Ischemic stroke occurs when a blood clot blocks or narrows an artery leading to the brain, cutting off blood flow and oxygen, and can be caused by conditions like high blood pressure, heart disease, diabetes, or smoking; symptoms include numbness, confusion, vision problems, or severe headache; treatment focuses on dissolving clots with drugs like alteplase, reducing risk factors through lifestyle changes and medications, and managing complications.

1. ISCHAEMIC
STROKE
PRESENTED BY:- RENUKA ATUL
BARI
PHARM D
MGV PHARMACY
COLLEGE PANCHAVATI NASHIK

2. DEFINITION
Ischemic stroke occurs when a blood clot
blocks or narrows an artery leading to the
brain. A blood clot often forms in arteries
damaged by the buildup of plaques
(atherosclerosis).

3. TYPES OF ISCHEMIC STROKE
• An ischemic stroke occurs when a blood vessel that supplies the brain becomes
blocked or "clogged" and impairs blood flow to part of the brain. The brain cells
and tissues begin to die within minutes from lack of oxygen and nutrients.
Ischemic strokes are further divided into 2 groups:
• Thrombotic strokes. These are caused by a blood clot that develops in the
blood vessels inside the brain.
• Embolic strokes. These are caused by a blood clot or plaque debris that
develops elsewhere in the body and then travels to one of the blood vessels in
the brain through the bloodstream.

4. ETIOLOGY (CAUSES)
• hypertension.
• Smoking or chewing tobacco
• Heart disease. This condition includes defective heart valves as well as
atrial fibrillation, or irregular heartbeat, which causes a quarter of all
strokes among the very elderly. ...
• Diabetes.
• Fatty deposits lining the vessel walls, called atherosclerosis.

5. SIGNS AND SYMPTOMS
• Sudden numbness or weakness of the face, arm or leg (especially on one
side of the body)
• Sudden confusion, trouble speaking or understanding speech.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause

6. PATHOPHYSIOLOGY

7. RISK FACTORS
• High blood pressure. Blood pressure of 140/90 or higher can damage blood
vessels (arteries) that supply blood to the brain.
• Heart disease. Heart disease is the second most important risk factor for stroke,
and the major cause of death among survivors of stroke. Heart disease and
stroke have many of the same risk factors.
• Diabetes. People with diabetes are at greater risk for a stroke than someone
without diabetes.
• Smoking. Smoking almost doubles your risk for an ischemic stroke.
• Birth control pills (oral contraceptives)
• History of TIAs (transient ischemic attacks). TIAs are often called mini-
strokes. They have the same symptoms as stroke, but the symptoms don’t last.
If you have had one or more TIAs, you are almost 10 times more likely to have a
stroke than someone of the same age and sex who has not had a TIA.

8. • High red blood cell count. A significant increase in the number of red blood
cells thickens the blood and makes clots more likely. This raises the risk for
stroke.
• High blood cholesterol and lipids. High cholesterol levels can contribute to
thickening or hardening of the arteries (atherosclerosis) caused by a buildup of
plaque. Plaque is deposits of fatty substances, cholesterol, and calcium. Plaque
buildup on the inside of the artery walls can decrease the amount of blood flow
to the brain. A stroke occurs if the blood supply is cut off to the brain.
• Lack of exercise
• Obesity
• Excessive alcohol use. More than 2 drinks per day raises your blood pressure.
Binge drinking can lead to stroke.
• Illegal drugs. IV (intravenous) drug abuse carries a high risk of stroke from
blood clots (cerebral embolisms). Cocaine and other drugs have been closely
linked to strokes, heart attacks, and many other cardiovascular problems.

9. • Race. African Americans have a much higher risk for death and disability
from a stroke than whites. This is partly because the African-American
population has a greater incidence of high blood pressure.
• Gender. Stroke occurs more often in men, but more women than men die
from stroke.
• History of prior stroke. You are at higher risk for having a second stroke
after you have already had a stroke.
• Heredity or genetics. The chance of stroke is greater in people with a
family history of stroke.

10. DIAGNOSIS
• CT scans
• A CT scan is like an X-ray, but uses multiple images to build up a more
detailed 3-dimensional picture of your brain to help your doctor identify any
problem areas.
• MRI scans
• An MRI scan uses a strong magnetic field and radio waves to produce a
detailed picture of the inside of your body.
• It's usually used in people with complex symptoms, where the extent or
location of the damage is unknown.
• Swallow tests
• A swallow test is essential for anybody who has had a stroke, as the ability to
swallow is often affected soon after having a stroke.

11. • Carotid ultrasound
• A carotid ultrasound scan can help to show if there's narrowing or
blockages in the neck arteries leading to your brain.
• When carotid ultrasonography is needed, it should happen within 48
hours.
• Echocardiography
• An echocardiogram makes images of your heart to check for any
problems that could be related to your stroke.

