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Blood clot in brain/stroke:
Understanding Symptoms, Diagnosis and Treatment

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1.What is a Stroke?

A stroke is synonymously used to describe a blood clot in the brain. Another term that is often used to describe a stroke is a brain attack. A stroke occurs when blood is unable to flow to a part of the brain or a reduced amount of blood flows to the brain. When this happens, the tissues in the brain are unable to get the required nutrients and oxygen. If this goes on for too long, then the cells in the brain begin to die. A stroke brain clot is considered a medical emergency which is why promptly treating the problem should be the priority. The earlier the action is taken, the higher the chances of recovery.

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2.Warning signs and symptoms of stroke

There are certain warning signs and symptoms of stroke that you should know. If you or someone you know has any of the following symptoms, then you should seek medical attention immediately.

  • All of a sudden, you are unable to see properly. Your vision is blurred. You may feel like you are seeing only black. You may start to see double of everything; this can happen with one or both of your eyes.
  • You cannot form words, you will have difficulty saying something. You suddenly feel very confused and are unable to understand what someone is saying to you. When you speak, your speech is slurry making it difficult for others to understand.
  • You may have trouble swallowing food and this can indicate a brain clot. You may be unable to swallow any type of liquids, as well. When you try to swallow you might feel like you are choking on the food or drink.
  • You can develop a sudden headache, that is severe. You can experience a headache only or you can experience other symptoms along with a headache. For example, you might feel like you need to vomit or you might feel giddy.
  • One side of your body may feel numb or paralyzed. This can happen in your leg, face or arm. Your mouth might feel like it is unable to stay in position and may droop as a result. When you try and raise your arms, one of your arms may be unable to rise.
  • You might suddenly experience difficulty in walking. This is because you suddenly feel giddy. You might feel like your coordination is being lost and you might feel like you are unable to balance yourself, properly.

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3.Types of stroke

Types of stroke

Ischemic stroke

About 90% of strokes are ischemic strokes. This stroke is caused by a brain blood clot. In this, a clot in the brain stops the blood flow that travels to the neck or the brain. The clot in the brain is formed inside the blood vessel, and there can be more than one clot. It is not necessary that the blood clot in the brain is the only reason a stroke occurs. If clots form in the upper chest or the heart, and the clot somehow blocks the blood that is flowing to the brain then you can still get a stroke; it is known as cerebral embolism. There are chances that the clot can dissolve by itself and if this happens, it is called transient ischemic attack or TIA.

Hemorrhagic stroke

Hemorrhagic stroke is another major stroke. This type of stroke is associated with bleeding that takes place in the brain and is usually the deadlier stroke variant. Usually, a hemorrhagic stroke occurs after an aneurysm. In this, part of the artery that is weak becomes bigger, which eventually leads to it bursting. Another scenario that can cause a hemorrhagic stroke is when the artery wall breaks because of fatty plaque. This happens over time and then can lead to hemorrhagic stroke. Blood thinners can cause brain hemorrhage; also, hypertension is another significant cause of brain hemorrhage.

There are two types of hemorrhagic strokes- subarachnoid hemorrhage and intracerebral hemorrhage. In subarachnoid hemorrhage, one of the main causes is an aneurysm burst. In this, the blood vessels start to narrow and widen, which can cause brain cell damage. This limits blood flow to the brain, which can cause further damage. Another cause is when an artery that is found near the brain’s surface bursts. This causes the blood to spill between the skull and the brain which can lead to severe headaches; The intense headaches indicate that bleeding has occurred.

Intracerebral hemorrhage can be caused by certain medications. These medicines include those taken for blood thinning, high blood pressure, or vascular malformations. There are some other conditions that can cause intracerebral hemorrhage. In this type of stroke, a blood vessel in the brain ruptures. When this happens, the blood is spilled where it reaches the brain tissue and it can harm the brain cells. The brain cells that are not affected by this are affected by the lack of blood supply. This results in damage to blood cells, until they eventually begin to die.

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4.Are you at risk?

The following are some of the factors that make you vulnerable to a stroke.

  • If you have a family history of someone who had a stroke, then you are quite likely to get a stroke.
  • People who are 65 or older are more prone to a stroke, although younger people can have a heart stroke, as well.
  • Any medicine that is used for blood thinning increases your chances of having a stroke. Medicines such as Warfarin and Apixaban are prime examples.
  • People who have had a stroke before, are likely to have a stroke again.
  • People in ethnic groups such as Alaska Natives, Hispanic descent, native Americans, and African-Americans are more likely to have a stroke.
  • Strokes affect more men than women, although it is more likely to affect women more severely than men.
  • You are more likely to have a stroke if you don’t exercise, use drugs, regularly smoke, or drink alcohol regularly.
  • Obese people are at risk of having a stroke.
  • Women who are pregnant can experience a stroke. Women who have taken birth control pills are highly likely to have a stroke too.
  • People who have conditions such as PCOS, sickle cell disease, diabetes, brain tumours, migraines, and conditions associated with excess bleeding are more prone to stroke.
  • People who have vascular or heart problems are more at risk of stroke.

