APPENDIX A

HYPERTENSIVE ATHEROSCLEROTIC CARDIOVASCULAR DISEASE AND RIGHT THALAMIC INFARCTION

Host AGENT
69 years old, female
Right thalamic infarct
↑ Total Cholesterol and glucose in the blood

Hypercholesterolemia Hyperglycemia

↑ Deposition of fatty plaque into arterioles ↑ Intracellular Glucose

↑ Advanced
↑ diacylglycerol
Atherosclerosis glycation end ↑ Sorbitol
product

Presence of fatty plaque on arterial walls ↑ vessel wall homeostasis

protein kinase C activation
Abnormal protein function
↑Alterations
Circulatingin
AGEs
osmolality myo-inositol, and redox potential.

Narrowing of Lumen Collagen linked AGE’s trap plasma proteins on vessel walls
Altered enzyme function, (cPLA2, Na, K-ATPase
Renal, vascular, connective tissue effects Altered regulation of hormones
Cyokines,
Altered cell growth factors
function
Arteriosclerosis

↑ oxidation and formation of LDL Altered cell function

↑ Peripheral resistance
↑ Hardening Altered gene
expression

Diabetes Mellitus
Diabetes Mellitus
 Hypertension ↑ Cardiac congestion

Dilation of atria Restriction of blood and

HACVD O2 to the vital organ

Activation of RAA Ischemia

High pressure blood system
flow Impaired distribution
Cerebral of oxygen and glucose
Hypoperfusion
↑ BV, ↑ CO, ↑ PR, ↑
Endothelial cell afterload
dysfunction Transient
Ischemic attack Tissue hypoxia and
↑ pressure to the cellular starvation
arterioles
Smooth muscle cell
emigration from media Artery occlusion
to intima Damage to the fragile walls Cerebral Ischemia
of the arterioles in the
brain
Macrophage engulfment of Travels to Brain
lipid and accumulation in
the intima Intracerebral Hemorrhage Pooling of Blood Slurring of Speech
Emboli
Proliferation of smooth
muscle, collagen and
extracellular matrix
Clot formation Latches off