Stroke

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Definition
A stroke, or cerebrovascular accident (CVA), occurs when blood flow to an area of
the brain is interrupted.

Types

🧠 Ischemic stroke → caused by a thrombus that forms during a cerebral

atherosclerotic infarction

🧠 Hemorrhagic strokes → bleeding in the brain due to a ruptured blood

vessel

Diagnosis
With signs ans symptoms

Stroke 1
 Brain imaging using computed tomography (CT) is ideally performed within 20
minutes of arrival to the emergency department.

Ischemic stroke
Alteplase

🧠 MOA: tissue plasminogen activator (tPA or rtPA). It binds to fibrin in a

thrombus (clot) and converts plasminogen to plasmin, resulting in
fibrinolysis.

🧠 CI: Must exclude intracranial hemorrhage before use, evere uncontrolled

BP, Active bleed.

Stroke 2
 🧠 Note: ONLY with acute managment.
It can be administered within three hours of symptom onset.
Must keep BP < 180/105 mmHg for at least the first 24 hours after
treatment

Aspirin

🧠 MOA: binds irreversibly to cyclooxygenase-1 and 2 (COX- 1 and 2)

enzymes, resulting in decreased prostaglandin (PG) and thromboxane A2
(TXA2) production

🧠 CI: NSAID or salicylate allergy; children and teenagers with viral infection
(due to risk of Reye’s syndrome)

🧠 SE: Dyspepsia, heartburn, nausea, tinnitus (in toxicity)

🧠 Note: Aspirin 162 - 325 mg PO within 24 - 48 hours after stroke onset is

recommended to prevent early recurrent stroke.
Aspirin should not be given within 24 hours of Alteplase.

Clopidogrel

🧠 MOA: prodrug that irreversibly inhibits P2Y12 ADP-mediated platelet

activation and aggregation.

🧠 CI: Serious bleeding, Tests to check CYP2C19 genotype.

Stroke 3
 🧠 SE: Gastrointestinal hemorrhage, hematoma, pruritus

🧠 Note: Stop 5 days prior to elective surgery.

Do not use in combination with aspirin long-term for stroke prevention

Hemorrhagic strokes
Managment

Reversal of the anticoagulant effects should be considered

Prophylactic anticonvulsant medication should not be used
These include elevating the head of the bed by 30 degrees and using mannitol or
hypertonic saline.

Mannitol

🧠 MOA:Mannitol produces an osmotic diuresis, use for Increased

intracranial pressure (ICP) by withdrawing water from the brain
parenchyma and excreting it in the urine.

🧠 CI: Severe renal disease (anuria), severe dehydration, progressive heart

failure.

🧠 SE: Fluid and electrolyte loss, dehydration, hyperosmolar-induced

hyperkalemia, acidosis,

🧠 Note: Maintain serum osmolality < 300-320 mOsm/kg

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Stroke 4
Stroke 5