski, MD to evaluate her for the possibility of fibromuscular dysplasia of the renal arteries. If he decides to do an angiogram of the renal arteries, than I would like to also add an angiogram of the carotid arteries to get a good view of the amount of stenosis. Alternately, I could get carotid ultrasound and follow any progression of stenosis that way. The course of further neurological workup will depend on what Dr. Danielski wants to do in evaluating her renal
A review of her medical record indicates that she has a history of functional decline, dementia, weakness, MRSA, cognitive communication deficit, presence of right artificial hip joint and HTN.
A review of her medical records indicates that she has not had any significant health events, such as falls or hospitalization since her last visit. She suffers from chronic stable hypothyroid, chronic DM which is mange with medication and chronic neuropathy.
It is “a sudden loss of function resulting from disruption of the blood supply to a part of a brain” (Hincle & Cheever, 2014). The type of stroke Patient S experienced was assumed to be from hyperlipidemia. An atherosclerotic plaque can form in the large blood vessels in the brain. When the plaque become big enough, it can rupture or a small bit may break off and flow into small arteries, which may block the smaller artery. If the artery is occluded, blood cannot flow to certain parts of the brain and an ischemic stroke can occur. Hypertension is a major risk for strokes as well as atrial fibrillation. These diseases increase the risk of an emboli or plaque
She was referred to, see a neurology doctor. Client reported she is currently seeing Dr. Lempert/Neurology.
Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.
Her vital signs are normal. Weight is 114 pounds. The visual acuity is 20/20 both eyes. The eye exam shows that the left eye is normal including her fundus. The right eye shows that her conjunctivae
Strokes are caused by pathophysiological changes. The two major mechanisms of stroke consist of ischemia and haemorrhage. Ischemia is when there is no oxygen or not, merely enough oxygen to fuel the tissue level in the body. Haemorrhage in the brain, causing strokes can be due to non-traumatic intracerebral haemorrhage (Shah, MD, n.d.) (see appendix 1). This essay will further discuss the implications of strokes on a cellular, organ and system level. Explain the clinical presentation of the signs and symptoms of strokes and how the condition will be managed by a paramedic.
Stroke previously known as Cerebrovascular accident is well-defined as ‘an abrupt cessation of cerebral circulation in one or more of the blood vessels distributing the brain. Due to the interruption or diminish of oxygen supply causes serious damage or necrosis in the brain tissues (Jauch, Kissella & Stettler, 2005). There is a presence of one or more symptoms such as weakness or numbness or paralysis of the face, arm or leg, difficulty speaking or swallowing, dizziness, loss of balance, loss of vision, sudden blurring or decreased vision in one or both eyes and headache. Stoke is categorised into two types, Ischaemic and haemorrhagic
parietal, and posterior temporal lobes. Proximal atherosclerotic stenosis of the vertebral or basilar artery is a course
Clinical Scenario: Adult female accountant complaints of right-sided lateral upper extremity numbness and tingling, pain, weakness, and dropping things held in right hand.
Her current prescription medications include a 225 mg tablet of Venlafaxine HCL once daily for anxiety related dizziness, and a 20 mg tablet of Atorvastatin for high cholesterol. She drinks alcohol socially, approximately two 12 ounce beers a day. She is a former smoker of one pack of cigarettes a day for nearly forty years. Her quite date was September, 2011. She denies the use of street drugs.
A stroke caused by a blocked artery by a blood clot or bursting of a blood vessel because of uncontrolled high blood pressure. There are main three types of the stroke. An ischemic stroke occurs when a blood clot blocks one of the arteries which supply blood to brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions. (mayo clinic). About 89%, strokes are ischemic strokes. Ischemic stroke includes thrombotic stroke. A thrombotic stroke occurs when a thrombus stuck in one of the arteries that supply blood to the brain. A clot build-up of fatty deposits in arteries. Another type of stroke is called the hemorrhagic stroke. This stroke occurs when a blood vessel leaks or ruptures in the brain. A bold vessel leaks or ruptures from many conditions like uncontrolled high blood pressure or overtreatment with anticoagulants and the weak spot in blood vessel walls. (mayo). Some people experience a mini-stroke it is known as a transient ischemic attack (TIA). A temporary decrease or clot stuck in a vessel in our brain causes TIA. It happens less than five minutes. This stroke does not have any symptom, because the blockage is
Cerebral vascular accident or a stroke is the destruction of brain substance, resulting from thrombosis, intracranial hemorrhage, or embolism, which causes vascular insufficiency. In addition, it is an area of the brain denied blood and oxygen that is required and damage is done to a part of the cells. The effect of the patient depends upon where the damage occurs and the severity of the stroke.