Mr. Quinn, age 64 years, developed a severe headache several hours ago that has not responded to acetaminophen. Now his speech is slurred, and his right arm and the right side of his face feel numb. He is very anxious and is transported to the hospital. Mr. Quinn has a history of smoking and arteriosclerosis, and there is family history of CVA and diabetes. Assessment at the hospital indicated weakness on the right side, including facial asymmetry and a blood pressure of 220/110 Hg mm. A CT scan showed damaged tissue on the left side of the brain, and an angiogram indicated narrowing of the carotid arteries and middle cerebral arteries, with occlusion of the left middle cerebral artery. Discuss the pathophysiology related to CVA due to thrombus vs. embolus. Describe the stages in the development of an atheroma. Explain the predisposing factors in this case and relate Mr. Quinn’s initial signs to the pathological changes. Discuss the treatments available after first aid for stroke patients and the patient’s prognosis.
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