12. TREATMENT- PHARMACOLOGICAL
• Thrombolysis – "clot buster" medicine
• Ischaemic strokes can often be treated using injections of a medicine
called alteplase, which dissolves blood clots and restores blood flow to the brain.
• This use of "clot-busting" medicine is known as thrombolysis.
• Alteplase is most effective if started as soon as possible after the stroke occurs –
and certainly within 4.5 hours.
• It's not generally recommended if more than 4.5 hours have passed, as it's not
clear how beneficial it is when used after this time.
• Before alteplase can be used, it's very important that a brain scan is done to
confirm a diagnosis of an ischaemic stroke.
• This is because the medicine can make the bleeding that occurs in
haemorrhagic strokes worse.

13. • Aspirin and other antiplatelets
• Most people will be given aspirin straight after having an ischaemic stroke. As
well as being a painkiller, aspirin is an antiplatelet, which reduces the chances of
another clot forming.
• Other antiplatelet medicines may be used later, such
as clopidogrel and dipyridamole.
• Anticoagulants
• Some people may be offered an anticoagulant to help reduce their risk of
developing new blood clots in the future.
• Anticoagulants prevent blood clots by changing the chemical composition of the
blood in a way that prevents clots from forming.
• Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of
anticoagulants for long-term use.
• There are also a number of anticoagulants called heparins, which can only be
given by injection and are used short term.

14. • Blood pressure medicines
• If your blood pressure is too high, you may be offered medicines to lower it.
• Medicines that are commonly used include:
• thiazide diuretics
• angiotensin-converting enzyme (ACE) inhibitors
• calcium channel blockers
• beta blockers
• alpha-blockers
• Statins
• You'll usually be advised to take a medicine known as a statin.
• Statins reduce the level of cholesterol in your blood by blocking a chemical
(enzyme) in the liver that produces cholesterol.
• You may be offered a statin even if your cholesterol level is not particularly high,
as it may help reduce your risk of stroke whatever your cholesterol level is.

15. • Thrombectomy
• A small number of severe ischaemic strokes can be treated by an
emergency procedure called a thrombectomy.
• This removes blood clots and helps restore blood flow to the brain.
• Thrombectomy is only effective at treating ischaemic strokes caused by a
blood clot in a large artery in the brain.
• It's most effective when started as soon as possible after a stroke.
• The procedure involves inserting a catheter into an artery, often in the
groin. A small device is passed through the catheter into the artery in the
brain.
• The blood clot can then be removed using the device, or through suction.
The procedure can be done under local anaesthetic or general

16. • Carotid endarterectomy
• Some ischaemic strokes are caused by narrowing of an artery in the
neck called the carotid artery, which carries blood to the brain.
• The narrowing, known as carotid stenosis, is caused by a build-up of
fatty plaques.
• If the carotid stenosis is very severe, surgery may be used to unblock the
artery. This is called a carotid endarterectomy.
• It involves the surgeon making a cut (incision) in your neck to open up
the carotid artery and remove the fatty deposits.

17. SUPPORTIVE TREATMENTS
• You may need further short-term treatment to help manage some of the
problems that can affect people who have had a stroke.
• For example, you may require:
• a feeding tube inserted into your stomach through your nose (nasogastric
tube) to provide nutrition if you have difficulty swallowing (dysphagia)
• nutritional supplements if you're malnourished
• fluids given directly into a vein (intravenously) if you're at risk
of dehydration
• oxygen through a nasal tube or face mask if you have low levels of
oxygen in your blood
• compression stockings to prevent blood clots in the legs (DVT)

18. PREVENTION
Managing underlying conditions
• treating atrial fibrillation
• treating high blood pressure
• medicines for high cholesterol
• type 1 diabetes and treating type 2 diabetes
• treating transient ischaemic attacks (TIA)
Diet
Exercise
Stop smoking
Cut down on alcohol

19. CASE STUDY
PATIENT NAME : XYZ
AGE: 68 yrs WEIGHT: 86kg
SEX: Male Height: 161cm
DATE OF ADMISSION: 05/04/23
DATE OF DISCHARGE: NOT YET DISCHARGED.
REFERENCED SHIFT.

20. MEDICAL HISTORY: Ischaemic stroke 1.5 month ago.
MEDICATION HISTORY: N/S
SOCIAL HISTORY: Mild alcoholism.
FAMILY HISTORY: N/S
PREVIOUS ALLERGIES: N/S
PHYSICAL EXAMINATION: Normal
GENERAL - P I C C L E+
VITAL SIGNS - PR: 88bpm; BP : 130/56 R.R:- Normal
HR-92 bpm
CVS – S1 S2+
CNS - unconscious

21. GLUCOSE : 72.1 mg/dl
UREA : 76.8 mg/dl
CREATININE : 1.08 mg/dl
BILLIRUBIN TOTAL :1.21 mg/dl
RANDOM BLOOD SUGAR : 13.0 mg/dl

22. TREATMENT:
Inj. Meropenum BD
Inj. Pan 40 mg OD
Inj. Lasix 20mg OD
Inj. Pipzo 4.5g 8 hrly
Tab. Ecosprin OD (anti platelet)
Tab. Clopitab (anti platelet or blood
thinner)
Tab. Amlodipine (HTN) 5mg OD
Tab. Xarelto (anti epileptic) BD
Tab. Mucinac 600 mg (Mucolytic
agent) BD
Tab. Emeflim (Nausea vomiting)
Medications are continued ….