A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die. Stroke can be either ischemic or hemorrhagic.

1. NAME: SABA ARIF
PHARMD, SUCP, HYD
GUIDED BY: SRINIVAS NAYAK SIR
SULTAN UL ULOOM COLLEGE OF
PHARMACY
PRESENTATION ON STROKE

2. DEFINITION
 A stroke occurs when the blood supply to part
of your brain is interrupted or severely
reduced, depriving brain tissue of oxygen and
food.
• Within minutes, brain cells begin to die.
• Stroke can be either ischemic or
hemorrhagic.
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3. STROKE
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4. RISK FACTORS:
LIFESTYLE RISK FACTORS: being
overweight or obese, physical inactivity, use of
illicit drugs like cocaine & methamphetamines,
high BP, cigarette smoking, diabetes, high
cholesterol.
OTHERS: Personal or family history
 AGE: 55 years or older
RACE: African-Americans have higher risk
GENDER- Men have higher risk.
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5. TYPES OF STROKE
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6. TYPES OF STROKE
ISCHAEMIC STROKE: Most common type,
caused by blockage of blood vessels supplying
the brain. This may be due to hardening and
narrowing of arteries.
HAEMORRHAGIC STROKE: The most severe
type, occurs when a blood vessel in the brain
bursts, allowing blood to leak and cause damage
to an area of the brain.
It has 2 sub-types: SUBARACHNOID
HAEMORRHAGE, INTRACEREBRAL
HAEMORRHAGE.
TRANSIENT ISCHEMIC ATTACK OR MINI
STROKE: Results when a cerebral artery is
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7. ISCHEMIC & HAEMORRHAGIC
STROKE
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8. TRANSIENT ISCHEMIC ATTACK
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9. PATHOPHYSIOLOGY
 ISCHEMIC STROKE: Are due to an
interruption in the blood supply to certain
areas of brain which leads to Ischemia,
infarction & eventual necrosis of tissue.
Ischemic stroke is further divided into focal &
global stroke.
• HAEMORRHAGIC STROKE: Are due to
rupture of a blood vessel leading to
compression of brain tissue from an
expanding haematoma. In addition, the
pressure may lead to a loss of blood supply to
affected tissue with resulting infarction.
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10. INTRACEREBRAL
HAEMORRHAGE
 It is the accumulation of blood anywhere in
the brain.
 This will form gradually enlarging haematoma.
 Intra-cerebral haemorrhages can be caused
by local vessel abnormalities (Hypertension ,
Vasculitis ) or Systemic factors (drugs,
trauma, tumours & sickle cell anaemia)
 Haemorrhaging directly damages brain tissue
& raises intracranial pressure giving
headaches, vomiting, nausea and eventually
coma and death.
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11. SUBARACHNOID
HAEMORRHAGE
 It is the gradual collection of blood in the
subarachnoid space of the Dura.
 These can be traumatic or spontaneous.
Spontaneous haemorrhages occur through
saccular aneurysms and through extensions
of intracranial haemorrhaging or due to similar
causes.
 Approximately 1/3rd of those who suffers
subarachnoid haemorrhage die.
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12. SIGNS & SYMPTOMS
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13. CLINICAL PRESENTATION
 Patients may be unable to provide a reliable
history because of neurologic deficits.
 SYMPTOMS include unilateral weakness,
inability to speak, loss of vision, vertigo, or
falling.
 ISCHEMIC stroke is not usually painful, but
headache may occur in HAEMORRHAGIC
stroke.
 Patients with posterior circulation involvement
may have vertigo and diplopia.
 Anterior circulation strokes may commonly
result in aphasia.
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14. COMPLICATIONS
Paralysis or loss of muscle movement
Difficulty in talking and swallowing
Memory loss or thinking difficulties
Pain
Changes in behaviour and self-care.
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15. DIAGNOSIS
 Laboratory tests for hyper-coagulable states
should be done only when the cause cannot be
determined based on presence of risk factors.
