1. Stroke By Asma Khatoon (Rph) Hospital Pharmacist at Ziauddin Hospital, Karachi

2. STROKE A 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.

3. 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),

4. Haemorrhagic stroke The 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.

5. 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; and perception.

6. 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.

7. 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).

8. Tests recommended : Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Cerebral Angiography : identify responsible blood vessel Electrocardiogram (ECG): underlying heart conditions Echocardiogram: blood clot from heart Carotid Duplex: carotid artery stenosis

9. Treatments Tissue 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

10. t-PA Dosing Chart (estimated weight) Estimat ed Weight (lbs) Convers ion to Kilogra ms (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 infusio n) Infusio n Dose (mg) Infusio n Rate (ml/hr) 220+100.090.09.0 10.081.0 21095.585.98.6 14.177.3 20090.981.88.2 18.273.6 19086.477.77.8 22.370.0 18081.873.67.4 26.466.3 17077.369.57.0 30.562.6 16072.765.56.5 34.558.9 15068.261.46.1 38.655.2 14063.657.35.7 42.751.5 13059.153.25.3 46.847.9 12054.549.14.9 50.944.2 11050.045.04.5 55.040.5 10045.540.94.1 59.136.8