On one particular day, two patients were brought in to a local emergency room, e

Question

On one particular day, two patients were brought in to a local emergency room, each with different signs and different prognoses, but each with the same underlying disease, stroke.

The first patient, a 70-year-old male, arrived by ambulance and was accompanied by his elderly wife. The patient was awake and alert, but was unable to move independently due to paralysis on his right side. He looked responsive and seemed to understand what was said to him, but he could not speak. His condition was first discovered by his wife when she woke him that morning. She called 911 when she realized that her husband could not get out of bed, he was unable to move his right arm and leg, and he could not talk to her.

The second patient arrived a few hours later, also by ambulance. Unlike the first patient, this woman was unconscious. She was breathing on her own and she showed no signs of paralysis. Her daughter had discovered her sitting in her chair, slumped over the table. She had been unable to arouse her and called 911.

CAT-scans were done on both patients and confirmed the tentative diagnosis of stroke. They were immediately treated with clot-dissolving drugs, in hopes of stopping more progressive damage. In Patient #1’s case, the CAT-scan revealed a blockage in the left middle cerebral artery which supplies the posterior portion of the frontal lobe called the pre-central gyrus. In the case of Patient #2, the blockage was seen in the basilar artery which supplies the brainstem.

1. What is a stroke? What causes it?

2. What is the desired effect of the clot-dissolving drugs? Are they always effective?

3. What is the function of the two different areas of the brain affected in these two different cases of stroke? How does that account for the differences seen in Patient #1 and #2?

4. What would account for Patient #1 seeming to understand what he heard, but not be able to speak? If the stroke had affected the first patient’s right cerebral artery instead, would the outcome have been different?

5. Why are strokes which affect the brainstem frequently fatal?

Explanation / Answer

1. Stroke is a medical emergency condition characterized by decreased blood flow to the parts of the brain depending on the site, resulting in cell death.

It can be either due to clotting or hemorrhage called as ischaemic or hemorrhagic stroke respectively.

2. Clot-dissolving drugs/anticoagulants are the drugs which commonly used to prevent the blood from forming dangerous clots that could result in a stroke.Also called blood thinners.

They are effective in cases of ischaemic stroke but their role in hemorrhagic stroke is not there.

Medications used in the treatment of hemorrhagic stroke include the following:

3. As seen in patient 1 the blockage is in the left middle cerebral artery.The left middle cerebral artery provides blood to a large part of the left side of the brain. Damage in this artery most often can cause changes in:

• Movement and sensation

• Attention, memory, and judgment

• Perception

• Speech • Vision Rarely, this type of stroke can cause hearing problems.

The stroke in this artery will show up on the right side of the body. The loss of movement or weakness occurs on the right side of the body. Often the muscles of the mouth, the tongue, and throat may be affected, making it hard to speak or swallow. as observed in the patient 1.

Anticonvulsants - To prevent seizure recurrence

Antihypertensive agents - To reduce BP and other risk factors for heart disease

Osmotic diuretics - To decrease intracranial pressure in the subarachnoid space

3 (b) In patient 2 the affected artery is basilar artery supplying brain stem.The brainstem also plays an important role in the regulation of cardiac(heart rate), respiratory function(breathing ) and central nervous system(eating etc), and is important in maintaining consciousness and regulating the sleep cycle. So, blockage in a basiliar artery can leads to unconsciousness as seen in patient 2.

4. In patient 1, as there is blockage seen in the left middle cerebellar artery and as it provides blood to a large part of the left side of the brain and any blockage in this will result into right neglect. Blockage of left side also leads to aphasia (a language impairment that makes it difficult to use language in those ways), so person's ability to use and comprehend language is hampered.

If there is a blockage in right cerebral artery, then the problems would have been same but will be observed on the left side of the body, as ischemia of right artery leads to LEFT NEGLECT.

5. As we know Brain stem controls basic body functions such as breathing, swallowing, heart rate, blood pressure, consciousness, and whether one is awake or sleepy. Blockage in vessels supplying brain stem results in can result in death, since the damaged brain stem can no longer control the body’s vital functions.

Related Questions

Navigate

• Browse (All)
• Browse O
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.