 Computed Tomography (CT) & Magnetic
resonance imaging (MRI) head scans can
reveal areas of haemorrhage and infarction.
 Carotid Doppler (CD), Electrocardiogram
(ECG), Trans-thoracic Echocardiogram(TTE),
studies can provide valuable diagnostic
information.
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16. CT SCAN
A CT-SCAN uses a
series of x-rays to
create a detailed
image of your brain.
A scan can show
bleeding in brain,
ischemic stroke,
tumour etc. Doctors
may inject a dye
into your
bloodstream to view
blood vessels in
brain & neck in
greater details.
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17. MRI SCAN
An MRI of the head is
often the 1st test
performed.MRI can
detect brain tissue that
has been damaged by
both ischemic &
haemorrhagic stroke.
Also, MRI is very
sensitive & specific in
distinguishing ischemic
lesions & identifying
pathologies that
resemble STROKE,
known as “stroke
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18. ULTRASONOGRAPHY
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19. TREATMENT
 GOALS OF TREATMENT: The goals are
1. Reduce ongoing neurologic injury and
decrease mortality and long term disability.
2. Prevent complications secondary to
immobility and neurologic dysfunction.
3. Prevent stroke recurrence.
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20. NONPHARMACOLOGIC
THERAPY
 Acute Ischemic stroke: Endovascular
thrombectomy with a stent retriever improves
outcomes in select patients with proximal
large artery occlusion.
 Haemorrhagic stroke: In SAH from ruptured
intracranial aneurysm, surgical intervention to
clip or ablate the vascular abnormality
reduces mortality from re-bleeding. After
primary intra-cerebral haemorrhage, surgical
evacuation may be beneficial in some
situation.
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21. PHARMACOLOGIC THERAPY
 FOR ISCHEMIC STROKE:
ANTICOAGULANT DRUGS: They are also called
as blood thinners. This medicine group keeps
clots from forming in the blood.
Example: low molecular weight heparin or un-
fractionated heparin(5000 units 3 times daily)
ANTIPLATELET DRUGS: These drugs interact
with platelets to prevent blood clots from forming.
Example: Aspirin in the dose of 160-325 mg/day
started between 24-48 hrs after completion of
alteplase reduces long term death & disability.
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22. PHARMACOLOGIC THERAPY
THROMBOLYTICS: They are used in stroke
caused by a clot in blood vessel.
Thrombolytics break apart clots and restore
blood flow.
Example: Alteplase (tissue plasminogen
activator) is initiated within 4.5 hours of
symptom onset reduces disability from
ischemic stroke.
STATINS: patients experiencing ischemic
stroke & who have low density lipoprotein
cholesterol above100mg/dl should be treated
with high intensity statin therapy for secndary
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23. PHARMACOLOGIC THERAY
 FOR HAEMORRHAGIC STROKE:
o There are no standard strategies for treating
intra-cerebral haemorrhage.
o All patients with warfarin-associated ICH
should receive intravenous vitamin k therapy .
o The calcium channel blocker nimodipine
60mg every 4 hours for 21 days, along with
maintenance of intravascular volume with
presssor therapy is recommended to reduce
the incidence & severity of neurologic deficits.
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24. PATIENT COUNCELLING
 Family members help the person regain lost
skills by encouraging them to use the affected
arm or leg, helping them with their speech or
teaching them how to do tasks which may
have been forgotten, such as combing their
hair using a comb or using a cup, knife and
fork.
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25. PREVENTION
Take your high blood pressure medicine
regularly.
Do not smoke or drink too much of alcohol.
If you have atrial fibrillation (irregular or fast
heart beat) you may need to take anti-
thrombotic medicines.
Keep your blood cholesterol level in a normal
range. Eat food low in fats to decrease the
risk of developing plaque (fatty deposits) in
your blood vessels.
Monitor and control your blood sugar level if
you have diabetes.
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26. THANK YOU
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