PATHOPHYSIOLOGY

RISK FACTORS: Age: 55 yrs. old Genetics: has family history of stroke and hypertension

PRECIPITATING FACTORS: Diet: High Fat/Cholesterol diet Hypertension Sedentary Lifestyle

Lipid deposits and turbulent blood flow in intima of arterial cerebral wall Inflammatory response Ingestion of Lipids Atheroma Formation Hypertension Narrowing of arterial lumen Plaque ruptures Thrombosis Occlusion of cerebral artery Lysed or moved thrombus from the vessel Vascular wall becomes weakened or fragile Leaking of blood from the fragile vessel wall Cerebral hemorrhage Legend: Bold applicable to patient - - - - signs and symptoms - flow of disease process 11 Impaired distribution of oxygen and glucose Fever

Mass of blood forms and proliferates Vasospasm of tissue and arteries Cerebral hypoperfusion Impaired distribution of oxygen and glucose

Tissue hypoxia and cellular starvation Cerebral ischemia Initiation of ischemic cascade

Anaerobic metabolism by mitochondria

Production of oxygenfree radicals and other reactive oxygen species Failure of production of ATP Failure of energy dependent process (ion pumping) Release of excitatory neurotransmitter glutamate Anaerobic metabolism by mitochondria

Generates large amounts of lactic acid Metabolic Acidosis

Damage to the blood vessel endothelium

Activates enzymes that digest cell proteins, lipids and nuclear material

Failure of mitochondria Further energy depletion 12

BreakBrain sustains an irreversible acid Release of metalloprotease (zinc Impaired down of collagen, hyaluronicand distribution of damage and other elements of connective tissue calcium-dependent enzymes) oxygen and glucose

Release of metalloprotease (zinc and calcium-dependent enzymes) Break down of collagen, hyaluronic acid and other elements of connective tissue Structural integrity loss of brain tissue and blood vessels Breakdown of the protective Blood Brain Barrier Cerebral edema Vascular Congestion Compression of tissue Increased intracranial Pressure Impaired perfusion and function

Middle Cerebral Artery

Lateral hemisphere, frontal, parietal and temporal lobes, basal ganglia

If managed (long-term medical and nursing intervention): Partial or total recovery in any of the following: Understanding and forming speech Cognitive loss Mobility of extremities and facial muscles Mental status

With ineffective or without medical and nursing interventions Continued insufficiency of blood flow Further compression of tissues Coma

Sx: Numbness or weakness of the face, arm, leg, esp. on one side of the body Confusion or change in mental status Memory deficits Trouble speaking or understanding speech (dysphasia, dysarthia, apraxia) Sensory loss Visual disturbances Drooping of eyelids Difficulty walking, dizziness Sudden severe headache 13

Cerebral Death

Loss of neural feedback mechanisms Cessation of physiologic functions

Cardiovascular System

Pulmonary System

GIT

GUT

Other systems

Loss of cardiac muscle function Sx: bradycardia

Relaxation of venous valves Sx: hypotension

Relaxation of intestines and sphincters Loss of bowel control Loss of lung movement

Sx: restlessness, abnormal thermoregulation, mental confusion, increased secretions, decreased urinary output.

Decreased cardiac output

Failure of accessory muscles for breathing function

Neurogenic bladder

Loss of sphincter control

Sx: Apnea Cardiopulmonary arrest Systemic Failure Death

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