Stroke

 Definition of Stroke
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing
brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.

A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain
damage and other complications. The good news is that many fewer Americans die of stroke now
than in the past. Effective treatments can also help prevent disability from stroke.

 Type of stroke

• Ischemic strokes: - Ischemic stroke is a stroke that characterised by the sudden obstruction of
blood vessel that supplies blood to an area of the brain, spinal cord or retina due to thrombus,
embolism or intracranial blood vessel disease.

• Haemorrhagic strokes: - haemorrhagic stroke occurs due to the rupture of blood vessel with
in the brain or cerebrospinal fluid. Haemorrhagic stroke has three sub-types. Those are-

A. Intraventricular haemorrhagic stroke- It refers to the bleeding within the ventricles.

B. Intracerebral haemorrhagic stroke- It refers to the bleeding with in the brain parenchyma.
C. Subarachnoid haemorrhagic stroke- It refers to the bleeding with in the sub arachnoid
space.

• Transient ischemic attacks (TIAs)

 ETIOLOGY
 For ischemic stroke: -
A. Embolism
B. Thrombus
C. Small vessel occultation
D. Systemic hypoperfusion
 For haemorrhagic stroke: -
A. Rupture cerebral artery or microaneurysm
B. Trauma
C. Reperfusion injury after ischemic stroke
D. arterial venous malformation

 RISK FACTORS
i. Age above 65 years
ii. Hypertension
iii. Diabetes mallitus
iv. Atrial fibrillation
v. Carotid artery stenosis
vi. Vasculitis
vii. Family history
 viii. Ischemic stroke

 CLINICAL MANIFESTATION
a. Weakness
b. Numbness (a loss of sensation)
c. Paraesthesia (an abnormal sensation, typically pricking or tingling)
d. Hemiparesis (muscle weakness or partial paralysis)
e. Dysphasia (problem in speaking)
f. Ataxia (impaired balance)
g. Dysphagia (swallowing difficulties)
h. Hemianopia
i. Severe headache, may be accompanied with nausea and vomiting

 DIAGNOSIS
A. Complete physical examination with vital signs, body temperature and oxygen
saturation.
B. Brief but through neurological examination.
C. CT and MRI are most important.
D. Routine investigation; like CBC, ESR, Hb, liver function test, serum electrolytes,
lipid profile, fasting and PP glucose level ETC.

 PHARMACOLOGICAL MANAGEMENT
Close attention is paid to the ABC; Airway, breathing and circulation of the patient.
Tab. Aspirin 75 mg OD.
Inj. Heparin 5000 IU SC.
Tab. Frusemide 40 mg OD.
Administer rtPA 0.9 mg/ kg IV (Max 90 mg/ kg IV) as 10 % of total dose by bolus,
followed by remainder of total dose over 1 hour.
Inj. Mannitol 20% 1g/ kg stat followed by 0.5 g/ kg IV infusion.

 NON-PHARMACOLOGYCAL MANAGEMENT
 Surgical clipping
 Endovascular coiling or endovascular embolization
 Stereotactic radiosurgery