N510 Advanced Pathophysiology Module 2 Assignment Essay

N510 Advanced Pathophysiology Module 2 Assignment Essay

N510 Advanced Pathophysiology Module 2 Assignment Essay

Pathophysiology

Types of Stroke

A stroke occurs following an alteration in the normal blood supply to the cerebrum. Strokes are generally categorized as ischemic or hemorrhagic. Ischemic strokes are further classified as thrombotic or embolic, while hemorrhagic stroke is classified based on the cause, either intracerebral hemorrhage stroke or Subarachnoid hemorrhage stroke (Murphy & Werring, 2020). Ischemic strokes result from inadequate blood flow to the brain from partial or complete occlusion of an artery. Approximately 80% of all strokes are ischemic strokes, either thrombotic or embolic.

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A thrombotic stroke is related to thrombosis, which occurs in relation to an injury to a blood vessel wall and the formation of a blood clot. This results in thrombosis or narrowing of the blood vessel and is the most common cause of stroke. A thrombotic stroke is mostly associated with the development of atherosclerosis in intracranial or extracranial arteries (Murphy & Werring, 2020). A rupture of the plaques exposes foam cells to blood-clotting factors, resulting in clot formation. If the clot is of considerable size, it alters blood flow to the cerebral tissue supplied by the vessel, resulting in an occlusive stroke. The process may happen over the years since collateral circulation to the affected area compensates for the occlusion (Murphy & Werring, 2020). The gradual occlusion of the arteries makes thrombotic stroke have a gradual onset, evolving over minutes to hours.

Embolic stroke is the second most common cause of stroke. It occurs when an embolus lodges in and occludes a cerebral artery through the carotid artery or vertebrobasilar system. This results in infarction and edema of the area supplied by the involved vessel (Murphy & Werring, 2020). Most emboli originate in the inside layer of the heart, with plaque breaking off from the endocardium and entering the circulation. Patients with an embolic stroke commonly have a rapid occurrence of severe clinical symptoms. Another source of emboli is the plaque that detaches from the carotid sinus or internal carotid artery. The emboli become lodged in the smaller cerebral blood vessels where the lumen narrows (Murphy & Werring, 2020). The onset of embolic stroke is usually sudden and may or may not be related to activity. The patient usually remains conscious, although they may have a headache. Besides, recurrence is common unless the underlying cause is aggressively treated.

Hemorrhagic stroke accounts for approximately 15% of all strokes. It results from bleeding into the brain tissue, subarachnoid space, or ventricles. Intracerebral hemorrhage (ICH) stroke occurs due to bleeding within the brain caused by the rupture of a vessel. Hypertension is the most important cause (Montaño et al., 2021). Hemorrhage commonly occurs during periods of activity and often causes a sudden onset of symptoms, progressing over minutes to hours because of ongoing bleeding. 

Subarachnoid hemorrhage (SAH) stroke occurs when there is intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and Pia mater. SAH is commonly caused by the rupture of a cerebral aneurysm (Montaño et al., 2021). Aneurysm rupture results in bleeding into the subarachnoid space, the ventricles, and the intracerebral tissue, which results in the worst headache of one’s life.

Difference between Primary and Secondary Parkinson’s Disease

Parkinson’s disease (PD) is a gradually progressing neurologic movement disorder that ultimately leads to disability. It primarily affects the neurons of the basal ganglia. PD is characterized by increased muscle tone (rigidity), slowness in the initiation and execution of movement (bradykinesia), tremors at rest, and impaired postural reflexes (Sundbøll et al., 2022). It is classified into primary and secondary PD. Most individuals have primary or idiopathic PD, while a few have secondary PD, usually from a known or suspected cause. Secondary PD includes corticobasal degeneration, dementia with Lewy bodies, multiple system atrophy, and progressive supranuclear palsy. Most patients diagnosed with PD, 80%–85%, have primary PD.

