This document provides information on ischemic stroke through a case study format. It discusses the types and causes of stroke, risk factors, signs and symptoms, diagnostic studies, treatment goals, and methods for prevention. The key points are: - Ischemic stroke is caused by a blockage in a brain blood vessel and accounts for 87% of strokes. Common causes are fatty deposits forming blood clots or traveling particles blocking small vessels. - Risk factors include age, gender, race, family history, diabetes, heart disease, smoking, hypertension, obesity, and oral contraceptive use. - Symptoms vary depending on the affected area of the brain but may include weakness, confusion, visual issues, difficulty walking, and severe

1. CASE STUDY ON ISCHEMIC
STROKE
Naga Swathi Sree Kavuri
Doctor of Pharmacy

2. Discussion Today
• Why should you care about stroke?
• About stroke
• Risk factors for stroke
• When a stroke occurs: what do you do?
• Can you prevent a stroke?
2

3. A STROKE IS
A brain injury caused when a blood vessel to
the brain becomes blocked or bursts, cutting
off blood flow and oxygen to the brain

4. Types of Stroke
• Ischemic (Blockage) 87%
–Caused by a blockage in the blood vessels to
• the brain
• Hemorrhagic (Bleeding) 13%
–Caused by burst or leaking blood vessels in
• the brain
7

6. Causes for an Ischemic Stroke
Fatty deposits line the blood vessel wall
– Thrombus: A blood clot
forms at the fatty deposit
– Embolus: A traveling
particle gets stuck in
a small vessel

7. Causes for a Hemorrhagic Stroke
A weakened blood vessel ruptures
– Aneurysms: Ballooning of a weakened spot of a
blood vessel
– Arteriovenous Malformations
(AVMs): Cluster of abnormal blood vessels

8. Transient Ischemic Attacks (TIAs)
• TIAs are “warning strokes” that can happen
before a major stroke
• They occur when blood flow through a
brain artery is briefly blocked or reduced
• TIA symptoms are temporary but similar to
those of a full-fledged stroke
• A person who has a TIA is 9.5times
more likely to have a stroke
• A TIA is a medicalemergency

9. • RISK FACTORS
Nonmodifiable
• Age
• Gender (women more likely to die)
• Race (African Americans)
• Heredity

10. • RISK FACTORS
Modifiable
• Asymptomatic carotid stenosis
• Diabetes mellitus
• Heart disease, atrial fibrillation
• Heavy alcohol consumption
• Hypercoagulability
• Hyperlipidemia

11. • Hypertension
• Obesity
• Oral contraceptive use
• Physical inactivity
• Sickle cell disease
• Smoking

12. ETIOLOGY AND PATHOPHYSIOLOGY
• Brain requires continuous supply of O2
and glucose for neurons to function
• If blood flow is interrupted
– Neurologic metabolism is altered in 30
seconds
– Metabolism stops in 2 minutes
– Cell death occurs in 5 minutes

13. • Atherosclerosis is a major cause of stroke
– Can lead to thrombus formation and contribute to
emboli
SITES for ATHEROSCLEROSIS

14. • Around the core area of ischemia is a border
zone of reduced blood flow where ischemia is
potentially reversible
• If adequate blood flow can be restored early
(<3 hours) and the ischemic cascade can be
interrupted
– less brain damage and less neurologic function
lost

15. Clinical Manifestations of Stroke:
• Affects many body functions
• Motor activity
• Elimination
• Intellectual function
• Spatial-perceptual alterations
• Personality
• Affect
• Sensation
• Communication

16. MOTOR FUNCTION
• Most obvious effect of stroke
• Can include impairment of
– Mobility
– Respiratory function
– Swallowing and speech
– Gag reflex
– Self-care abilities

17. • Characteristic motor deficits (contra-lateral)
– Loss of skilled voluntary movement
– Impairment of integration of movements
– Alterations in muscle tone (flaccid → spastic)
– Alterations in reflexes (hypo → hyper)
COMMUNICATION
• Patient may experience aphasia when stroke
damages the dominant hemisphere of the brain
– Aphasia: total loss of comprehension and use of
language
– Dysphasia: difficulty with comprehension and use of
language
• Classified as nonfluent or fluent

18. • Dysarthria
– Disturbance in the muscular control of speech
– Impairments in pronunciation, articulation, and
phonation; NOT meaning or comprehension
DIAGNOSTIC STUDIES
• When symptoms of a stroke occur, diagnostic
studies are done to
– Confirm that it is a stroke
– Identify the likely cause of the stroke
• CT is the primary diagnostic test used after a
stroke

20. Stroke is Preventable, Beatable and
Treatable!
• 80% of all strokes can be
prevented with healthy
behaviors
• Long-term effects of a stroke
may be minimized with
immediate treatment
• More people are surviving and
beating stroke

21. 12
When a Stroke Occurs:
What Do You Do?

