Stroke is sudden death of brain cells result from deprivation of oxygen ,that caused from
blockage of blood flow or rapture of an essential artery of brain or by cerebral thrombosis that may caused the stroke ,that occurs in varying signs and symptoms from temporary paralysis and loss of speech to the brain damage and death .
Stroke also called brain attack or CVA (Cerebrovascular Accident),it is one of the most risky and critical neurological disorder and also it is the third most common cause of
death in development country(after heart disease and cancers) .it is cause of death in people that younger than 45 years ,that cases account 3000 annually ,stroke also is one of 10
causes of death children and that include 5-10% cases of stroke.
Stroke is clinical syndrome that’s clinical features develops rapidly through minutes because
of a vascular causes
Stroke is a disease that affects the arteries within the brain.
It is the 5th cause of death and a leading cause of disability in the United States.
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs,and brain cells die.
Stroke is a disease that affects the arteries within the brain.
It is the 5th cause of death and a leading cause of disability in the United States.
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs,and brain cells die.
Stroke I Incidence, Types, Causes, Risk Factors & Management - Dr Rohit BhaskarDr Rohit Bhaskar, Physio
Bhaskar Health News and Medical Education is leading source for trustworthy health, medical, science and technology news and information. Providing world health information Medical Education.
Bhaskar Health News and Medical Education is dedicated to medical students, physiotherapists, doctors, nurses, paramedics, physician associates, dentists, pharmacists, midwives and other healthcare professionals.
We're committed to being your source for expert health guidance. Bhaskar Health and Medical Education.
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Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
International Organization of Scientific Research (IOSR)iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Stroke I Incidence, Types, Causes, Risk Factors & Management - Dr Rohit BhaskarDr Rohit Bhaskar, Physio
Bhaskar Health News and Medical Education is leading source for trustworthy health, medical, science and technology news and information. Providing world health information Medical Education.
Bhaskar Health News and Medical Education is dedicated to medical students, physiotherapists, doctors, nurses, paramedics, physician associates, dentists, pharmacists, midwives and other healthcare professionals.
We're committed to being your source for expert health guidance. Bhaskar Health and Medical Education.
Source : https://www.bhaskarhealth.com
Health Shop: https://www.bhaskarhealth.org
@drrohitbhaskar @bhaskarhealth
#DrRohitBhaskar #BhaskarHealth
#Health #Medical #News #Physiotherapy
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
International Organization of Scientific Research (IOSR)iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
An Overview on Sudden Cardiac Death by Bibin Rijo W | Aswin A V | Divika S | ...ijtsrd
As the most prevalent cause of death in developing nations is heart disease, over 7 lakh people in India and over 4 5 million worldwide pass away from sudden cardiac death SCD each year. It is the most prevailing kind of unexpected mortality brought on by cardiac anomalies like congenital heart disorders, hereditary channelopathies, heart failure and ischemic heart diseases. Nevertheless, non cardiac causes such aortic syndromes, stroke and pulmonary embolism can also result in sudden cardiac death and must to be taken into account as alternative diseases. Additionally, younger individuals experience sudden cardiac death, which is pertaining to obesity, stress, lifestyle changes, alcoholism and fibrosis non ischemic causes of sudden cardiac death . This study exemplifies the causes of sudden cardiac death SCD , most notably for those with cardiovascular diseases. Bibin Rijo W | Aswin A V | Divika S | Dr. K C Arul Prakasam | Dr. N Senthil Kumar "An Overview on Sudden Cardiac Death" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63453.pdf Paper Url: https://www.ijtsrd.com/pharmacy/other/63453/an-overview-on-sudden-cardiac-death/bibin-rijo-w
A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues.
Without oxygen, brain cells and tissue become damaged and begin to die within minutes. Check out exactly how stroke effects the body.
Strokes fall into three main categories: transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke.
The MRI will help see if any brain tissue or brain cells have been damaged. A CT scan will provide a detailed and clear picture of your brain that shows any bleeding or damage in the brain. It may also show other brain conditions that could be causing your symptoms.
Stroke : Introduction, types and treatment.Obed Adams
Stroke is defined as the rapid loss of brain function due to disturbance in blood flow and supply to the brain.
OR
An acute episode of focal dysfunction of the brain, retina, or spinal cord.
It is clinically defined as the rapid onset of cerebral deficit lasting more than 24hours and is caused by acute vascular injury to parts of the brain. Presented by Obed Adams.
