StrokeBy

Asma Khatoon (Rph)Hospital Pharmacist at

Ziauddin Hospital, Karachi

STROKEA stroke is a medical emergency in which the

blood supply to any portion of the brain is interrupted or reduced.

Alternative names: Cerebrovascular accident/ disease (CVA), Cerebral infarction, Cerebral hemorrhage.

TYPES OF STROKES :There are 2 main types of strokes:

1. ischaemic stroke .

2. haemorrhagic stroke. Ischaemic stroke The most common type of stroke and is caused

by a blockage of the blood vessels supplying the brain. This may be due to ‘hardening’ and narrowing of the arteries (atherosclerosis) or by a blood clot blocking a blood vessel. This may be :

thrombotic stroke caused by a blood clot (thrombus) 

an embolic stroke (or cerebral embolism), 

Haemorrhagic strokeThe most severe type of stroke is a

haemorrhagic stroke. It occurs when a blood vessel in the brain bursts, allowing blood to leak and cause damage to an area of the brain.

There are 2 types: 1.subarachnoid haemorrhage, which occurs in the

space around the brain; 2. intracerebral haemorrhage, the more common

type, which involves bleeding within the brain tissue itself.

SYMPTOMS : The symptoms of a stroke are dependant on

what portion of the brain is damage. ability to perform movements — usually

affecting one side of the body;speech;part of vision;co-ordination;balance;memory; andperception.

warning sign of stroke :Sudden weakness or numbness of the face,

arm and leg on one side of the body.Loss of speech, or difficulty in talking.Dimness or loss of vision.Unexplained dizziness, especially when

associated with any of the above signs.Unsteadiness or sudden falls.Headache (usually severe and of sudden

onset).Confusion.

risk factors Cigarette smoking, excessive alcohol intake, being overweight and raised blood cholesterol increase the risk of

high blood pressure and artery disease Diabetes. atrial fibrillation (AF). 

Tests recommended :Computed Tomography (CT) Magnetic

Resonance Imaging (MRI) Cerebral Angiography :

identify responsible blood vessel Electrocardiogram (ECG): underlying heart

conditionsEchocardiogram: blood clot from heart

Carotid Duplex: carotid artery stenosis

TreatmentsTissue plasminogen activator (tPA) can be

given within three hours from the onset of symptoms. In addition to being used to treat strokes, the following can also be used as preventative measures. Anticoagulants/Antiplatelets Carotid Endarterectomy Angioplasty/Stents

t-PA Dosing Chart (estimated weight)

Estimated

Weight (lbs)

Conversion

to Kilograms (Kg)

Total iv t-PA Dose (mg)  at 0.9 mg/kg

t-PA Bolus (mg) *10%

of total*

t-PA Bolus (ml)

Discard

Dose  t-PA (Not for

infusion)

Infusion

Dose (mg)

Infusion

Rate (ml/hr

)

220+ 100.0 90.0 9.0 9.0 10.0 81.0 81.0210 95.5 85.9 8.6 8.6 14.1 77.3 77.3200 90.9 81.8 8.2 8.2 18.2 73.6 73.6190 86.4 77.7 7.8 7.8 22.3 70.0 70.0180 81.8 73.6 7.4 7.4 26.4 66.3 66.3170 77.3 69.5 7.0 7.0 30.5 62.6 62.6160 72.7 65.5 6.5 6.5 34.5 58.9 58.9150 68.2 61.4 6.1 6.1 38.6 55.2 55.2140 63.6 57.3 5.7 5.7 42.7 51.5 51.5130 59.1 53.2 5.3 5.3 46.8 47.9 47.9120 54.5 49.1 4.9 4.9 50.9 44.2 44.2110 50.0 45.0 4.5 4.5 55.0 40.5 40.5100 45.5 40.9 4.1 4.1 59.1 36.8 36.8