Men And Women : Risk Factors And Pathophysiology, Epidemiology, Presentation, Treatment, And Outcomes

There are two major branches of strokes: those caused by narrowing or blockage of the arteries leading towards the brain, and those caused by blood vessel leaking or rupturing in the brain. Ischemic strokes account for approximately 87% of Stroke cases, which reduces the blood flow to the brain. About half of the Ischemic strokes are caused by clotting in small or large arteries, a smaller portion are caused by

Hemorrhagic strokes may be intracerebral (within the brain) or subarachnoid which occur from an aneurysm or atypical blood vessels.

In elderly patients, the decision-making ability is deteriorated and this could lead to a delay to seek medical help (Ganzer, Insel, & Ritter, 2012). Several included studies in this review have demonstrated that women were significantly older than men when they got the stroke symptoms (Maeda, Toyoda, Minematsu, & Kobayashi, 2013; Park et al., 2013). Hence, advanced age is likely to be another cause of pre-hospital delay in females. Additionally, some studies in this review have determined that elderly females with acute stroke are more likely to live alone than males (Mandelzweig et al., 2006; Park et al., 2013; Smith et al., 2010; Yanagida et al., 2014). Furthermore, earlier research has reported that acute stroke patients who lived alone were 2.63 times more likely to have longer hospital arrival times than patients who lived with others (p < 0.001) (Eissa et al., 2013). Thus, another possible cause of the delay time in females could be living alone.

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.

Treatment of stroke, in general and ischemic stroke specifically, in particular, is aone of the most pressing issues in both nursing and medical science today. This is due to the fact that there are very few available treatment options for the various kinds of stroke. Acute ischemic stroke carriesis a prominent medical issue with a high risk of death or morbidity (Kakma, Stofko, Binning, Liebman & Veznedaroglu, 2014). Stroke, including ischemic and other types, is recognized, further, as a one of the most prominent leading causes of disabilities (Saver et al., 2015). While cerebral infarction resulting from thrombotic occlusion of brain arteries is the most common stroke type, ischemic stroke is also quite common. Each year ischemic stroke affects over a half-million victims in the United States alone;. o Of this group, about 150,000 deaths occur, along with 300,000 victims suffering from any number of disabilities following a stroke (CITE)after the fact.

Each year according to National Institute of Neurological Disorders and Stroke more than 700,000 Americans suffer a stroke and about 160,000 die from stroke-related causes. In early 2011 at the American Stroke Association it was reported that the incidence of stroke has rose 51% among men and 17% among women aged fifteen though thirty-four years between 1994-1995 and 2006-2007.

An ischemic stroke is caused by a blood vessel that has been blocked (for example, by a clot), whereas a hemorrhagic stroke is caused by a vessel bursting and bleeding into the brain (Kolb & Whishaw, 2012, p. 45). Although both types of strokes result in the same ending - the brain not getting the fluids that it needs- they are caused by extremely different events. In addition, ischemic strokes are more common and typically less fatal. An estimated eighty to ninety percent of stroke suffering patients seen in hospitals have endured an ischemic stroke. For this reason, the primary treatment for all strokes is to give the individual a blood thinner. However, if an individual is suffering from a hemorrhagic stroke, this type of treatment will only make the situation worse, and likely lead to

Tidy’s studies, this type of stroke is caused when an artery in the brain ruptures or leaks blood causing there to be pressure thus damaging the brain cells and causing tissue death.(See Figure 2) Tidy explains that ruptures are caused by conditions such as, hypertension, trauma, blood-thinning medication, or aneurysms (weakness in blood vessels walls). Hemorrhagic strokes are classified as either an intracerebral or a subarachnoid hemorrhagic strokes. An Intracerebral hemorrhagic stroke is the most common. Tidy explains that these are usually caused by leaking blood vessels in the brain. Intracerebral strokes are usually caused by high blood pressure and aging blood vessels. An intracerebral hemorrhagic stroke can also be caused by an

Hemorrhagic Strokes happen in about 15% of patients, but are responsible for almost 40% of deaths caused by stroke. A hemorrahagic stroke includes bleeding within the brain and the bleeding normally happens between the inner and the outer layers of the tissue that covers the brain. Brain aneurisms or weak blood vessel leaks are examples of hemorrhagic stroke causes.