It is one of three type of hearing loss
Hearing loss due to defect in the sensory apparatus cochlea (sensory)
Or in the pathway of conduction of nerve impulses to the brain (neural)
Neural causes can be
peripheral:8 nerve
Central:auditory pathway or cortex
A hernia happens when an organ or maybe fatty tissue squeezes through a weak
spot in a surrounding muscle or connective tissue called fascia.
Hernias were
once the leading cause of acute intestinal obstruction.
Public alertness of early
repair has markedly reduced the frequency of incarceration of intestine in these
musculofascial defects.
The common sites for these defects, in order of frequency,
are inguinal, umbilical, incisional and femoral. Techniques of repair continue to
evolve but tension-free, mesh repairs are the current standard.
You may have a hernia if you can feel a soft lump in your belly or groin or in a
scar where you had surgery in the past. The lump may go away when you press on
it or lie down. It may be painful, especially when you cough, bend over, or lift
something heavy.
Möbius syndrome: is rare congenital neurological disorder
There are four group: Simple hypoplasia, Primary lesions in CNs, Focal necrosis in brainstem nuclei and Primary myopathy.
Signs and symptoms: Limb abnormalities, Chest-wall abnormalities, Crossed eyes and Difficulty in breathing and/or in swallowing.
It results from a vascular disruption, The use of drugs and a traumatic pregnancy associated with development of Möbius syndrome.
There is no single course of medical treatment for Möbius syndrome.
Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders
Schizophrenia , psychosis, bipolar disorder are different type of psychiatric disorder
Features of schizophrenia are delusions and hallucinations
Bipolar affective disorder is one of the most common psychiatric illness
elevated mood and pressured speech are clinical features of bipolar disorder
Hearing loss is one of the most frequent sensory deficient in human population. It affects more than 360 million people.
Consequences of hearing impairment include reduced ability to communicate, economic and educational disadvantage, social isolation and stigmatization.
we will talk also about the common types & causes of hearing loss and the possible applicable methods to treat these conditions.
Define rheumatic fever.
what are the main causes of rheumatic fever.
List the clinical finding of rheumatic fever.
To list and identify the most commonly used laboratory tests to detect the rheumatic fever.
How to treat rheumatic fever .
To list some of the procedures that are used for the prevention of the rheumatic fever .
Can be defined as a dense loss of memory for recent events but with preserved intelligence and personality ,memory can be either totally or partially lost according to the extent of damage that was caused .
Can be defined as a dense loss of memory for recent events but with preserved intelligence and personality ,memory can be either totally or partially lost according to the extent of damage that was caused .
Define rheumatic fever.
what are the main causes of rheumatic fever.
List the clinical finding of rheumatic fever.
To list and identify the most commonly used laboratory tests to detect the rheumatic fever.
How to treat rheumatic fever .
To list some of the procedures that are used for the prevention of the rheumatic fever .
Hepatitis is generally refer to inflammation of liver, it is resulted from infectious causes (such as viral, bacterial and fungal causes ) or noninfectious ( such as alcohol drugs, autoimmune diseases and metabolic diseases) , in this research , I’m going to focus on viral hepatitis because it is the most common cause of acute hepatitis in USA ( 50% of cases ).
The commonness and important viruses that cause viral hepatitis are (A,B,C,D,E) types, approximately 4.4 million Americans are currently living with chronic hepatitis B and C.
The liver continuously filters blood which circulates throughout the body, converting nutrients and drugs absorbed from the digestive tract into ready for using chemicals. The
liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the
blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream.
We all Know that the most dangerous medical condition in our modern life is cancer!
There are two types of this awful condition, BENIGN and MALIGNANT. The first is safe
and can be removed by many ways without large effects on the patients, but the last
one is very killing and can cause a lot of consequences on the patient, even death.
In my report, I will discuss one of the cancer's types that occur in the human body,
which is "Melanocytes tumors".
I mentioned everything about Melanocytes tumor, starting with signs and symptoms,
and finishing with diagnosis and treatment.
The Melanocytes are found in two areas of the human body, (Eye and skin). It can be
hidden for a lot of time without discovering by patients or doctors, so all people need
to be checked every month or years to be sure that they are safe from this killing
condition.
Also, this condition can be normal without problems and found in all people
approximately, such we called it "Nevus" or "Shama" in Arabic language which is one of
the beauty sings.
ARDS is a widespread acute inflammatory lung injury with various degrees of intensity that occurs in response to a pulmonary or systemic insult and invariably leads to abnormalities in gas exchange (predominantly hypoxemia) and in pulmonary mechanics. It is a prototypical disease of reduced lung compliance that causes acute respiratory failure in both children and adults.
