Diagnosis and Treatment for a Stroke

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A stroke is the acute neurologic injury that come as a result of an effect of ischemia or haemorrhage of the encephalon. Ischemia is caused by diminished supply of arterial blood which carries sugar and oxygen to brain tissue. Haemorrhagic stroke is due to intracerebral or subarachnoid bleeding and it damages the brain directly at the site of the bleeding by compressing the encircling tissue. Ischemic strokes can be embolic or thrombotic. Thrombotic stroke consequences from clot formation in the arterial blood vessel that provides blood to the encephalon, and can bear upon either large vessel or small vessel.
Small vessel disease affects the intracerebral arterial system. A stroke due to impedimenta of these vessels is referred to as a lacunar infarction. Lacunar infarctions are small (0 2 to 15 millimeter in diameter) noncortical infarctions caused by occlusion of a single penetrating branch of a large cerebral arterial blood vessel. Lacunar stroke has 5 classic syndromes and motor stroke is the most syndrome. The typical presentation is hemiparesis of face, arm or leg of one side. Clinical symptoms of stroke are slurred speech, right hand numbness, weak right mitt grip, and right sided facial palsy.(health direct, 2014)and most common among ischemic strokes (Rathore, Hinn, Cooper, Tyroler, & Rosamond, 2002).

Mechanisms of ischemic cell injury and death
There is progressive vasoconstriction of arterioles until the BP exceeds the upper limit of auto regulation, followed by breakthrough vasodilation, increase in cerebral blood flow, blood-brain barrier dysfunction, and cerebral oedema(Rodriguez-Yanez et al., 2006). Cerebral ischemia results in severely ischemic tissue with failure of electrical activity and ionic pumps (Rodriguez-Yanez et al., 2006) There is increase in the release of the excitatory amino acid glutamate due to electrical failure. (Rodriguez-Yanez et al., 2006) . Glutamate receptors are activated as a result and cause the opening of ion channels that allow potassium ions to leave the cell and sodium and calcium ions to enter. This has a number of physiological effects.
The above events end in cell death, including depletion of ATP, changes in ionic concentrations of sodium, potassium, and calcium, increased lactate, acidosis, accumulation of oxygen free radicals, intracellular accumulation of water, and activation of proteolytic processes.(Deb, Sharma, & Hassan, 2010). Surrounding this is the penumbra(Rodriguez-Yanez et al., 2006)

Different cellular signaling pathways respond to calcium levels. The inflow of calcium resulting from glutamate receptor stimulation leads to their activation.

In this essay, the author

  • Explains that nitric oxide is a significant signaling molecule in the body and is essential at normal physiologic levels.
  • Explains that ct scan is diagnostic tool for lacunar infarction as it shows clinical syndrome consistent with the location of a small noncortical stroke. clinical signs and symptoms are significant in diagnosing stroke
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