Primary PD, in most cases, has a familial tendency and is connected with the removal of mitochondrial DNA (mtDNA). The removal results in a loss of neurons that usually produce dopamine in the substantia nigra. Particular genetic mutations have been found in some families with PD (Sundbøll et al., 2022). One of the genetic mutations found in the parkin 1 gene on chromosome 4. On the other hand, secondary PD is usually caused by conditions such as atherosclerosis, brain tumors, head trauma, viral infections, and chronic use of certain antipsychotic drugs. Some infectious diseases, like encephalitis and AIDS, can cause symptoms similar to PD. The symptoms may also be due to exposure to toxins like carbon monoxide, hypoxia (a lack in the brain, and metabolic conditions like hypocalcemia. One key difference between primary and secondary PD is that dopaminergic drugs like levodopa are usually effective in patients with primary PD but not secondary PD (Sundbøll et al., 2022). This is because conditions causing secondary Parkinsonism contribute to motor symptoms similar to those in primary PD, but the underlying biological cause varies.   

Categories of Pain and Their Pathways

Pain is an obnoxious sensory and emotional experience related to actual or potential tissue damage. Pain is categorized into nociceptive, neuropathic, inflammatory, nociplastic, and radicular pain. Nociception refers to the response of the body’s sensory nervous systems towards actual or potentially damaging stimuli. Nociceptors are the sensory endings triggered by such stimuli and are primarily responsible for the first stage of pain sensations (Yam et al., 2018). Two types of primary afferent nociceptors, Aδ- and C-fibers, react to noxious stimuli presented in the body. The two nociceptors have specialized free nerve endings in the skin, joint capsule, muscle, bone, and some major internal organs. Aδ-fibers are triggered under thermal and mechanical stimuli resulting in a brief-pricking type of pain sensation (Yam et al., 2018). Nevertheless, the C-fibers are triggered by mechanical, thermal, or chemical stimuli, which often cause poor localization and dull pain sensation.

Neuropathic pain is mostly referred to as a nerve injury or nerve impairment and is frequently linked with allodynia. Allodynia refers to a central pain sensitization caused by repetitive non-painful stimulation of the receptors. It elicits a pain response from a stimulus that is considered non-painful in normal circumstances because of the sensitization process from the repetitive stimulation (Yam et al., 2018). Neuropathic pain can be due to damage to the nerve involved in the somatosensory nervous system and can be produced by PNS or CNS disorders. Nociceptors exhibit a dynamic expression of ion channels, like Nav channels, which are the major channels in regulating neuronal excitability, induction, and propagation of action potentials.

Inflammatory pain is caused by inflammation, a natural biological response from body tissues. It is a reaction to the harmful stimuli to eliminate necrotic cells and begin the tissue repairing process. Neutrophils are normally the first defendant of an inflammatory response, and they congregate at the site of injury through the bloodstream, followed by the discharge of other chemical mediators (Yam et al., 2018). Inflammation results in three major responses: allodynia, hyperalgesia, and sympathetic pain. Inflammation can also trigger mast cell degranulation, which releases the platelet-activating factor and triggers the release of 5-HT from the circulating platelet (Yam et al., 2018). The local inflammatory reaction then triggers the release of free arachidonic acid from the phospholipids, which are converted into prostaglandins through the cyclooxygenase pathways.

Nociplastic pain refers to pain that results from disrupted nociception. This occurs despite having no apparent evidence of real or threatened tissue damage resulting in activation of peripheral nociceptors or proof of disease of the somatosensory system contributing to the pain (Yam et al., 2018). Nociplastic pain is associated with conditions with chronic extensive pain like complex regional pain syndromes, fibromyalgia, irritable bowel syndrome, and chronic non-specific low back pain. These conditions are characterized by central sensitization and are connected with fear-avoidance, psychological distress, and pain catastrophizing. 