In effect, ARDS impairs the lungs' ability to exchange oxygen and carbon dioxide with the blood across a thin layer of the lungs' microscopic air sacs known as alveoli. The syndrome is associated with a death rate between 20 and 50% .
Syphilis is a sexually transmitted disease (STD) caused by an infection with spirochete
bacteria known as Treponema pallidum.
Like other STDs, syphilis can be spread by any type of sexual contact. Syphilis can also be
spread from an infected mother to the fetus during pregnancy or to the baby at the time of
birth.
The signs and symptoms of syphilis vary depending in which of the four stages it presents
(primary, secondary, latent, and tertiary)
Rubella is a directly transmitted immunizing infection that usually occurs during childhood and is associated with low morbidity and mortality. Infection of women during early pregnancy can lead to spontaneous abortion, fetal death or children born with congenital rubella syndrome (CRS), which is associated with multiple disabilities that can require lifelong care , including hearing impairment, cataracts and congenital heart disease
Hashimoto's thyroiditis (HT) is one of the most common human autoimmune
diseases responsible for numerous morbidity in women. Hashimoto’s disease
is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or
autoimmune thyroiditis. Hashimoto’s disease is at least 8 times more common
in women than men. Although the disease may occur in teens or young women,
it more often appears between ages 40 and 60. Your possibility of developing
Hashimoto’s thyroiditis increases if other family members have the disease.
It is an organ-specific T-cell mediated disease that affects the thyroid gland,
and genetics play a contributory role in its complexity. To date, significant
progress has been made in identifying and characterizing those genes involved
in the disease.
The hearing impairment is one of the most frequent sensory deficient in human population.
Consequences of hearing impairment include inability to interpret speech sounds, often producing a reduced ability to communicate, delay in language acquisition, economic and educational disadvantage, social isolation and stigmatization. The function of the ear and the hearing process play an important role in the verbal communication between individuals and make a noticeable impact on individual’s life. So, we decide here to talk about hearing function of the ear from many different points of view. These points of view will include mainly the anatomical, physiological and pathological basis of ear and hearing process. After that, we will talk about the common types and causes of hearing loss and the possible applicable methods to treat these conditions.
Hypopituitarism is defined as a diminished function of the pituitary gland. First described in 1914 by Simmonds, it is
also known as Simmonds’ disease. There are two main reasons for the hypofunction of the pituitary gland: it can
result from pituitary dysfunction per se or from hypothalamic damage. In both cases, the production of pituitary
hormones is diminished. When a single pituitary hormone is affected, this is called isolated pituitary deficiency.
When two or more pituitary hormones are affected, this is referred to as multiple pituitary hormone deficiency.
Panhypopituitarism is a state of reduction of all pituitary hormones.
The multiple aspects of normal pituitary function serve to predict the wide range of clinical manifestations of hypopituitarism which are determined by the severity, extent and duration of the condition.
The discovery of antibiotics existed one of the significant events in medical history and said to have added a decade to the life expectancy of human beings. Antibiotics also known as antibacterial medications that inhibits or slows down
the growth of bacteria. Bacteria are microscopic organisms that cause many types of infection in the human beings.
We have special white blood cells that attack the harmful bacteria and this is the main function of our immune system. In some cases the body can’t defend itself
and needs the help of antibiotics with the immune system to attack the harmful bacteria.
Children and infants represents a large part of population in the developing
nations and those groups are usually prone to recurrent attacks of gastrointestinal and respiratory infections of viral origin and usually misuse of antibiotics in these groups have been reported
Oxygen is an essential and fundamental term for life. Cells use oxygen to
produce energy for normal cell activities, Free radicals are normal
consequence of ATP production in the mitochondria. These by-products
are in general reactive oxygen species (ROS) and reactive nitrogen
species (RNS). These two species are referred collectively as ROS/RNS.
The phrases "free radicals" and "reactive oxygen species" (ROS) are
frequently used interchangeably although this is not always correct. The
physiological state of increased steady-state ROS level along with certain
physiological effects has been called oxidative stress. These species play
a dual role. As benefit compounds at low or moderate levels. And as toxic
compounds at high concentrations by generation of oxidative stress .The
delicate balance between their two antagonistic effects is clearly an
important aspect of life [1-5]. Free radicals are, by definition, species
which contain an odd number of electrons. They may be positively
charged, negatively charged, or neutral and all three types are important
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. 2
Introduction:
Stroke is sudden death of brain cells result from deprivation of oxygen ,that caused from
blockage of blood flow or rapture of an essential artery of brain[1]or by cerebral thrombosis
that may caused the stroke ,that occurs in varying signs and symptoms from temporary
paralysis and loss of speech to the brain damage and death[2] .
