PATHOPHYSIOLOGY OF LEFT CEREBRAL INFARCTION

Legend: Etiology Disease process

Signs and symptoms

Modifiable risk factor: Diabetes mellitus HPN

Non-modifiable risk factors: Genetics: Family Hx of HPN Age: 70 Race : Asian

Laboratory Studies

peripheral insulin resistance

Insulin does not bind into cell membrane Glucose cannot enter the cell glucose in the bloodstream

-cells in the pancreas increases insulin secretion to maintain balance between glucose and insulin in the bloodstream

-cells become exhausted and decreases insulin secretion

Balance between insulin and glucose is disrupted glucose in the bloodstream

FBS:
7.45 mmol/L

Body utilizes stored fats as food for the cells

Stored fats are converted into glucose

Waste products (lipids) in the conversion process are secreted in the bloodstream

serum lipid in the bloodstream Lipid accumulate in the blood vessel wall Diameter of the blood vessel wall narrows Heart pumps harder to meet bodys O2demand pressure exerted by the blood on the blood vessel wall blood flow through the blood vessel blood supply to the kidney blood supply to the myocardium SA node is damaged Prolonged low blood supply Electrical impulse is affected Cardiac rhythm is altered Atrial fibrillation X-ray Impression: Atheromatous aorta Plaque buildup in the blood vessel wall

Baroreceptors detects the decreased blood volume Renin is secreted Renin converts angiotensin to angiotensin I ACE in the lungs converts angiotensin I to angiotensin II permeability of glomeruli membranes RBC passes through the glomeruli membrane RBCescape into the urine blood pressure Urinalysis: RBC : 6-10/hpf glomerular filtration
+

Damage to glomeruli

kidney tubular reabsorption sodium reabsorption Na retains fluid

Irregular heart ryhtm develops

Atheroma is dislodged Embolus travels through the blood vessel

Angiotensin II causes vasoconstriction

urine output Fluid accumulates in the interstitial space Passes through the internal carotid artery Embolus reaches the Left middle cerebral artery

Edema +2

Embolus occludes the vessel Blood supply is disrupted O2 supply to brain cells is diminished Cells cannot proceed with aerobic respiration Mitochondria switches to anaerobic respiration Less ATP is produced Lactic acid is produced

CT Scan Impression: Left middle cerebral artery districution

Less ATP to power cellular activities Membrane pump fails

Sodium and calcium ions will rush into the cell

Glutamate will exit the cell

Cerebral cells begin to die Damage to brain stem Damage to Left Frontal Lobe Brocas area is affected Level of Consciousness is altered Gag reflex is diminished

Gastric acid aspiration

Aspiration pneumonia Motor control is diminished Control of speech is diminished Sensory perception diminished Coma

Productive Cough Right sided paralysis Aphasia Decreased sensation