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5.Complications that may arise

  • People who have experienced a stroke are more likely to become depressed. This can cause various emotional problems to crop up. People may have difficulty in controlling how they feel and this can impact them deeply.
  • People who have experienced a stroke may want to be alone all the time. They may become more withdrawn and may not want to speak to other people. They might become more impulsive too.
  • Stroke survivors may lose the ability to take care of themselves after they have suffered from a stroke. They may need help doing daily chores that were once easy for them. This means they will need help grooming themselves too.
  • People can have muscle movement-related problems. One side of the body may become paralyzed or there may be loss of control of certain muscles. Usually, it is one of the arms or one side of the face that is affected.
  • People who had a stroke are more likely to develop memory problems. In fact, 1 in 4 people are likely to have dementia after they have had a stroke and it is more prevalent in men than women.
  • People who had a stroke may experience a tough time when they try to swallow. This is because a stroke can affect the muscles that are in your throat and mouth. People can have trouble talking after a stroke too.
  • People who had a stroke may have difficulty in understanding things. This means their ability to make proper decisions is impaired as a result. People may have difficulty in thinking clearly and reasoning abilities too.
  • People may have a tingling sensation in the body part that was affected by the stroke. They can experience pain in certain areas of their body too. Some may experience numbness in the parts affected by the stroke.

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6.Diagnosis of a stroke

Diagnosis of a stroke

Firstly, your doctor will perform a physical exam. Then your blood pressure will be checked and the doctor will observe your heartbeat. The doctor will want to ensure that stroke symptoms are not caused by other conditions such as a heart problem, migraines, or low blood sugar. They will ask you about what you are experiencing and how you feel at the moment.They will ask you about whether you have speech or vision trouble, trouble paying attention, or numbness in any part of your body. He will check your balance and coordination and if you are having any trouble with that.

Once this is complete, he will perform two types of tests; blood tests and imaging tests. These are used to determine the type of stroke that you have. In a blood test, there are two particular factors that are going to be checked- clotting time and complete blood count. In blood count test, the number of platelets and electrolyte levels are going to be checked. For computing blood clotting time, prothrombin time test or PT and partial thromboplastin time or PTT are two tests that are used. Your doctor will check the blood clot rates, and if there is a problem then it will be shown in the form of delay in blood clotting.

There are various imaging tests that can be done, for instance, a carotid ultrasound will help find the fatty plaque that is causing problems by blocking arteries which carry blood to the brain. Angiograms help determine whether there is any type of blockage in your blood vessels. These tests are done on your neck and head. CT is another test that helps determine if bleeding in your brain has occurred. CT can help determine if your brain cells have been damaged. An echocardiogram is another test that helps determine whether there are clots present in your heart or not. MRI helps create a detailed brain picture so that any injuries to the brain can be detected.

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7.Emergency treatment in case of stroke

Having a stroke is an emergency situation. If you experience it, then you should contact emergency services immediately, without any delay. If you receive quick treatment, then the chances of your recovery are higher and you are more likely to survive. There are different emergency treatments, and they depend on the type of stroke.

Even a small blood clot in the brain can result in ischemic stroke. When you have an ischemic stroke, the doctor will try to dissolve the clot. Usually, aspirin is given to ensure that there is no further formation of clots. Otherwise, clot-busting drugs such as thrombolytics will be provided, in the case of ischemic stroke. Other types of emergency treatment can be mechanical thrombectomy. This is the use of catheters to remove the clot from the affected artery. This medical procedure can take place a day after stroke symptoms appear. Sometimes, surgery may be necessary to ensure the pressure in the brain is reduced.

If the doctor has found that it is hemorrhagic stroke then certain medications will be given. These help reduce the bleeding to occur and they help to decrease blood pressure as well. If you take blood-thinning medications then your doctors will prescribe medications to stop their effect because blood thinners make bleeding worse. Surgery might be required in some cases but this depends on how severe the blood loss is. In the surgery, excess blood is removed so that your brain is not under pressure. The surgery will help repair the blood vessel that has been damaged during the stroke.

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8.Prevention of a stroke

There are many ways in which you can prevent a stroke. The following are some of the strategies that you can adopt.