Stroke also called brain attack or CVA (Cerebrovascular Accident)[3],it is one of the most
risky and critical neurological disorder[4] and also it is the third most common cause of
death in development country(after heart disease and cancers)[5].it is cause of death in
people that younger than 45 years ,that cases account 3000 annually ,stroke also is one of 10
causes of death children and that include 5-10% cases of stroke[6].
Stroke is clinical syndrome that’s clinical features develops rapidly through minutes because
of a vascular cause [7].
There are very many causes of stoke more than 150 known causes and also there is unknown
causes [8].The most Common risk factor of stroke divided into 2 groups:
Modifiable fixed
High blood pressure Age
Heart disease(arterial fibrillation, heart attack,
endocarditic)
Gender (more in female)
Diabetic mellitus Race
Hyperlipedaemia hereditary
polycythaemia Previous vascular event (myocardial
infarction, stroke )
Smoking, excess of alcohol High fibrinogen
Social deprivation ,obesity
fig (1), table (1) that shows risk factor of stroke[1].
3. 3
Classification of stroke
Stroke sub typing can help us in describing patients in clinical trial ,divided patients into
groups in an epidemiological study ,phenotyping of patient in a genetic study and classify
patient is benefited in treatment [10].American stroke association published recently an
updated of classification of stroke ,it classes into 2 types ischemic and hemorrhagic [11].
Ischemic stroke:
It is sudden loss of blood flow to an area of brain, it lead to loss of neurological functions ,
it is more common than other types (hemorrhagic stroke)[12].
The main subtypes of ischemic stroke are: Embolic, large artery thromboiotic, Lacunars
stroke, cytogenic stroke and other are less common e.g. arteritis[13].
1-Embolic stroke:
More sever and serious than other sub types of ischemic stroke [14], it involves 20-25% of
ischemic stroke [15].it occur by blockage of one of the arteries to the brain, this is result
from blood clot that has formed elsewhere may be in ascending aorta that is source of
atheromateus emboli [16],frequently emboli from left atrium or the left side heart
valve[15].the major risk factor of embolic stroke is arterial fibrillation , hypertension,
hypercholestremia ,diabetes mellitus , smoking , coronary artery disease[17].
2-thrombotic stroke:
it occurs blood clot that form in one of arteries that supply the brain .the blood clot occurs
by fatty deposit that build up in arteries and lead to atherosclerosis[18],this type of stroke
lead to brain cells in that area to stop function and die very quickly[19], and is most common
cause of ischemic stroke [20].
The risk factors are involve high blood pressure, hyperlipidaemia , smoking, diabetes
,sedentary life style[19].
4. 4
Fig (2) that shows thromboiotic stroke[2]
3-Lacunar stroke:
It is a stroke occurs in deep area of brain e.g.(in thalamus, basal ganglia, pones),occurs by
occlusion in small and deep blood vessels in this area[19].it differ from other types of stroke
that occur in white matter of brain so not affected mental ability but it causes damage the
main conduction fibers that controlling speech,…[5].it very difficult to know and border the
site of lesion [21].
The major risk factors are hypertension and diabetes[19].
4-cytogenic stroke:
Is a cerebral ischemia of unknown origin and the causes also remain until now unknown
[22].it is 40% of ischemia stroke and patient can be seen more than50% of cases of stroke
so it is critical and important [23].
5. 5
A B C
Fig(3) shows different types of ischemia stroke A[cytogenic stroke(3)], B[embolic stroke (2)]
C [LACUNAR stroke (4)].
Hemorrhagic stroke:
It is a Stroke caused by rapture of blood vessel in or on the surface of the brain with bleeding
into surrounding tissue, that caused from aneurysm or an abnormal formed blood
vessels[24].
It is 15% of all stroke.[25],but it responsible for about 40% of all stroke death[26].
Hemorrhagic stroke subtypes are intracerebral hemorrhagic and aneurismal subarachnoid
hemorrhagic [25].
1-Intracerebral hemorrhagic stroke:
Is Also called or known as cerebral bleed is type of intracranial bleed that occurs within the
brain tissue or ventricle [2 7],the causes of ICH include brain trauma ,aneurysm
arteriovenous malformation ,brain tumor[28].
