acute

Stroke (Emergency Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Ischemic Stroke - StatPearls (NCBI Bookshelf NBK499997) - https://www.ncbi.nlm.nih.gov/books/NBK499997/: "An organized stroke protocol is highly recommended to expedite patient evaluation and treatment", "a plain CT scan of the head is recommended within 20 minutes of patient presentation to exclude hemorrhage", and "tPA or TNK should be considered if a thrombotic cerebrovascular accident (CVA) is identified within 4.5 hours of symptom onset." · ESO Guidelines for the management of ischaemic stroke 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111)

Verified against2 documents

Ischemic Stroke - StatPearls (NCBI Bookshelf NBK499997) - https://www.ncbi.nlm.nih.gov/books/NBK499997/: "An organized stroke protocol is highly recommended to expedite patient evaluation and treatment", "a plain CT scan of the head is recommended within 20 minutes of patient presentation to exclude hemorrhage", and "tPA or TNK should be considered if a thrombotic cerebrovascular accident (CVA) is identified within 4.5 hours of symptom onset."
Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

Pin down when the patient was last known to be well, along with risk factors and current medicines
With bleeding into the brain, the deficit typically deepens over minutes to a few hours [bleeding]
Nausea, vomiting and headache are the usual complaints when the brain has bled [headache · nausea · vomiting]
Fits with a brain bleed come at the moment of bleeding or within 24 hours [bleeding · seizures]
A bleed into the surface spaces announces itself as a sudden, violent headache, the worst ever felt [headache]
It usually comes with neck pain or stiffness, dislike of light, vomiting, muddled thinking or a blackout [confusion · neck pain · photophobia · syncope · vomiting]
Some describe a warning headache days or weeks earlier [headache]
Both kinds of bleed usually begin during ordinary activity, rest or sleep, not only on exertion
Low blood sugar, a fit and migraine are the mimics that most often masquerade as stroke [hypoglycaemia · seizures]

Signs — what you find (6)

Check the vital signs and carry out a targeted neurological examination
With a surface bleed, look for loss of vision in one eye, visual neglect and paralysed eye movement [loss of vision · paralysis]
Fundoscopy may show retinal, subhyaloid or vitreous bleeding [bleeding]
Third or sixth nerve palsy, one-sided weakness, loss of speech or profound apathy may all appear [cranial nerve palsy · one-sided weakness]
Getting worse in hospital is common and usually means the collection of blood is enlarging
No bedside assessment can separate a brain bleed from the alternatives without a scan

Tests (11)

Anyone with a suspected stroke needs emergency brain imaging on arrival, before any specific treatment
A plain CT or an MRI is enough to exclude bleeding before clot-busting treatment is given
Within 6 hours of onset with a small infarct core, CT or MR angiography selects patients for clot retrieval
From 6 to 24 hours with a large-vessel blockage at the front, use diffusion-weighted MRI with or without perfusion imaging
For a wake-up stroke or unknown onset time, MRI showing diffusion change without FLAIR change decides on thrombolysis
After a brain bleed, CT angiography in the first few hours picks out those whose collection of blood may enlarge
Repeat head CT scans through the first 24 hours to see whether the bleed has grown
A surface bleed is diagnosed on plain CT; if it is negative and suspicion stays high, do a lumbar puncture
When CT angiography is inconclusive, catheter angiography with 3D reconstruction is the gold standard for aneurysms
Measure blood glucose in everyone before thrombolysis, because both high and low sugar copy a stroke
Do a baseline ECG and troponin, but never let either delay thrombolysis or clot retrieval

If not this — what else fits (6)

A fit is the condition most often mistaken for a stroke
Fainting, sepsis, an ordinary headache disorder and a brain tumour complete the top five
Low blood sugar is the treatable mimic to exclude first
Migraine is a common mimic of stroke
Twenty diagnoses account for almost everyone who turns out not to have had a stroke or TIA
Telling a bleed from a clot needs a scan; clinical assessment alone cannot do it

Scores

Glasgow Coma Scale — How depressed is this level of consciousness?

