# Cerebrovascular Disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Cerebrovascular Disease - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK430927/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND70 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) · Cerebrovascular Disease - disease-level clinical article (cerebrovascular-disease-full.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Egyptian National Drug Formulary - Cardiovascular - Cerebrovascular Disease - disease-level clinical article (cerebrovascular-disease-clinical.txt) - Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) - Cerebrovascular Disease - disease-level clinical article (cerebrovascular-disease-full.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) - Clopidogrel — oral.solid - Acetylsalicylic acid — 75 mg — oral.solid ## Complete treatment card ```text CEREBROVASCULAR DISEASE Sources: Cerebrovascular Disease - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK430927/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND70 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) · Cerebrovascular Disease - disease-level clinical article (cerebrovascular-disease-full.txt) Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Egyptian National Drug Formulary - Cardiovascular, Cerebrovascular Disease - disease-level clinical article (cerebrovascular-disease- clinical.txt), Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases), Cerebrovascular Disease - disease-level clinical article (cerebrovascular-disease-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (1) - The single most critical history item is time of symptom onset, or time last known normal, since it decides eligibility for thrombolysis or endovascular therapy SIGNS - what you find (9) - Subtle arm weakness on exam may show up only as a pronator drift - Facial weakness is tested by asking the patient to smile [facial weakness] - A gaze preference typically deviates the eyes toward the side of the lesion - Anterior cerebral artery infarct: motor aphasia, personality change, and contralateral leg weakness/numbness, with the hands and face usually spared [ischaemia · leg weakness · numbness · slurred speech] - Middle cerebral artery syndrome: contralateral arm and face numbness/weakness, gaze deviation to the affected side, aphasia with left-sided lesions, neglect with right-sided lesions [numbness · slurred speech] - Posterior cerebral artery infarct classically causes homonymous hemianopsia; deep PCA involvement can add hypersomnolence, cognitive change, and hemisensory loss [hemianopia · ischaemia] - Bilateral distal PCA infarction can cause cortical blindness with denial of the deficit, called Anton-Babinski syndrome [ischaemia · loss of vision] - Cerebellar stroke presents with ataxia, dysarthria, nausea, vomiting, and vertigo [nausea · slurred speech · unsteadiness · vertigo · vomiting] - Lacunar strokes are pure motor, pure sensory, or ataxic-hemiparetic, and generally spare memory, cognition, consciousness, or speech [unsteadiness] TESTS (8) - Initial workup follows the ABCs, with a rapid NIHSS exam run alongside IV access, telemetry, and blood draws - A stat noncontrast head CT, sometimes with CT angiography and perfusion imaging, follows right away - On CT perfusion, the infarct core shows matched reduced cerebral blood volume with prolonged transit time - irreversibly damaged tissue - The penumbra on CT perfusion shows prolonged transit time but preserved blood volume - salvageable tissue - On MRI, early hyperacute stroke raises DWI signal and lowers the apparent diffusion coefficient; beyond 6 hours, a FLAIR T2 signal appears - Baseline labs: metabolic panel, CBC, cardiac markers, coagulation profile (PT/INR/aPTT), lipid panel, and HbA1c - Transthoracic echo, telemetry, and neck-vessel imaging help pin down the stroke's cause - Elevated blood pressure in acute stroke should not be treated aggressively, and a baseline ECG is recommended IF NOT THIS - what else fits (2) - Metabolic and vascular stroke mimics: TIA, hypoglycemia, hyponatremia, and hemiplegic migraine - Structural and functional mimics: encephalitis, brain abscess, cerebral neoplasm, syncope, and conversion disorder Source StatPearls "Cerebrovascular Disease" - disease-level clinical article Status traced to the source above Rx: Main treatment | Antiplatelet - aspirin limb of dual antiplatelet therapy MAIN TREATMENT - choose one 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Covers a prior transient ischaemic attack, stroke, or investigation-confirmed cerebrovascular disease; a GP manages long-term secondary prevention with an antiplatelet, statin, and blood pressure control, while any new acute event needs emergency referral. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Covers a prior transient ischaemic attack, stroke, or investigation-confirmed cerebrovascular disease; a GP manages long-term secondary prevention with an antiplatelet, statin, and blood pressure control, while any new acute event needs emergency referral. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Use the ACT FAST acronym for recognizing early stroke symptoms: face droop, arm weakness, speech difficulty, time to call emergency. RED FLAG - Sudden new focal weakness, speech disturbance or facial droop is an acute stroke and an emergency. Recurrent transient neurological symptoms (crescendo TIA), or severe headache with neurological signs (possible haemorrhage), need urgent referral. 2. CLOPIDOGREL [2nd line] Adult 75 mg once daily Peds No paediatric dose is stated in the sources held for this drug. Source Egyptian National Drug Formulary - Cardiovascular Why Oral antiplatelet agent for secondary prevention of ischemic stroke and transient ischemic attack. Caution Increases bleeding risk - caution with other antiplatelets/anticoagulants and before surgery. Avoid in active pathological bleeding (e.g. peptic ulcer, intracranial haemorrhage). Effectiveness is reduced by strong CYP2C19 inhibitors such as omeprazole - use pantoprazole instead if a PPI is needed. If combined with aspirin, bleeding risk is higher - confirm indication and planned duration of dual therapy. The disease article recommends the aspirin-plus-clopidogrel combination be started within 24 hours of a minor stroke or high-risk TIA and continued for 21 days to prevent early recurrence; the ENDF states no duration for dual therapy, so the length of the dual phase follows the treating stroke service. Egypt BLOTAGRIL 75MG 30 F.C. TABS. MEDIZEN PHARM... 33.00 EGP (1.10/unit) ITOLAVIX 75 MG 30 F.C. TABS. SIGMA > INTER... 54.00 EGP (1.80/unit) BORGAVIX 75MG 30 F.C. TABLETS BORG 66.00 EGP (2.20/unit) SIGAGREL 75MG 10 F.C. TAB. SIGMA 30.00 EGP (3.00/unit) CLOPACIRC 75 MG 30 F.C.TABS. COPAD PHARMA 117.00 EGP (3.90/unit) IDIAVIX 75MG 10 F.C.TAB. INTERNATIONAL... 48.00 EGP (4.80/unit) PLAVIX 75 MG 28 F.C.TABS. SANOFI WINTHR... 311.00 EGP (11.11/unit) PLAVIX 300 MG 30 F.C.TABS. SANOFI WINTHR... 704.00 EGP (23.47/unit) ANTIPLATELET - ASPIRIN LIMB OF DUAL ANTIPLATELET THERAPY 3. ACETYLSALICYLIC ACID [2nd line] Adult 75 to 150 mg once daily; higher doses up to 300 mg may be needed in acute cases for a short time Peds Not applicable - an adult cerebrovascular condition. The ENDF's paediatric aspirin figures are for thromboprophylaxis after cardiac surgery and for Kawasaki disease, not for this indication. Source Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, management of cardiovascular diseases) Why The card carried clopidogrel alone. The disease article's 2019 update strongly recommends dual antiplatelet therapy - aspirin AND clopidogrel - within 24 hours of a minor stroke or high-risk TIA, continued for 21 days, so the card named one half of a two-drug regimen. The ENDF's aspirin indications name ischemic stroke and transient ischemic attack explicitly. The article's 21-day limit on the DUAL phase is a decision for the treating stroke service and is stated in the cautions rather than written into this row's duration field, because the ENDF states no duration for it. Caution Hypersensitivity to NSAIDS Patients with asthma, rhinitis, and nasal polyps Active peptic ulceration Use in children or teenagers for viral infections, with or without fever. The disease article recommends the aspirin-plus-clopidogrel combination be started within 24 hours and continued for 21 days to prevent early recurrence; the ENDF states no duration for dual therapy, so the length of the dual phase follows the treating stroke service. Egypt AGGREX 75MG 60 TABS. RAMEDA 33.00 EGP (0.55/unit) ASPOCID 75MG 20 TAB. CID 22.00 EGP (1.10/unit) ASPOCID 75MG 30 TAB. CID 33.00 EGP (1.10/unit) ASPIRIN-CHEMIPHARM 75 MG 30 CHEW.TABS. CHEMIPHARM 12.00 EGP RIVO 75 MG 30 CHEW. TABS. ARAB DRUG COM... 21.00 EGP ASPOCID PAEDIATRIC 75MG 30 CHEW. TABS. CID 35.00 EGP EZACARD 75 MG 30 E.C. TABS. MULTI-APEX 51.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)