Risk factors of ICH include spontaneous bleeding are high blood pressure, amyloidosis
,alcoholism., low cholesterol and cocaine.ICH occurs more in male and older people[29].
6. 6
2-Subarachnoid hemorrhagic stroke:
Is bleeding into subarachnoid space in the area between the arachnoids membrane and the
pia matter surrounding the brain .it Occurs as result from head injury or aneurysm, risk
factors of SAH are hypertension, smoking and family history.[30],one third of patient will
alive with good recovery, one third will live with a disability and the one third of patient will
be die[31].
Fig (4) subarachnoid stroke [5] Fig (5) intracerebral Stroke [5]
7. 7
History of stroke
Hippocrates who is first recognized stroke over 2,400 years ago. in this time stroke was called
apoplexy, which means "struck down by violence" in Greek. This was because of the fact
that a person developed sudden paralysis and change in well-being[32].
Late on, in the 1600s, the doctor Jacob Wepfer discovered that something disrupted the
blood supply in the brains of people who died from apoplexy. In some of these cases, there
was great bleeding into the brain. In others, the arteries were blocked [33].
in the 1700s, Bonet publishes Sepulchretum sive Anatomical Practica, which becomes a
prominent principle for physicians during the 18th century[34].
In1800s,The earliest known stroke treatments begin to occur, when surgeons start
doing surgery on the carotid arteries. Surgeons begin operating to reduce from cholesterol
build up and remove blockages that could then cause a stroke[35].Reports of successful
closures of injuries to the carotid arteries are documented [36].
In1900sEarly in the 20th century, most of the treatments for stroke patients are limited to
rehabilitation after an acute stroke, and most patients are usually still with permanent and
severe deficits[36].
In the 1950s new techniques and therapies are developed to recognized and modify the
internal processes of cerebrovascular disease[37]. In the 1960s carotid endarterectomy is
used but is used mostly for stroke prevention and there is still no effective treatment after
an acute stroke. In the 1970s aspirin is found to be very effective in stroke prevention. In the
1980s cigarette smoking is found to be a definite risk factor for stroke, and smoking
cessation programs become very important. In the 1990s tissue plasminogen activator starts
to be used for treatment of embolic or thrombotic stroke [36].
Later on in 2000s rapid diagnosis is crucial for direct treatment. Stroke remains the second
most common cause of death worldwide, about 6.7 million patients die in 2012[38].[From
1990 to 2010, the age-standardised incidence of stroke significantly decreased by 12%
in high-income countries, and increased by 12% in low-income and middle-
income countries. In the same time , mortality rates presented a significant decrease in all
countries[39].
8. 8
sEpidemiology of stroke
Stroke was the second most cause of death in 2011, accounting for 6.2 million deaths (~11%
of the total)[38], Approximately 17 million people had a stroke in 2010 and 33 million people
have previously had a stroke and were still survive [39].
Between 1990 and 2010 the number of strokes decreased by approximately 10% in the
developed world and increased by 10% in the developing world,Overall, two-thirds of
strokes happened in those over 65 years old.[14] South Asians are at particularly high risk
of stroke, it is 40% of global stroke deaths[38]. In the United States stroke is a leading cause
of disability, and recently declined from the third leading to the fourth leading cause of
death[40].Geographic disparities in stroke incidence have been observed, including the
existence of a "stroke belt" in the south eastern United States, but causes of these disparities
have not been explained[39].
The risk of stroke increases from 30 years of age, and the cause of stroke varies by age[41].
one of the most significant stroke risk factors is advanced age or elder people, 95% of strokes
happen in people age 45 and older, and two-thirds of strokes happen in these over the age of
65[22].
stroke can happen at any age, including in childhood,Family members may have a genetic
tendency for stroke or share a lifestyle lead to stroke. Higher levels of Von Will brand
factor are more common with people who have had ischemic stroke for the first
time.[39] The results of this found that the only significant genetic factor was the
person's blood type. Having had a stroke in the past greatly increases one's risk of future
strokes , Men are 25% more likely to suffer from strokes than women [25]. Yet 60% of
deaths from stroke happen in women[42].
Fig (6); subtypes of stroke and its incidence[6]
9. 9
clinical features of patient with stroke
The clinical presentation of stroke depends on which arterial territory is included and the
size of the lesion, both of which will have a sharing on management, such as appropriate for
carotid endarterectomy. The neurological deficit can be recognized and identified from the
patient’s history and, if the deficit is persistent, from the neurological examination[9].clinical
feature different from person to other depend on the the cause of stroke and type of
strok[43],most common signs and symptoms are:
1-Hemiparesis, monoparesis, or (rarely) quadriparesis.