SourceStatPearls "Acute Stroke" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Antiplatelet - after imaging, not before | Main treatment

ANTIPLATELET - AFTER IMAGING, NOT BEFORE

ACETYLSALICYLIC ACID

Antiplatelet - after imaging, not before

1st line

Strength300 mg

Formoral.solid

Adult dose and duration

NOT IN THE CLINIC AND NOT BEFORE THE SCAN. Once a haemorrhage has been excluded and the thrombolysis decision has been made: 75 to 150 mg once daily; up to 300 mg daily may be needed acutely, for a short period. - Within 24 to 48 hours of symptom onset - but 24 hours after intravenous alteplase if that was given - and continued

Paediatric dose

Stroke in a child is a different problem with different causes and is not covered here. The formulary's standing rule applies: do not give aspirin under 18 in a child who has or is recovering from chickenpox or an influenza-like illness, because of Reye's syndrome.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph, p111)

Why

The cited article recommends antiplatelet treatment with aspirin within 24 to 48 hours of symptom onset, and gives no amount. The Egyptian formulary names ischaemic stroke and transient ischaemic attack among the vascular indications for acetylsalicylic acid and gives 75 to 150 mg once daily, with up to 300 mg for a short time in acute cases.

Cautions

THIS IS NOT A REASON TO DELAY THE AMBULANCE, AND NOT SOMETHING TO GIVE BEFORE IT ARRIVES. It is printed so that a GP knows what the patient will be started on and when, not so that it is started here.
IMAGING FIRST. Aspirin is for ischaemic stroke. Given in a haemorrhage it makes the bleed worse, and only a scan tells the two apart.
TIMING AROUND THROMBOLYSIS IS NOT OPTIONAL. The article states that aspirin is typically delayed until 24 hours after intravenous alteplase, and that intravenous aspirin must not be given within 90 minutes of starting it.
THE CLOCK IS THE POINT OF THE REFERRAL, NOT THE TABLET. The article gives alteplase at 0.9 mg/kg (10% as a bolus over a minute, maximum 90 mg over 60 minutes), or a single tenecteplase bolus of 0.25 mg/kg (maximum 25 mg) in a patient eligible for thrombectomy. Those are hospital decisions inside a narrow window - which is why the transfer comes first and this drug does not delay it.
DUAL ANTIPLATELET THERAPY IS A DEFINED SUBGROUP, NOT THE DEFAULT. The article limits aspirin with clopidogrel started within 24 hours to minor, non-cardioembolic ischaemic stroke in a patient who did not receive alteplase.
Do not give in hypersensitivity to NSAIDs, in asthma with rhinitis and nasal polyps, or in active peptic ulceration.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ASPOCID 300 MG 200 TABS.	CID	80.00 EGP (0.40/unit)

MAIN TREATMENT

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Adult dose and duration

Call emergency services immediately for urgent transport to a hyperacute stroke centre for emergency brain CT or MRI and revascularisation assessment (intravenous thrombolysis / mechanical thrombectomy). Do NOT give aspirin and do NOT lower the blood pressure in primary care - the aspirin entry above is what the patient is started on AFTER the scan has excluded a haemorrhage and after the thrombolysis decision, not before. - Immediate emergency transfer

Paediatric dose

Pediatric stroke requires immediate emergency transport to a tertiary pediatric intensive care unit with pediatric neurovascular capabilities.

Dose source

Why

Acute stroke is a time-critical emergency requiring emergency neuroimaging to differentiate ischemic from hemorrhagic stroke before any antithrombotic or antihypertensive treatment is initiated.

Cautions

TIME-CRITICAL EMERGENCY: Transport immediately to a stroke center capable of brain CT/MRI and IV thrombolysis (within 4.5 hours of onset) or mechanical thrombectomy (within 6-24 hours).
DO NOT administer aspirin, NSAIDs, anticoagulants, or antiplatelet therapy prior to neuroimaging excluding intracranial hemorrhage.
DO NOT acutely lower blood pressure in primary care pre-hospital setting. Rapid blood pressure reduction impairs cerebral perfusion to the ischemic penumbra; acute hypertensive management (>220/120 mmHg) is performed only in hospital after CT/MRI neuroimaging (NICE NG128 / ESO).
Check point-of-care capillary blood glucose immediately to rule out hypoglycemia, which mimics acute stroke.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.