Cerebrovascular Accidents (CVAs)

• • Hemorrhagic Stroke: This occurs when a blood vessel in the brain ruptures, leading to bleeding into brain tissue or the subarachnoid space. This can be caused by:
    • Intracerebral hemorrhage: Bleeding directly into the brain tissue, often due to hypertension.
    • Subarachnoid hemorrhage: Bleeding into the space between the brain and the surrounding membranes, often due to a ruptured aneurysm.  
     
• Major Risk Factors:
  • Hypertension: Damages blood vessel walls, increasing the risk of both ischemic and hemorrhagic strokes.  
  • Atherosclerosis: Plaque buildup in arteries, increasing the risk of thrombosis and embolism.  
  • Atrial fibrillation: Increases the risk of embolism due to blood clot formation in the heart.  
  • Diabetes mellitus: Damages blood vessels and increases the risk of atherosclerosis.  
  • Smoking: Damages blood vessels and increases blood clotting.  
  • Hyperlipidemia: High cholesterol contributes to atherosclerosis.  
  • Obesity: Increases the risk of hypertension, diabetes, and other risk factors.  
  • Sedentary lifestyle: Contributes to obesity, hypertension, and other risk factors.
  • Family history of stroke.
  • Age: Stroke risk increases with age.  
  • Race: Black individuals have a higher stroke risk.  
• Prevention Strategies:
  • Primary Prevention (preventing the first stroke):
    • Lifestyle modifications: Healthy diet, regular exercise, smoking cessation, weight management, and limiting alcohol intake.  
    • Medical management: Controlling hypertension, diabetes, and hyperlipidemia with medications.
  • Secondary Prevention (preventing recurrent strokes):
    • Antiplatelet or anticoagulant medications (e.g., aspirin, warfarin, or newer anticoagulants) for patients with a history of ischemic stroke.  
    • Blood pressure and cholesterol-lowering medications.
    • Addressing underlying conditions like atrial fibrillation.  
    • Carotid endarterectomy or angioplasty for significant carotid artery stenosis.  
    • Lifestyle modifications, continued.

Deep Tendon Reflex Scoring

• 0 to 4+ Scale:
  • 0: Absent reflex.  
  • 1+: Hypoactive reflex.
  • 2+: Normal reflex.  
  • 3+: Hyperactive reflex without clonus.
  • 4+: Hyperactive reflex with clonus (rhythmic muscle contractions).
• Assessing Neurological Health:
  • This scale helps assess the integrity of the peripheral and central nervous systems.
  • It evaluates the reflex arc, which involves sensory neurons, motor neurons, and the spinal cord.
• Abnormal Findings:
  • Absent or hypoactive reflexes can indicate peripheral nerve damage, spinal cord injury, or neuromuscular disorders.
  • Hyperactive reflexes can indicate upper motor neuron lesions, such as those caused by stroke, spinal cord injury above the reflex arc, or multiple sclerosis.  
  • Clonus is a sign of upper motor neuron damage.  

Diabetic Peripheral Neuropathy (DPN)

• Pathophysiology:
  • Chronic hyperglycemia damages peripheral nerves through several mechanisms:
    • Advanced glycation end products (AGEs) accumulate, damaging nerve cells.  
    • Increased oxidative stress damages nerve cells.  
    • Reduced blood flow to nerves due to microvascular damage.
    • Impaired nerve cell function and structure.
     
• Clinical Signs and Symptoms:
  • Numbness, tingling, or burning pain in the feet and legs.
  • Loss of sensation, especially to touch, temperature, and vibration.  
  • Muscle weakness and atrophy.
  • Impaired balance and coordination.  
  • Foot ulcers and infections.
  • Allodynia (pain from non-painful stimuli).
• Prevention and Management:
  • Lifestyle Modifications:
    • Strict blood glucose control.
    • Regular exercise.
    • Healthy diet.
    • Smoking cessation.
    • Foot care: Daily inspection, proper footwear.
  • Medication Management:
    • Pain medications (e.g., gabapentin, pregabalin, duloxetine).
    • Medications to improve blood flow (e.g., alpha-lipoic acid).
    • Medications to control blood glucose.
  • Patient Education:
    • Importance of blood glucose control.
    • Foot care instructions.
    • Recognition of symptoms.
    • Strategies to prevent injuries.

Cushing's Syndrome

• Pathophysiology:
  • Cushing's syndrome results from prolonged exposure to high levels of cortisol.  
  • This can be caused by:
    • Exogenous corticosteroids (e.g., prednisone).
    • Pituitary adenoma (Cushing's disease).
    • Adrenal tumors.
    • Ectopic ACTH production (e.g., by lung tumors).  
  • Excess cortisol leads to various metabolic and physiological changes, including:
    • Increased gluconeogenesis.
    • Protein catabolism.
    • Fat redistribution.
    • Mineralocorticoid effects (e.g., hypertension, hypokalemia).  
    • Immune suppression.
• Impact on Overall Health:
  • Hypertension, diabetes, osteoporosis, muscle weakness, skin thinning, increased risk of infections, mood disorders, and cognitive impairment.
• Major Risk Factors:
  • Long-term use of corticosteroids.
  • Pituitary, adrenal, or ectopic tumors.
  • Genetic predisposition.
• Risk Mitigation:
  • Lifestyle Modifications:
    • Healthy diet to manage weight and blood glucose.
    • Regular exercise to maintain muscle strength and bone density.  
    • Stress management techniques.
  • Medication Management:
    • Careful monitoring of corticosteroid use.
    • Medications to control blood pressure, blood glucose, and other complications.
    • Medications to inhibit cortisol production (if applicable).
  • Patient Education:
    • Importance of adhering to medication regimens.
    • Recognition of symptoms.
    • Strategies to manage side effects.
    • Education on the signs and symptoms of adrenal insufficiency if the medication is stopped.

Cerebrovascular Accidents (CVAs/Strokes)

• Pathophysiological Mechanisms:
  • Ischemic Stroke: This is the most common type, caused by a blockage in a cerebral artery. This blockage can result from:
    • Thrombosis: A blood clot forming within the cerebral artery.
    • Embolism: A blood clot or other debris traveling from elsewhere in the body (often the heart) and lodging in a cerebral artery.  
    • Systemic hypoperfusion: A general decrease in blood flow to the brain, often due to cardiac failure or severe hypotension.