2-Hemisensory deficits.
3-Monocular or binocular visual loss.
4-Visual field deficits.
5-Diplopia.
6-Dysarthria.
7-Facial droop.
8-Ataxia.
9-Vertigo (rarely in isolation).
10-Aphasia.
11-Sudden decrease in the level of consciousness.[44][43].
clinical features of The ischemic strokes subtypes:
1-embolic stroke : sudden onest of signs and symptoms with deficit maximal at onset[43].
2_thrombosis stroke:clinical features of it involve essentially of headache, focal neurologic
deficit ,epileptic, seizures and impairment of consciousness, in different combination and
degree of severity ,the onest of headache usually gradual but in up to 15 of patients it is
sudden[45].
3-Lacunar stroke: clinical features of it are five which well recognized: pure motor hemi
paresis, pure sensory stroke, sensorimotor stroke, dysarthria—clumsy hand syndrome[46].
10. 10
Clinical features of hemorrhagic stroke:
In subarachnoid hemorrhagic stroke,clinical feature is sudden onest of sever diffuse
headache that peaks within minutes and usually lasts 1_2 weeks,in generalpractice the
headache is only symptoms of one third of patient of subarachnoid hemorrhagic stroke .[45]
Other sign associated vomiting,headache and vomiting occur in hemorrhagic stroke more
than ischemic stroke because of increased in intracranial pressure[43].
Causes of stroke
Stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a
blood vessel (hemorrhagic stroke) ,or (Transient ischemic attack )also known as a mini_
stroke occurs when a clot or debris blocks blood flow to part of brain. is a brief period of
symptoms , which often last less than five minutes because the blockage is temporary[18].
Type of stroke causes
Intracerebral hemorrhage stroke Complex small vessels disease with distribution
of vessel wall,amyloid angiopathy,impaired
blood clotting ,vascular anomaly ,substance
misuse .
Subarachnoid hemorrhage stroke Vertebral dissection,saccular anyrusym
Ischemic stroke Cardic source[arrhythmias,valve
disorder,dilated cardiomyopathy,recent
myocardial infraction paradoxical
emboli],small vessels occlusive disease
[hypertension,isolated central nervous system
a niglitis,systemic lupus erythematosus],large
vessel disorder[atheroscelrosis,or dissection in
carotid or vertebrobasilar
system],hematological disorder[polycithemia,
thrombocytosis, sever leukocytosis,protein c
deficiency , …]
Fig(7) in this table shows the diseases and disorder that causes the stroke[1]
11. 11
Pathogenesis of stroke
Ischemic stroke:
is often occurred due to a lack of blood flow to all or part of the brain ,resulting in
deprivation of neurons of vital glucose and oxygen, this deprivation if it sever and prolonged
,result in interruption of normal cellular processes and eventual cell death with breakdown
of the neuronal cell membrane[47],also it resulting in Atherosclerosis that could disrupt the
blood supply by narrowing the lumen of blood vessels that caused reduction of blood flow,
by causing the formation of blood clots within the vessel, or by releasing showers of
small emboli through the disintegration of atherosclerotic plaques[48].
since the blood vessels of brain blocked , the brain becomes decreased in energy, and thus it
resorts into using anaerobic metabolism within the region of brain tissue affected by
ischemia Anaerobic metabolism produces low adenosine triphosphate (ATP) but releases a
by-product called lactic acid[47]. Lactic acid is an irritant which could potentially destroy
cells since it is an acid and disrupts the normal acid-base balance in the brain. The ischemia
area is known as the "ischemic penumbra”[49].
A major cause of neuronal injury is the release of the excitatory neurotransmitter glutamate.
The concentration of glutamate outside the cells of the nervous system is normally kept in
low concentration by so-called uptake carriers, which are powered by the concentration
gradients of ions (mainly Na+) across the cell membrane[9]. However, stroke cuts off the
supply of oxygen and glucose which supported the ion pumps maintaining these
gradients[46]. As a result, the transmembrane ion gradients run down, and glutamate
transporters reverse their direction, releasing glutamate into the extracellular space[49].
Glutamate acts on receptors in nerve cells (especially NMDA receptors), producing an influx
of calcium which activates enzymes that digest the cells' proteins, lipids, and nuclear
material. Calcium influx can also lead to the failure of mitochondria, which can lead further
toward energy depletion and may trigger cell death due to programmed cell death[50]..
