Mrs. B. is an overweight, 61-year-old, white female. Upon hospital admission, she had a severe right-sided headache, slurred speech, and some severe right-handed numbness with a weak hand grip on the left. Her smile was asymmetric with right-sided facial weakness that had persisted for 48 hours. Mrs. B. has a history of smoking moderately for 40 years and use of estrogen replacement for 20 years. Her mother had adult-onset diabetes and died of breast cancer at age 62; her father died of a gunshot accident at 29; one sister died of a subarachnoid hemorrhage at age 63, and another sister is hemiparietic because of a CVA. One brother is hypertensive, and three other younger siblings are apparently healthy.
Vital signs showed a normal temperature, elevated heart rate, and normal respirations, but Mrs. B. had a blood pressure of 220/158. A lumbar puncture was negative for blood with normal protein and glucose levels. A normal electrocardiogram was found. EEG showed localized activity in the right hemisphere. A CT showed increased density on the left. Blood chemistry was normal except for elevated glucose.
Develop/locate a critical path for CVA for Mrs. B.
Discuss the pathophysiological changes that occur with CVA specifically noting signs and symptoms for Mrs. B.
What factors from Mrs. B’s history could be contributing factors for CVA?
