Types of extremity paralysis in strokes and the weakness exhibited by the patient
Neuro Case Study
You are consulted to visit a 72 year old male client who had a stroke last year which left both his upper and lower right sided extremities weakened. He is obese and has a history of smoking for 57 years. His history also includes being diagnosed with type 2 diabetic, high blood pressure, coronary artery disease, polycythemia, and atrial fibrillation. His father died of an MI at age 53. Both of his parents had type 2 diabetes. His mother dies of cancer. His paternal grandfather had 2 strokes, 0neyear apart, dying two weeks after the second stroke.
1. What types of extremity paralysis ( weaknesses) can occur in strokes and how do they differ? What type of weakness does this patient exhibit?
2. The lesion that caused the motor function problem in this patient is located on which side of the brain? Why does it occur in this manner?
3. Given the history of this patient, what type of stroke did this patient have,
ischemic, or hemorrhagic? Please provide your rationale.
4. What is the relationship between atrial fibrillation, and the stroke
5. What other risk factors are identified for this patient and what is the relationship of these to a stroke?
6. Your patient’s wife tells you “My husband’s grandfather had a stroke and could not talk, but he could talk> My husband can not walk, but can talk. I do not understand Why?” The APN would address this issue in what manner? What information is shared?
7. The patient’s wife adds, the doctor said to call him if he suffered a TIA. I thought TIA’s go away. Why is this important and how will I know it is happening? The APN addresses this situation in what manner. What information will be shared?
8. How do adult strokes differ from pediatric strokes?
Types of extremity paralysis in strokes and the weakness exhibited by the patient:
Hemiplegia: This is a complete paralysis of one side of the body, affecting both the upper and lower extremities. The patient in this case study exhibits hemiplegia since both his upper and lower right-sided extremities are weakened.
Location of the lesion causing motor function problems and its occurrence:
The lesion causing motor function problems in this patient is located on the left side of the brain. This is because the brain is contralateral, meaning that the left side of the brain controls the right side of the body. When a stroke occurs on the left side of the brain, it affects the motor function on the right side.
Type of stroke and rationale:
Given the history of this patient, it is likely that he had an ischemic stroke. Ischemic strokes occur when there is a blockage or clot in a blood vessel supplying blood to the brain. The presence of risk factors such as high blood pressure, diabetes, smoking, and a family history of strokes and heart disease increases the likelihood of an ischemic stroke.
Relationship between atrial fibrillation and stroke:
Atrial fibrillation (AFib) is a condition where the heart's upper chambers (atria) beat irregularly, allowing blood to pool and potentially form clots. If a clot forms in the atria and travels to the brain, it can cause an ischemic stroke. AFib increases the risk of stroke by nearly five times compared to individuals without AFib.
Other risk factors for stroke and their relationship:
Obesity: Excess weight can contribute to other risk factors such as high blood pressure, diabetes, and heart disease, all of which increase the risk of stroke.
Smoking: Smoking damages blood vessels, increases blood pressure, promotes clot formation, and reduces oxygen delivery to tissues, all of which contribute to an increased risk of stroke.
Addressing the patient's wife's question:
The APN would explain that strokes can affect different areas of the brain, causing varying symptoms. In this case, the patient's grandfather may have had a stroke that specifically affected his ability to speak (aphasia), while this patient's stroke impacted his ability to walk (hemiplegia). Different brain regions control different functions.
Explaining the importance of TIA and how to identify it:
The APN would inform the patient's wife that a transient ischemic attack (TIA) is often a warning sign of an impending stroke. TIAs are temporary disruptions of blood flow to the brain, causing stroke-like symptoms that resolve within 24 hours. It is crucial to seek medical attention if a TIA occurs because it signifies an increased risk of a full-blown stroke. The APN would educate her on recognizing symptoms like sudden weakness, difficulty speaking, vision changes, and dizziness.
Differences between adult strokes and pediatric strokes:
Adult strokes are more commonly caused by atherosclerosis (plaque buildup in arteries), whereas pediatric strokes are often associated with congenital heart defects, sickle cell disease, or infections.
Pediatric strokes can lead to developmental delays or learning disabilities due to their impact on a developing brain.
Risk factors for adult strokes include hypertension, diabetes, smoking, and high cholesterol, while pediatric strokes are often associated with underlying medical conditions or genetic factors.
Treatment approaches and long-term management may differ between adult and pediatric populations due to variations in underlying causes and age-specific considerations.