Ischemia also induces production of oxygen free radicals and other reactive oxygen species.
These react with and damage a number of cellular and extracellular elements[9]. In fact,
many antioxidant neuroprotectants such as uric acid and NXY-059 act at the level of the
endothelium and not in the brain per se. Free radicals also directly initiate elements of the
programmed cell death cascade by means of redox signaling[51].
Hemorrhagic stroke:
Hemorrhagic strokes are classified depended on their underlying pathology and etiology
into intracerebral and subarachnoid hemorrhagic stroke [52],this stroke caused by
12. 12
hypertension,anticoagulant,bleeding disorder, cerebral amyloid angiopathy ,ruptured
arterial aneurysm ,arteriovenous malformation[53].
Intracerebral hemorrhagic stroke:
Is an fatal type that caused 30,000 death cases annually in united states [54]. The bleeding
occurs into brain parenchyma happened in this type of stroke, the mechanisms of
intracerebral hemorrhagic stroke included leakage from the small intracerebral arteries
damaged that caused by chronic hypertension, other mechanism involved bleeding
diatheses, iatrogenic anticoagulation and cerebral amyloidosis[55]. The common locations of
cerebral arteries aneurysms are close to the anterior communication and anterior cerebral
arteries, close to junctions close to middle cerebral artery and at the junction between basilar
and posterior cerebral artery[56],the most common sites of intracerebral hemorrhagic
stroke are thalamus,putamen ,cerebellum and brainstem[55] .
Intracerebral hemorrhagic stroke involves 3 phases: 1) initial hemorrhage.2) hematoma
expansion. 3)peri-hematoma edema[57].
Initial hemorrhage is result from rupture of cerebral artries that caused by chronic
hypertension and other risk factor of ICH,hematoma expansion happened through hours
after initial symptom onset, includes an increasing in intracranial pressure that affect on the
integrity of the local tissue and blood brain barrier and also affected on obstructed venous
outflow that induces the release of tissue thromboplastin[58].hematoma expansion is
associated with hyperglycemia, hypertension and anticoagulation [59].the initial size of
hemorrhagic and the rate of hematoma expansion are important in prognosis, the hematoma
that its size>30 ml is lead to increased mortality[60].cerebral edema forms around the
hematoma ,secondary to inflammation and damaged of blood brain barrier, and it develops
over days[59].
Subarachnoid hemorrhagic stroke: Is life threatening type of stroke result from
bleeding occurs in the two inner most protective covering layers of brain ( subarachnoid
space between the pia and arachnoid) due to aneurysms or arterial venous malformation,
aneurysms are specific to intracranial arteries because it doesn’t have an external elastic
lamina and involved very thin adventitia [61].after hemorrhage the subarachnoid space is
filled by erythrocytes in cerebrospinal fluid ,these erythrocytes follow many pathways, some
will shared with a clot that forms in bleeding site ,and other will be enclosed in arachnoids
villi and cleared from cerebrospinal fluid into blood vessels within a day and the majority
cleared within a week, and other erythrocytes removed by phagocytosis[62].
13. 13
Treatment of stroke
Ischemic stroke
the only emergency approved treatment for ischemic strokes is tissue plasminogen activator
also known as IV rtPA,given through IV in the arm, tPA act by dissolving the clot and allow
blood flow into the part of brain that deprived from blood flow and it give also chances to
recovering from stroke[63]. The drugs that also used to treat the patient who have a stroke
are involve: platelet aggregation inhibitors ( e.g. clopidogrel),thrombolytic (e.g. alteplase
systemic),calcium channel blocking (e.g. nimodipine ),ACEI,betabloker ( e.g. labetalol),
vasodilator ,vitamin k antagonist, aspirin that reduces the overall risk of recurrence by 13%
[64] .
another treatment option is an endovascular procedure that known as thrombectomy ,by
this procedure the large blood clot can removed by using a catheter through an artery that
is blocked in brain[63].
Hemorrhagic stroke :
the treatment of patient with acute intracerebral hemorrhage depend on the cause and
severity of bleeding ,the medication that used in treatment of acute stroke
involve;anticonvulsant (for prevention of the seizure recurrence),antihypertensive agents
(for reduction blood pressure) and osmotic diurites for decreasing the intracranial pressure
in subarachnoid space[65].
