STROKE
Dr. Ali Akhtar
Pharm.D
MS (Clinical Pharmacy)
PhD (Clinical Pharmacy)
What is stroke?
Interruption of blood flow to the brain, resulting in damage to
the brain tissue.
Types of stroke:
• Ischemic Stroke (Blockage in an artery in the brain caused
by a blood clot)
• Haemorrhagic Stroke (Bleeding into the Brain when a blood
vessel bursts)
What is a (TIA)?
(transient ischemic attack)
• Symptoms of a stroke that last only for a short time. (minutes, up to
approx. 1 hour)
• A “mini strokes” or “warning strokes”.
• TIA can be followed by a full stroke.
• Seek immediate medical attention.
Signs and symptoms of a stroke or tia
• Sudden Weakness/Numbness
Sudden loss of strength or sudden numbness in the face, arm or leg
even if temporary
• Sudden Trouble Speaking
Sudden difficulty speaking or understanding or sudden confusion, even
if temporary
• Sudden Vision Problems
Sudden trouble with vision, even if temporary
• Sudden Headache
Sudden severe and unusual headache
• Sudden Dizziness
Sudden loss of balance, especially with any of the above signs
There are two types of risk factors for
stroke
• Non-modifiable
• Modifiable
Non-modifiable risk factors
• Age (>55 years);
• Family history;
• Gender (more common in men than women);
• Ethnicity (high risk groups are Asian, African-American &
Aboriginal);
• Certain medical condition increase your likelihood of having a stroke
or another stroke.
Modifiable risk factors
(medical conditions) (lifestyle)
• Previous Stroke or TIA; • Sedentary Lifestyle;
• High Blood Pressure; • Overweight;
• High Cholesterol; • Excessive Alcohol use;
• Heart Disease; • Stressful Lifestyle;
• Atrial Fibrillation; • Smoking;
• Diabetes. • Cocaine/Ecstasy use.
Epidemiology
• Third most common cause of death after cancer and ischemic heart disease
• Most common cause of severe physical disability
• Death rate is about 0.6 per 1000
• Incidence and prevalence of stroke is on the rise due to increasing adoption of
unhealthy lifestyle and an increasing life expectancy.
Diagnosis
Stroke happen fast and will often occur before an individual can be seen by a
doctor for a proper diagnosis.
The acronym F.A.S.T. is a way to remember the signs of stroke, and can help
identify the onset of stroke quickly:
• Face drooping: if the person tries to smile does one side of the face
droop?
• Arm weakness: if the person tries to raise both their arms does one
arm drift downward?
• Speech difficulty: if the person tries to repeat a simple phrase is their
speech slurred or strange?
• Time to call emergency services: if any of these signs are observed,
contact the emergency services.
There are several different types of diagnostic tests that doctors can use
in order to determine which type of stroke has occurred:
• CT scans of the brain are one of few ways to determine which type of
stroke a person has had.
• Physical examination: a doctor will ask about the patient’s symptoms
and medical history. They may check the blood pressure, listen to the
carotid arteries (a pair of blood vessels that supply oxygen-rich blood
to the brain and head) in the neck and examine the blood vessels at the
back of the eyes, all to check the indications of clotting.
• Blood tests: a doctor may perform blood tests in order to find out how
quickly the patient’s blood clots, the levels of particular substances
(including clotting factors) in the blood, whether or not the patient has
an infection.
• CT scan: a series of X-rays that can show hemorrhages, strokes,
tumors and other conditions within the brain.
• MRI scan: radio waves and magnets create a image of the brain to
detect damaged brain tissue.
• Carotid ultrasound: an ultrasound scan to check the blood flow of
the carotid arteries and to see if there is any plaque present.
• Cerebral angiogram: dyes are injected into the brain’s blood vessels
to make them visible under X-ray, in order to give detailed view of the
brain and neck arteries.
• Echocardiogram: a detailed image of the heart is created to check for
any sources of clots that could have traveled to the brain to cause a
stroke.
Treatment of stroke
Ischemic Strokes
• Aspirin can be given, as can an injection of a tissue plasminogen activator
(TPA)
• A carotid endarterectomy (a procedure to remove plaque buildup from
narrowed or blocked arteries)
• Angioplasty
Hemorrhagic Stroke
• Treatment can begin with drugs being given to reduce the pressure in the brain,
overall blood pressure, prevent seizures and prevent sudden constrictions of
blood vessels. If the patient is taking anti-coagulant or anti-platelet medication
like Warfarin or Clopidogrel, they can be given drugs or blood transfusions
to counter the medications' effects.
• Surgery can be used to repair any problems with blood vessels
that have led or could lead to hemorrhagic strokes. Surgeons can
place small clamps at the base of aneurysms or fill them with
detachable coils to stop blood flow to them and prevent rupture.
• Surgery can also be used to remove small arteriovenous
malformations (AVMs) if they are not too big and not too deep
within the brain. AVMs are tangled connections between arteries
and veins that are weaker and burst more easily than other normal
blood vessels.
Rehabilitation
• Strokes are life-changing events that can affect a person both
physically and emotionally, temporarily or permanently. After a stroke,
successful recovery will often involve specific rehabilitative activities
such as:
• Speech therapy: to help with problems producing or
understanding speech. Practice, relaxation and changing
communication style, using gestures or different tones for example,
all help;
• Physical therapy: to help a person relearn movement and co-
ordination. It is important to get out and about, even if it is difficult
at first.
• Occupational therapy: to help a person to improve their
ability to carry out routine daily activities, such as bathing,
cooking, dressing, eating, reading and writing.
• Joining a support group: to help with common mental
health problems such as depression that can occur after a
stroke. Many find it useful to share common experiences and
exchange information.
• Support from friends and family: to provide practical
support and comfort. Letting friends and family know what
can be done to help is very important.
Prevention
The best way to prevent a stroke is to address the underlying
causes. This is best done by living healthily, which means:
• Eating a healthy diet;
• Maintaining a healthy weight;
• Exercise regularly;
• Not smoking;
• Avoiding alcohol or moderating consumption.
Other measures taken to help reduce the risk of stroke include:
• Keeping blood pressure under control;
• Managing diabetes well;
• As well as these lifestyle changes, a health care provider can help to
reduce the risk of future strokes through prescribing anti-coagulant
and anti-platelet medication. In addition to this, the arterial surgery
previously mentioned can also be used to lower the risk of repeat
strokes.