First I feel that, it is important to understand the clinical manifestation of the different strokes. The Ischemic stroke can cause a wide range of neurologic symptoms depending on the location and the size of the effective area. Patients may present with symptoms, such as, numbness or weakness of the face, arms, legs, more so, one side of the body, changes in moody or behavior, trouble with speaking or understanding speech, visual disturbances, having difficulty in walking, dizziness or loss of balance and sudden server headaches. Hemorrhagic stroke has, also, presents with the same clinical manifestation as a Ischemic stroke, however, most patients complain of server headache.

Because of the complex anatomy and physiology of the brain and its vasculature, the clinical manifestations of stroke are highly variable. Evidence suggests that gender influences the various clinical presentations of ischemic stroke and how they respond to treatment. 7 Women tend to have a higher overall lifetime risk of stroke as well as higher rates of post stroke disability, depression, and mortality in comparison to men.7 Approximately, 6.8 million individuals in the United States have had a stroke, most of which are women (3.8 million).3

The prolonged excitatory activation of ionotropic N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) receptors as well as metabotropic glutamate receptor lead to neuronal cell death (Caccamo et al., 2004, Park et al., 2004). It is commonly accepted that ionotropic glutamate receptors are responsible for the harmful effect of excitotoxicity. The continued binding of excess glutamate to NMDA receptor induces the uncontrolled influx of calcium ions (Ca2+). This massive overload of intracellular Ca2+ leads to activation of calpain and mitochondrial oxidative phosphorylation which ultimately causes apoptosis (Caccamo et al., 2004, Choi, 1992, Lawson and Lowrie, 1998). The AMPA receptor is involved in regulating the influx of sodium ions (Na+). The continued activation of AMPA receptors, due to the unwarranted glutamate level, induces influx of Na+ which consequently leads to osmotic imbalance and swelling of the neurons (Caccamo et al., 2004). The excess swelling of neurons can leads to necrosis (Park et al., 2004). Consider as a therapeutic target, extracellular glutamate concentrations increase to neurotoxic levels within the first three hours after the injury (Liu et al., 1999, Liu and Bilkey, 1999, McAdoo et al., 1999), leaving a small time window for immediate treatment to prevent

A cerebral vascular incident can happen to anyone at anytime. Some people know it be called a stroke, CVA, or brain attack. The majority of patients who have had a stoke will have another one within one year. Stoke tend to occur more often in the southern United States also known as the “stroke belt”. This may be related to the larger number of elderly, tobacco use, and obesity. A cerebral vascular accident ranks high in the major leading causes of death in the United States, and it happens nearly every four minutes. There are three different types of stroke ischemic, hemorrhagic, and transient ischemic attacks. The larger number of cerebral vascular accidents is known to be ischemic. The artery that supplies the brain with blood

A cerebrovascular accident, which is commonly known as a stroke, is the leading cause of disability and the fifth leading cause of death in the United States ("About Stroke," n.d.). Two fundamental causes of stroke are atrial fibrillation, where the heart flutters rather than contracting in the manner of a normal heartbeat, and carotid artery disease (Sobieszczyk & Beckman, 2006). Carotid artery disease is the narrowing of the carotid arteries, which are located on either side of the neck and deliver blood to the brain (Sobieszczyk & Beckman, 2006). Blockages consisting of low-density lipoprotein (LDL) cholesterol often cause this narrowing (Sobieszczyk & Beckman,

Stroke: A more mechanical term for stroke is Cerebrovascular Accident (CVA). The term stroke itself is not clearly defined and is not a precise medical term. In simple terms, stroke ‘suffocates’ brain tissue and often produces an area of dead or dying brain tissue. A stroke always occurs in the brain and is the most common type of cerebrovascular disease. The most frequently encountered of the cerebrovascular diseases is the Cerebrovascular accident (CVA). It was earlier called apoplexy or an apoplectic attack and is now commonly referred to as stroke. Medically speaking a stroke is a “focal neurological disorder of abrupt development due to a pathological process in blood vessels” (J. N. Walton, 1994).