Surgical treatments are present in treatment of hemorrhagic stroke to stop bleeding ,by
metal clip may be placed surgically at the base of the aneurysm to secure it [63].
In subarachnoid hemorrhage, early treatment for underlying cerebral aneurysms may
reduce the risk of further hemorrhages. Depending on the site of the aneurysm this may be
by surgery that involves opening the skull or endovascular (through the blood vessels)[66].
14. 14
Diagnosis of stroke:
Mainly by CT scan and MRI and other testing depend on type of stroke[65].See fig(8).
.fig(8)Table that show investigation of stroke[1].
Prevention of stroke
primary prevention include using aspirin for cardiovascular prophylaxis was taking
from2002 ,Statins reduce the risk of ischemic stroke in patients at high risk of atherosclerosis
and are well tolerated[65].
Secondary prevention refers to the treatment of individuals who have already had a stroke
or transient ischemic by using clopidogrel and aspirin, The comparative benefits of
clopidogrel and aspirin plus ER-DP in secondary stroke prevention are under evaluation in
the ongoing Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study,
which has enrolled >20 000 patients with a recent history of ischemic stroke randomized to
either the combination of ER-DP plus aspirin or clopidogrel monotherapy. With results
expected in 2008[67].
Tertiary prevention :goes beyond secondary prevention measures to address the care of
persons who have already suffered a first stroke. Tertiary measures are aimed at the
prevention of a second or third stroke and the minimalization of disability through patient
Diagnostics question Investigation
Is it a vascular lesion? CT scan/MRI
Is it ischemic or hemorrhagic ? CT scan/MRI
Is it subarachnoid hemorrhagic? CTscan/ lumber puncture.
Is there any cardiac source of embolism ? Electrocardiogram
Echocardiogram
What are the risk factors? Full blood count.
Cholesterol.
Blood glucose.
Is there unusual cause? ERS.
SERUM protein electrophoresis
Clotting / thrombophillia screen
15. 15
rehabilitation, in order torestablish partial or complete independence and improve quality
of life[ 22].
Fig( 9)Strategies for secondary prevention of stroke.[1]
16. 16
Summary:
Stroke is sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow
or rapture of an artery to the brain or cerebral thrombosis may cause the stroke which can
occur in varying degree of severity from temporary paralysis and slurred speech to
permanent brain damage and death. Stroke is the third most common cause of death (after
heart attack and cancers) in developing countries. Stroke is clinical Syndrome characterized
by rapidly developing (usually over minutes)symptoms or signs of focal neurological
dysfunction due to a vascular cause. Very recently the American stroke association published
an updated for classification of stroke it classes into 2 types ischemic and hemorrhagic.
Ischemic stroke It is characterised by sudden loss of blood circulation to an area of brain
resulting in a corresponding loss of neurologic function ,it is more common than
hemorrhagic stroke. The main subtypes of ischemic stroke are: Embolic ,large artery
thromboiotic ,small vessel (lacunar ) stroke , cytogenic stroke.
Hemorrhagic stroke Stroke caused by rapture of blood vessel in or on the surface of the brain
with bleeding into surrounding tissue ,occur from aneurysm or an abnormal formed blood
vessels. Hemorrhagic stroke subtypes are intracerebral hemorrhagic and aneurysmal
subarachnoid hemorrhagic.
Hippocrates, the father of medicine, first recognized stroke over 2,400 years ago. At this time
stroke was called apoplexy, which means "struck down by violence" in Greek. This was due
to the fact that a person developed sudden paralysis and change in well-being.
Stroke Having had in the past greatly increases one's risk of future strokes ,Men are 25%
more likely to suffer strokes than women . yet 60% of deaths from stroke occur in women.
The clinical presentation of stroke depends upon which arterial territory is involved and the
size of the lesion, both of which will have a bearing on management.
Ischemic stroke: is often due to a lack of blood flow to all or part of the brain ,resulting in
deprivation of neurons of vital glucose and oxygen, this deprivation if sever and prolonged
,result in interruption of normal cellular processes and eventual cell death with breakdown
of the neuronal cell membrane.
Hemorrhagic stroke :this stroke caused by hypertension,anticoagulant,bleeding disorder,
cerebral amyloid angiopathy ,ruptured arterial aneurysm ,arteriovenous malformation.
The management of stroke depended on the type of it ,mainly diagnosis by CT Scan and
MRI,treatment by medication or surgically depended on the type of stroke .
The prevention involve primary ,secondary and tertiary , generally it summarized by
reduction of occurring the risk factor of stroke.
17. 17
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