Mrs. B. is an overweight, 61-year-old, white female. Upon hospital admission, she had a severe right-sided headache, slurred speech, and some severe right-handed numbness with a weak hand grip on the left. Her smile was asymmetric with right-sided facial weakness that had per­sisted for 48 hours. Mrs. B. has a history of smok­ing moderately for 40 years and use of estrogen replacement for 20 years. Her mother had adult-onset diabetes and died of breast cancer at age 62; her father died of a gunshot accident at 29; one sister died of a subarachnoid hemorrhage at age 63, and another sister is hemiparietic because of a CVA. One brother is hypertensive, and three other younger siblings are apparently healthy.

Vital signs showed a normal temperature, ele­vated heart rate, and normal respirations, but Mrs. B. had a blood pressure of 220/158. A lumbar puncture was negative for blood with normal protein and glucose levels. A normal elec­trocardiogram was found. EEG showed localized activity in the left hemisphere. A CT showed increased density on the right. Blood chemistry was normal except for elevated glucose.

**Discuss the pathophysiological changes that occur with CVA specifically noting signs and symptoms for Mrs. B.**

**What factors from Mrs. B’s history could be contributing factors for CVA?**

*2 references from medical journals please cite in text, and minimum of 150 words*