A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of

the brain is suddenly interrupted by occlusion (called an ischemic stroke --

approximately 90% of strokes), by hemorrhage (called a hemorrhagic stroke -- about
10% of strokes) or other causes. Ischemia is a reduction of blood flow most commonly
due to occlusion (an obstruction). On the other hand, hemorrhagic stroke (or intracranial
hemorrhage), occurs when a blood vessel in the brain bursts, spilling blood into the
spaces surrounding the brain cells or when a cerebral aneurysm ruptures. The mortality
and long-term morbidity prognosis is generally worse for hemorrhagic strokes than for
ischemic strokes. A small proportion of strokes are watershed strokes caused by
hypoperfusion (usually due to hypotension) or other vascular problems including
vasculitis.

Pathophysiology
Neurons and glia die when they no longer receive oxygen and nutrients from the blood
or when they are damaged by sudden bleeding into or around the brain. These damaged
cells can linger in a compromised state for several hours. With timely treatment, these
cells can be saved. Intriguingly, when the brain cells suffer the ischemia, they begin to fill
up with free zinc ions which are released from some of their proteins, especially
metallothionein, which can release 7 zinc ions per molecule. This released zinc is a major
player in the ensuing death of the brain cells. Drugs that buffer the zinc and reduce the
level of free zinc are already being tested to reduce brain cell death after stroke.

Cellulitis generally follows a break in the skin, such as a fissure, cut, laceration, insect
bite, or puncture wound. Patients with tinea pedis and those with lymphatic obstruction
are chiefly vulnerable to recurrent episodes of cellulitis. Organisms on the skin and its
appendages gain entry to the dermis and multiply to cause cellulitis. The vast majority of
cases are caused by Streptococcus pyogenes or Staphylococcus aureus. Infrequently,
cellulitis may be caused by the emergence of subjacent osteomyelitis. Cellulitis may
hardly ever result from the metastatic seeding of an organism from a distant focus of
infection, especially in immunocompromised individuals. This is chiefly common in
cellulitis due to Streptococcus pneumoniae and marine vibrios.

More about the cellulitis

Cellulitis is an acute, dispersal infection of the dermis or subcutaneous layer of the skin.
It might follow damage to the skin, such as a bite or wound. As the cellulitis spreads,
fever, erythema, and lymphangitis may take place. Persons with comorbid conditions,
such as diabetes, immunodeficiency, or impaired circulation, are at augmented risk. If
treated promptly, the prognosis is generally good. As the offending organism assault the
compromised area, it overwhelms the defensive cells like that of neutrophils, eosinophils,
basophils, and mast cells that normally contain and localize inflammation and cellular
debris accumulates. As cellulitis progresses, the organism occupy tissue around the initial
wound.

Conclusion
The elderly and those with destabilized immune systems are especially vulnerable to
contracting cellulitis. Diabetics are more prone to cellulitis than the general population
because of impairment of the immune system; they are especially prone to cellulitis in the
feet because their disease causes impairment of blood circulation in their legs leading to
their having foot ulcers that commonly become infected. Immune-repressive drugs, HIV,
and other illnesses or infections that weaken the immune system are also factors that
make infection more likely. In addition, chickenpox and shingles frequently result in
blisters that break, providing a gap in the skin that bacteria can enter through.
Lymphedema, which causes swelling on the arms and/or legs, can also put an individual
next to risk. Diseases that affect blood circulation in the legs and feet, such as chronic
venous deficiency and varicose veins, are also risk factors for cellulitis.

Cellulitis is the infection of the skin and soft tissues typified by swelling, redness,
warmth, and pain in the affected areas. The severity of the infection depends on its
opportunity to spread and affect other parts of the skin or body. Its infectious nature alone
involves complex processes that can become deadly. In fact, cellulitis can affect virtually
any part of the body, which is why there are several types of cellulitis, including facial,
breast, leg, perianal, periorbital, and orbital cellulitis. This article will discuss cellulitis
pathophysiology.

Risk Factors Linked To The Onset Of Cellulitis

Cellulitis is often triggered by broken skin, such as with lacerations, cuts, puncture
wounds, fissures, and animal/insect bites. Cellulitis can also be more prevalent among
individuals who have lymphatic obstruction, toe web intertrigo, tinea pedis, pressure
ulcers, venous insufficiency, obesity, impaired immune systems, and diabetes.

What Happens Under The Microscope

When the infectious bacterium invades a vulnerable area (such as an open wound), it
overcomes the defensive cells in our body, which includes mast cells, eosinophils,
basophils, and neutrophils. These defecnsive cells often act to hold inflammation in just
one area. When infection further progresses cellular debris builds up, and infectious
bacteria soon engulfs tissue surrounding and located at the affected area.

Cellulitis pathophysiology: Complications

If the affected area is left untreated, complication is a high possibility. When the skin
turns red or a rash occurs, this may indicate a deeper and more severe infection. In this
case, infection has most likely reached the inner layers of the skin. When the infectious
bacteria are able to reach below the skin, they can spread faster. In this case, bacteria are
able to get into the lymph nodes, reach the bloodstream and extend all throughout the
body.
The infection can spread so easily that if left untreated, bacteria can spread to the deep
layer of tissue, or fascial lining. This is called a deep-layer infection. This type of
infection is characterized by the flesh-eating strep or necrotizing fasciitis. The prevalence
of this condition is quite rare, but individuals who do not treat severe cellulitis definitely
have a higher risk of developing necrotizing fasciitis.

Streptoccoccus pyogenes is responsible for the flesh-eating strep and actually belongs to
the group A streptococcus type of bacteria that causes cellulitis. The flesh-eating bacteria
spreads in the deeper skin layer, as that area of the body is softer. Bacteria initially break
through the protective skin layer. These organisms contain enzymes that digest protein
and therefore enable them to eat their way through the fascia. Soon the bacteria is able to
reach muscles and tendons. The fascia becomes liquefied with the enzymes and provide
bacteria with the perfect condition to thrive and proliferate at a faster rate. Extremely
serious cases like this requires emergency treatment, which may involve surgical
procedures, IV antibiotics, oral antibiotics, supportive therapy, or a combination of these.

Cellilitis pathophysiology may vary among the different types of celliulitis. For instance,
the signs and symptoms surrounding orbital cellulitis (infection of the eye) can be a
manifestation of other health conditions such as sinus problems. The most typical paths
of infection in this case come from the sinuses or teeth and/or injury in those areas.
Proper diagnosis will often determine any underlying cause of cellulitis or the severity of
the infection.