Ethnic Variables That May Impact Physiological Functioning Essay

Pathophysiology

Case overview:

78 year old man with a history of hypertension and smoking develops sudden onset of difficulty speaking with drooling from the left side of his mouth and weakness in his left hand while having dinner with his wife. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. Upon arrival in the ED blood pressure was elevated at 178/94; pulse of 78. On examination he had a mild facial droop; left arm cannot resist gravity and left leg with mild drift. All other examination findings were normal.

Neurological and pathophysiological processes:

From the clinical presentation and history the most probable diagnosis is Hemorrhagic stroke. It occurs secondary to rapture of blood vessels leading into the brain. Most common risk factors associated with the disease include: hypertension, cigarette smoking, alcohol consumption, chronic liver disease old age, male gender, dyslipidemia and others. Explosive entry of blood into the brain parenchyma results in cessation of function in that area as the neurons and glia are structurally disrupted (Montaño et al., 2021). There is also mitochondrion dysfunction, neurotransmitter release, oligaemia and cellular swelling. The release of thrombin activates microglia lading to edema and inflammation. Ethnic Variables That May Impact Physiological Functioning Essay

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The primary injury is caused by brain tissue compression by the hematoma and increased ICP, intra-cranial pressure. Whereas the secondary injuries is brought about by edema, disruption of the blood-brain barrier, inflammation and over production of free radicals, release of hemoglobin and glutamate induced excytotoxicity. In most cases the hematoma enlarges within 2-3 hours (Kumar et al., 2022). If large enough it can cause a shift of the intracranial contents leading to trans-tentorial coning and even death. The clinical manifestation of hemorrhagic stroke is usually acute and progressive. The symptoms are dependent on the extent and location of the hemorrhage.

Racial variables affecting the disease:

Research studies have shown that African Americans are at a high risk of suffering from hemorrhagic stroke as compared to White Americans (Leasure et al., 2019). This racial disparity has been contributed to increased prevalence or severity of stroke risk factors among the African Americans and a lower social-economic status. Ethnic Variables That May Impact Physiological Functioning Essay

How these processes interact to affect the patient:

Clinical studies have showed that African American have risk factors such as hypertension, diabetes, smoking, drugs and substance abuse, obesity, excessive alcohol consumption and poor dietary habits. Treated and Untreated hypertensions are a risk factor for stroke with untreated one conveying a higher risk. Also the socio-economic status may affect access to healthcare services, early detection and compliance to anti-hypertensive drugs which eventually increases the risk of hemorrhagic stroke. In addition having a private insurance is associated with a notable reduction in the risk of hemorrhagic stroke (Leasure et al., 2019). Patients with insurance are more likely to have a physician and therefore more likely to have a stroke diagnosed. Reduced levels of education also influence the health seeking behaviors. Better knowledge of hemorrhagic stroke may reduce the burden of the disease specifically among those who are at risk. Research studies suggest other less well defined factors such as genetics may influence disease development thus causing the disparity between African American and the White Americans. Ethnic Variables That May Impact Physiological Functioning Essay

References

Kumar, A., Das, J. M., & Mehta, P. (2022, May 15). Hemorrhagic Stroke. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559173/

‌ Leasure, A. C., King, Z. A., Torres-Lopez, V., Murthy, S. B., Kamel, H., Shoamanesh, A., Al-Shahi Salman, R., Rosand, J., Ziai, W. C., Hanley, D. F., Woo, D., Matouk, C. C., Sansing, L. H., Falcone, G. J., & Sheth, K. N. (2019). Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence. Neurology, 94(3), e314–e322. https://doi.org/10.1212/wnl.0000000000008737

Montaño, A., Hanley, D. F., & Hemphill, J. C. (2021). Hemorrhagic stroke. Interventional Neuroradiology, 229–248. https://doi.org/10.1016/b978-0-444-64034-5.00019-5

In your Case Study Analysis related to the scenario provided, explain the following:

Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient. Ethnic Variables That May Impact Physiological Functioning Essay

74-year-old male with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, patient‘s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left arm cannot resist gravity, left leg with mild drift. Sensation intact. Neglect- Mild neglect to left side of body. Language- Expressive and receptive language intact Ethnic Variables That May Impact Physiological Functioning Essay