Kate is a 35-year-old African-American woman who is both a wife and mother. She is moderately obese (BMI of 32.5) and has smoked three packs of cigarettes a day for the past 15 years. She wakes up one morning with severe headache, and weakness on her right side. She is a bit confused, sees double, and speech is slurred. Unable to recognize her own husband, she then stumbles and falls. Her husband suspects that she has suffered a stroke and calls 911. EMS personnel arrives within minutes and transports her to San Mateo Medical Center. Upon exam, she is found to remain confused, eyes responding to speech, unable to obey commands but moves to localized pain. Kate is found to have right hemiparesis and diminished pinprick and two-point discrimination on the right side of her head and arm. Her deep tendon reflexes are brisk on the right and there is dorsiflexion of the great toe (on the right side) when stimulated. Husband confirms initial onset of symptoms 20 minutes ago. In addition, her systemic BP was 170/110 mmHg. A serum lipid profile was performed and the results are below: Triglycerides: 240 mg/dL Total Cholesterol: 300 mg/dL LDL: 230 mg/dL HDL: 20 mg/dL QUESTIONS: 1. Define stroke and describe the mechanism(s) by which stroke occurs: 2. List the risk factors that predispose an individual to suffer a stroke: 3. What are the five warning signs that indicate an individual is having a stroke? 4. What is the functional relationship between Broca’s area and Wernicke’s area? 5. Explain the significance of the findings of brisk deep tendon reflexes and Babinski sign on the affected side of Kate’s body. 6. Based upon the historical and physical exam findings, what specific area(s) of Kate’s brain have been damaged as the result of this stroke? 7. List 5 interventions applicable to Kate (consider her deficits when enumerating these interventions, and is she qualified for tPA).

 
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