Disease State Diagnosis

Stroke, traumatic brain injury (TBI) and spinal cord injury (SCI) represent three of the most catastrophic occurrences that human beings can suffer. There are approximately 700 000 strokes per year in the USA, most, but not all, affecting the elderly. Ninety per cent of strokes are 'ischemic' in nature, involving a thromboembolic blockage of a brain artery that impairs cerebral blood flow and oxygenation to the point of causing infarction of the brain region that is dependent upon the blocked vessel for most of its blood supply. The remaining 10% of strokes are 'hemorrhagic'. Within this category, there are two types of insult. The first is intracerebral hemorrhage, where blood is released into the brain parenchyma and produces brain damage by triggering brain edema (swelling) and mass effects, which result in secondary ischemia within the tissue surrounding the intracerebral mass of blood (hematoma). The second type of hemorrhagic stroke is subarachnoid hemorrhage (SAH), where the blood is released into the subarachnoid space (between the subarachnoid and pial membranes covering the brain) from a burst congenital berry aneurysm ballooning out from one of the major arteries at the base of the brain. The pathophysiology of this type of hemorrhagic stroke also involves the triggering of a secondary ischemic insult due to the induction of delayed cerebral vasospasm that peaks in incidence at 4-7 days post-SAH. There are about 30 000 aneurysmal SAHs per year in the USA, mainly occurring in those in their early fifties and with a 2:1 female:male preponderance.

With regard to TBI, it is estimated that there are 1.5 million cases per annum in the USA, ranging from mild to severe. Of these, 1.2 million seek medical care. Of these most are 'mild' in severity, but about 58000 are severe (Glasgow Coma Score 3-8) and 64000 moderate (Glasgow Coma Score 9-12), and often require intensive medical treatment and extended recovery periods. In the case of SCI, there are about 11 000 new injuries each year in the USA, and the overall prevalence of SCI is approximately 250000. Although TBI and SCI can victimize active individuals at any age, most occur in young adults in the second and third decades of life. Moreover, the majority of stroke, TBI, and SCI patients now survive their neurological insults due to improvements in emergency, neurological intensive care and surgical treatments. Nevertheless, the need for intensive rehabilitation and the reality of prolonged disability exacts a significant toll on the individual, his or her family, and society. Effective ways of maintaining or recovering function could markedly improve the outlook for those with stroke, TBI, or SCI by enabling higher levels of independence and productivity.

Your Heart and Nutrition

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