22. F.A.S.T. IS
• Face Drooping Does one side of the face droop or is it numb? Ask the
person to smile.
• Arm Weakness Is one arm weak or numb? Ask the person to raise both
arms. Does one arm drift downward?
• Speech Difficulty Is speech slurred, are they unable to speak, or are they
hard to understand? Ask the person to repeat a simple sentence, like "the
sky is blue." Is the sentence repeated correctly?
• Time to call 911 If the person shows any of these symptoms, even if the
symptoms go away, call 9-1-1 and get them to the hospital immediately.

23. Others Stroke Symptoms
• Sudden numbness or weakness of the leg
• Sudden confusion or trouble understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of
balance or coordination
• Sudden severe headache with no known cause

24. Why Spotting a Stroke Is Important
• The sooner a stroke victim gets to the hospital,
the sooner they'll get life saving treatment.
– A clot-busting drug called tissue plasminogen
activator (tPA) may improve the chances of
getting better but only if you get them help right
away.
– Other treatments

26. 19
Can you Prevent a Stroke?

27. 80% of all Strokes Are Preventable
20

28. Reduce You StrokeRisk
• Control high blood pressure
• Don’t smoke
• Consume less sodium
• Lower cholesterol
• Lose excess weight
• Get physically active
21

29. SOAP NOTE:
S-SUBJECTIVE FINDINGS
• weakness of left UL and LL
• deviation of mouth to Right side
• weakness of limbs is sudden onset
• progressive nature and associated with seizure attack of 4
episodes since one day back
• History of lip bite
• K/C/O-seizures
O-OBJECTIVE FINDINGS
BP-110/70 mmHg
Hb-9.3 gm/dl
CNS examination:
Tone- right –normal, left-decreased

30. Power- Right Left Reflux: B T S A K
UL-4/5 0/5 LUL-+ + + + +
LL-4/5 0/5 LLL-+ + + + +
Babinski sign present
A-ASSESSEMENT
Diagnosis: CVA ischemic stroke with left hemiplegic
Assessment of current therapy:

31. DRUGS DOSE ROUTE FREQUE
-NCY
DURATION MOA INDICATION
Inj.Mannitol 100ml IV TID D1-D4 Inhibits reabsorption of Na+ and
K+ from renal tubules there by
decreasing intracranial pressure
To treat stroke
By decreasing
ICP
Tab.Aspirin 150mg ORAL BD D1-D9 Aspirin acts to stop the platelet
aggregation and prevent the
formation of clot
To treat stroke
Tab.Atorva 40mg ORAL OD D1-D9 Statins are HMG co-A
reductase inhibitors acts to stop
cholesterol synthesis
Prophylaxis for
stroke
Inj. Pantop 40mg IV OD D1-D9 Inhibits H+-ATPase transport
of H+ ions and prevents release
of excess acid
To treat gastric
irritation
Inj.Eptoin 100mg IV TID D1-D9 Acts to block the voltage-
dependent block of voltage
gated sodium channels
To treat
seizures
Tab. CBZ 200mg ORAL BD D5-D9 Acts on GABA receptors and
cause hyperpolarisation
To treat
seizures

32. P-PLAN
Goals of therapy:
 reduce the patient from hospitalization
 reduce morbidity, reduce symptom of stroke and
epilepsy/seizures
 increased QOL
 prevents further complication of stroke and epilepsy
 increased functional ability of hemiplegic limbs by
physiotherapy and exercise
Therapeutic monitoring:
1.Monitor for seizure attacks (EEG)
2. Monitor for stroke attack and symptoms
3. Monitor for drug efficacy and BP

33. Toxicity monitoring:
Monitor for toxic reaction for Phenytoin
Statins for Rhabdomyolysis
Aspirin and anticoagulants for bleeding risk
Mannitol for head ache and other side effects of Mannitol
Pharmacist interventions:
Drug interactions ADRs Med
error
s
Necessary
drugs
Unnecessary
drugs
Phenytoin and
Aspirin  Aspirin
displaces Phenytoin
from plasma protein
binding site there by
causes Phenytoin
toxicity
Lethargy,
vomitings,
nausea on day-
5th  that may
be due to
Phenytoin
Nill Add drug for
vomitings 
Ondansetron -
4mg BD
Nill

34. Points to physician:
1. Add drug for vomitings as patient complaint about vomitings on
day -5
2. interaction between Phenytoin and aspirin monitor for toxicity and
need maintain at least of 2hr gap between drugs administration
Points to patient:
1. Exercise regularly of at least 30 mins
2. reduce stress by doing meditation and yoga
3. Take healthy food which is protien-high, carbs-moderate, fat-low
4. avoid taking junk foods which leads to obesity, risk factor for
stroke.
5. regular physiotherapy is necessary for stroke patient mainly for
hemiplegics
6. Maintain stress free and healthy life for well being and in order to
increased quality of life

35. THANK
YOU