A Case of Cerebrovascular Accident

Case Presentation



Samuel Dexter is a 52-year-old African-American man who is both a
husband and father. He is moderately obese (BMI of 32), and has smoked
two packs of cigarettes a day for the past 38 years. He awakes one
morning with weakness on his right side. He is a bit confused, sees
double, and his speech is slurred. When he attempts to walk to the
bathroom, he stumbles a few times and falls once. His wife suspects that
he has suffered a stroke and calls 911. Emergency personnel arrive
within minutes of her call and transport Samuel to the emergency room of
the nearest hospital.

Upon examination by the emergency room physician, Samuel is found to
have right hemiparesis and diminished pinprick and two-point
discrimination on the right side of his head and arm. His deep tendon
reflexes are brisk on the right and there is a positive Babinski reflex
on the right. He has difficulty articulating answers to the questions he
is asked, speaking only a few words and frequently responding with just
a verb or a noun. His ability to respond to complicated verbal
commands, whether spoken or written, is not impaired. In addition, his
systemic blood pressure was found to be 160/100. A serum lipid profile
was performed and the results are shown in the table below.

Table 1. Serum Lipid Profile Results
Triglycerides	220 mg/dl
Total Cholesterol	280 mg/dl
LDL	210 mg/dl
HDL	30 mg/dl

Questions

1. Define the terms ischemia and infarction.
   
2. What is a stroke? Describe the mechanism(s) by which
   strokes occur.
   
3. Define the term collateral blood flow,
   and describe how this and other factors affect the development of
   stroke.
   
4. List the risk factors that predispose an individual to
   suffer a stroke. What are the five warning signs that indicate an
   individual is having a stroke? Which of the risk factors and warning
   signs did Mr. Dexter possess based on the clinical history?
   
5. What are Brodman areas and how
   do they relate to the neurological deficits that occur as the result of
   stroke?
   
6. What is the functional relationship between Broca’s area and Wernicke’s area?
   
7. Define the terms ipsilateral
   and contralateral as they apply to the
   functionality of the central nervous system.
   
8. Explain the significance of the findings of brisk deep
   tendon reflexes and Babinski sign on the affected side of Samuel’s body.
   
9. Based upon the historical and physical exam findings,
   what specific area(s) of Samuel’s brain have been damaged as the result
   of his stroke?
   
10. Describe the means by which individuals who survive a
    stroke regain at least part of their lost abilities.
    

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