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Cerebrovascular accident (CVA) better known as a stroke, occurs when blood flow is interrupted to any part of the brain. There are two main types of cerebrovascular accident: ischemic stroke and hemorrhagic stroke. Cerebrovascular accidents are major causes of morbidity and mortality (Vora et al., 2019). Risk factors for CVA are divided into modifiable and non-modifiable risk factors. Non modifiable risk factors include age, sex, ethnicity and geography, family history of stroke. Modifiable risk factors include smoking, alcohol consumption, drug abuse, arterial hypertension, diabetes mellitus, dyslipidemia, heart disease and hyperhomocysteinemia. Sudden signs of stroke consist of FAST: face drooping, arm weakness, slurred speech, time to call 9-1-1. . Cultures are at higher risk for Cerebrovascular accidents are American Indian/Alaska natives. Native Americans have 2.3 greater odds of being diagnosed with diabetes than non-Hispanic Caucasians, a condition that is a risk factor for heart attack and stroke (Van Hooser et al., 2020). Native American continue to experience healthcare disparities therefore causing lack of awareness to heart diseases, diabetes, and stroke.  Deep tendon reflex reveals involuntary muscle contraction, the intactness of the reflex arc at specific spinal levels, and the normal override on the reflex of the higher cortical levels. The DTR is sometimes called stretch reflex or myotatic reflex because of the stretch action and the muscle response involved (Rodriguez-Beato & De Jesus, 2020). The deep tendon reflex has 5 components: an intact sensory nerve (afferent), a functional synapse in the cord, an intact motor nerve fiber (efferent), the neuromuscular junction, and a competent muscle. The reflex response is graded on a 4-point scale: 0 No response, 1+ Diminished, low normal, or occurs only with reinforcement, 2+ Average, normal, 3+ Brisker than average, may indicate disease, probably normal, 4+ Very brisk, hyperactive with clonus, indicative of disease.Peripheral neuropathy is symmetric damage to peripheral nerves (feet or hands), resulting in pain without stimulation of the nerves. Diabetic peripheral neuropathy manifests as lack of sensation in the toes spreading to the foot, and the leg causing numbness and pain (Tahir et al., 2020). What I would expect to find in a person with diabetic peripheral neuropathy impaired light touch sensation to the feet, hands or legs, vibratory perception, absent or diminished ankle-deep tendon reflexes as well as muscle weakness. Due to neuropathy, patients have difficulty with mobility and daily activities.  We constantly have diabetic patients in the COVID unit. Most of my family members are diabetic as well, my mother has daily neuropathy pain. At work many of my diabetic patients go have dialysis. I recall a time when I cared for a diabetic patient with bilateral lower extremity amputation and an unstageable pressure ulcer to the sacrum. Wound healing is difficult in diabetic patients. Wound debridement was done.  Patient was frequently repositioned, pain medication administered, glucose levels maintained, and wound care provided. Because of diabetic peripheral neuropathy, skin cuts and blisters often go unnoticed and lead to complications if not treated on time.

ReferenceVora, C., Talsaniya, K., & Prajapati, B. (2019). Clinical profile of cerebrovascular accident patients with special reference to serum homocysteine level. International Archives of Integrated Medicine, 6(1), 76–82.Rodriguez-Beato, F. Y., & De Jesus, O. (2020). Physiology, Deep Tendon Reflexes. In StatPearls. StatPearls Publishing.Van Hooser, J. C., Rouse, K. L., Meyer, M. L., Siegler, A. M., Fruehauf, B. M., Ballance, E. H., Solberg, S. M., Dibble, M. J., & Lutfiyya, M. N. (2020). Knowledge of heart attack and stroke symptoms among US Native American Adults: a cross-sectional population-based study analyzing a multi-year BRFSS database. BMC Public Health, 20(1), 40. https://doi.org/10.1186/s12889-020-8150-xTahir, M., Adil, M., Khalid, S. R., Khan, S., & Tariq, S. B. (2020). Prevalence and Risk Factors for Diabetic Peripheral Neuropathy among Type 2 Diabetes Mellitus Patients. Professional Medical Journal, 27(9), 1885–1890. https://doi.org/10.29309/TPMJ/2020.27.09.4239

REPLY

Cerebrovascular accident also known as stroke affects the blood flow to the brain. Most risk factors are lifestyle based and others are unconditional. The first lifestyle-based risk factor is high blood pressure which is caused by the blood exerting more pressure than normal weakening the blood vessel walls causing cerebrovascular accident. Cigarette smoking also causes stroke. Smoke from cigarette constricts the arteries altering movement of blood through the vessels causing stroke. Among diabetic people, high blood sugar levels cause atherosclerosis hence stroke. Another common risk factor to stroke that attributes to hypertension and high cholesterol is obesity. Lack of regular exercise increases the chances of cerebrovascular accident as one is exposed to obesity and high blood pressure. There are however uncontrolled factors such as age where the elderly is more exposed, gender, where men are at a higher risk than women and family history in regards to the disease.

            Like most chronic illnesses, the prevalence of high blood pressure and heart diseases vary among individuals on the basis of ethnicity, and cultural backgrounds. Due to migration, the average blood pressures between traditional and modernized communities shows that the modernized community is exposed to obesity due to the different cultural lifestyles (Kyaw et al, 2018). Cultures such as drinking, smoking and drug use involve making decisions under uncertainties and may cause high blood pressure.

             According to Rodriguez- Beato & De Jesus (2020) the deep tendon reflex is graded as, “0 = no response; normal, 1+= a slight response which may or may not be normal depending on the patient’s medical history, 2+ = a brisk response which is normal, 3+ = a very brisk response which may or may not be normal and 4+ = a tap elicits a repeating response which is abnormal”. Analysis of findings such as evidence of disease, muscle strength and tone determine other reflexes.

            Diabetic neuropathy, also, nerve damage is a complication among diabetic patients. A patient diabetic peripheral neuropathy has numbness in their feet and are unable to feel their feet while walking. Sharp pains are also evident among them. They lose their balance as they walk and feet begin to look deformed. With sores and blisters. The patients have exaggerated sensations where warm feels very hot and hurts when touched by a person with cold hands according to Iqbal et. al (2018).

            A patient with lower back pain and diabetes showed general body weakness. Muscle strength and tone, tendon reflexes and sensitivity to touch were examined. Nerve conduction testing was done to measure how quickly the nerves in the arms and feet conduct electrical signals. Since the condition has no specific treatment the treatment conducted was meant to relieve pain, manage complications and help the body regain function and cause slow progression of the disease. Maintaining the blood sugar levels within the patients was hence essential and giving prescription medications; antidepressants and anti-seizure dugs to relieve diabetes related nerve pain. Urinary tract infections, digestive complications, orthostatic hypotension were sexual dysfunction were managed in treatment. 

References

Iqbal, Z., Azmi, S., Yadav, R., Ferdousi, M., Kumar, M., Cuthbertson, D. J., & Alam, U. (2018). Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clinical therapeutics, 40(6), 828-849.

Kyaw, H., Raju, F., Shaikh, A. Z., Lin, A. T., Abbound, J., & Reddy, S. (2018). Staphylococcus lugdunensis endocarditis and cerebrovascular accident: a systematic review of risk factors and clinical outcome. Cureus, 10(4).

Rodriguez-Beato, F. Y., & De Jesus, O. (2020). Physiology Deep Tendon Reflexes. StatPearls [internet]

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