Radicular pain is a specific type of pain that occurs from compression or inflammation of the spinal nerve. It radiates from the back and hip into the lower limbs through the spine and spinal nerve root (Bonezzi et al., 2020). Individuals with radicular pain often experience numbness, tingling sensation, and muscle weakness. The pain that radiates from the back and into the lower limb is referred to as radiculopathy.

Etiology of Chronic and Acute Pain

The two primary types of pain are acute and chronic. Acute pain has a short duration and usually has a well-defined cause, while chronic pain lasts more than three months and may or may not have a well-defined cause. Acute pain occurs due to tissue injury and is caused by the arousal of peripheral pain receptors and their particular A delta and C sensory nerve fibers (Bonezzi et al., 2020). Chronic pain caused by constant tissue injury is seemingly a result of persistent arousal of these fibers. Nonetheless, the extent of tissue injury does not always project the severity of chronic or acute pain. Chronic pain can also be due to constant damage to or dysfunction of the peripheral or central nervous system.

Acute pain is normally temporary, has an abrupt onset, and is localized. It is generally confined to the injured area and may alleviate with or without treatment. As the injured part heals, the pain sensation changes (Bonezzi et al., 2020). On the other hand, chronic pain has a gradual onset, and the pain’s character and quality change over time. Since it mostly involves deep body structures, chronic pain is poorly localized.

Pathophysiology And Common Clinical Manifestations Of Diabetes Mellitus Type II

            Type 2 diabetes mellitus (T2DM) is characterized by insufficient insulin secretion when body cells develop insulin resistance. Hepatic insulin resistance results in an inability to contain hepatic glucose production, while peripheral insulin resistance disrupts peripheral glucose uptake. For T2DM to develop, insulin resistance and insufficient insulin secretion must be present. The combination results in fasting and postprandial hyperglycemia with very high insulin levels, mostly early in the disease. Later in the course of T2DM, insulin production reduces worsening hyperglycemia. Obesity and overweight are significant determinants of insulin resistance in T2DM. The clinical manifestations of T2DM include hyperglycemia, polyuria, polyphagia, polydipsia, weight loss, blurred vision, and paresthesia in the lower extremities.

References

Bonezzi, C., Fornasari, D., Cricelli, C., Magni, A., & Ventriglia, G. (2020). Not All Pain is Created Equal: Basic Definitions and Diagnostic Work-Up. Pain and therapy, 9(Suppl 1), 1–15. https://doi.org/10.1007/s40122-020-00217-w

Montaño, A., Hanley, D. F., & Hemphill, J. C., 3rd (2021). Hemorrhagic stroke. Handbook of clinical neurology, 176, 229–248. https://doi.org/10.1016/B978-0-444-64034-5.00019-5

Murphy, S. J., & Werring, D. J. (2020). Stroke: causes and clinical features. Medicine (Abingdon, England: UK ed.), 48(9), 561–566. https://doi.org/10.1016/j.mpmed.2020.06.002

Sundbøll, J., Szépligeti, S. K., Szentkúti, P., Adelborg, K., Horváth‐Puhó, E., Pedersen, L., … & Sørensen, H. T. (2022). Risk of Parkinson Disease and Secondary Parkinsonism in Myocardial Infarction Survivors. Journal of the American Heart Association, 11(5), e022768. https://doi.org/10.1161/JAHA.121.022768

Yam, M. F., Loh, Y. C., Tan, C. S., Khadijah Adam, S., Abdul Manan, N., & Basir, R. (2018). General Pathways of Pain Sensation and the Major Neurotransmitters Involved in Pain Regulation. International journal of molecular sciences, 19(8), 2164. https://doi.org/10.3390/ijms19082164

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Write a 1500-2000-word APA formatted essay of the following topics:

Classify and differentiate at least four types of stroke
Elaborate on the difference between primary and secondary Parkinson’s disease
Summarize the five categories of pain. Discuss their pathways. Explain the etiology of chronic and acute pain
Explain the pathophysiology and common clinical manifestations of Diabetes Mellitus Type II