  • People with hypertension should control their blood pressure. You can do this by taking medications prescribed by your doctor and limiting your sodium intake. Stress management and weight management are important too.
  • You should quit smoking because it increases the risk of a stroke. You should avoid secondhand smoke as well.
  • Weight is an important factor that you should not ignore. Obese and overweight people are more prone to having a stroke which is why lowering your weight can be beneficial. This can help lower cholesterol levels and blood pressure too.
  • If you have diabetes, then you should ensure that you are taking your medicines and are able to successfully manage your diabetes.
  • Cholesterol raises the risk of a stroke. This is why controlling the level of cholesterol in your body is recommended. You can do this by making changes to your diet such as by decreasing consuming foods that are high in trans fats and saturated fats.
  • You should avoid taking illegal drugs such as cocaine. When you take cocaine, it causes your arteries to narrow which in turn decrease the flow of blood which increase chances of stroke.
  • Regular exercise and keeping fit is a good way to maintain overall health, as well as reducing the risk of a stroke. Include cardio exercise in your regime as this helps to improve blood vessel health, it is great for your heart too. Aim for at least 30 minutes of exercise every day.
  • You should avoid drinking alcohol and if you do need to drink, then drink in moderation. If you take medications then speak to your doctor about how much liquor you can consume safely.
  • You must include vegetables and fruits in your diet. Fresh fruits and vegetables that have high fibre content are recommended as these help prevent a stroke. You can try the Mediterranean diet but consult your doctor before resorting to any type of diet.

You can speak to your doctor about what changes you need to make to prevent a stroke from occurring.

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9.Treatment options to consider

In addition to the treatment options discussed above, in the emergency treatment section, there are other treatment options that are available. For instance, in the case of ischemic stroke, your doctor might recommend procedures to prevent a stroke from recurring. Carotid endarterectomy is one of the recommended medical procedures. In this process, plaque is removed from carotid arteries through an incision and then completed with stitching. This procedure is risky for people who have certain medical conditions or who are suffering from heart problems. Another option is using angioplasty and stents.

In hemorrhagic stroke, there are additional treatment options that are available if AVM or any type of vascular malformation has caused the stroke. Endovascular embolization is an option that helps the blood to clot. Another option is stereotactic radiosurgery which helps to treat vascular malformations. Surgical clipping might be recommended by your doctor.This procedure prevents an aneurysm from bursting; It can also help prevent further bleeding. Another medical procedure that is an option, is surgical AVM removal. This is only possible if the AVM is small and it can be easily accessed in your brain.

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10.Road to recovery

Recovery after a stroke

How you recover depends on how the stroke impacted you. The area of impact and the severity of the damage will help determine how you can recover. If brain tissue on the right side of your brain is affected during the stroke, then your senses and movement of the left side of your body are affected. If brain tissue on the left side of your brain is affected, then the impact can be seen on the right side of your body. You can experience movement-related problems, peech problemss, and language difficulty. The road to recovery from a stroke can be a tough one. Different people react differently to a stroke.

Some people are able to get back to their usual activities within a few days after a stroke. For other people, it can take many months to get back to normal. For some people, it can even take some years to get back to their normal self and be able to do what they could comfortably do. Recovery is an ongoing process and being positive throughout the whole process is the way to go when it comes to stroke. Knowing about what you can do to prevent stroke in the future is something you should speak to your doctor about too. You should openly speak to your doctor about any doubts and questions regarding aftercare.

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11.FAQs: All your concerns addressed

Q.   What is the outlook of Stroke?

  1. The outlook of a stroke depends on the type of stroke that you experienced. How quickly you got treatment after the stroke also determines the outlook. People who have ischemic strokes have a more favourable outlook than those who have hemorrhagic strokes. This is because hemorrhagic strokes have more complications associated with them which can lead to a host of other problems.

Q.   When should I contact emergency care?

  1. You should contact emergency care as soon as you notice any signs that signal that you or someone else has a stroke. Even if you feel that the symptoms are going away you should still contact emergency care. If you wait for the symptoms to go away then there can be severe brain damage as a result and it can even cause disability to occur. In some cases, it can also lead to death which is why you need to carefully observe if someone seems to be exhibiting stroke symptoms until emergency care is given.

Q.   What are the types of questions that you should ask your doctor?

  1. Once you have had a stroke, you should ask your doctors questions like how fast your recovery will be and if you need to make any lifestyle changes for faster recovery. You should ask about what activities you can do and which activities you should avoid doing. You can ask about what caused a stroke and if there are any chances for you to reduce your risk of having another stroke. Asking your doctor about therapy is a good idea too. You can ask about any medications that you can take to help you recover. You can ask about prevention techniques that will help prevent you from having another stroke.

Q.   I find it challenging to cope with the fact that I had a stroke. I feel depressed. What should I do?

  1. Firstly, it is important to know that it is normal to find difficulty in coping with a stroke experience. Stroke changes your life and it can easily take a toll on you emotionally. But giving up and living a life that you don’t enjoy is not recommended. While this is easier said than done, you must know that it is in your control to turn your life around. You need to accept the fact that it is a tough journey and it can take time. This will ensure that you can go a step further and do something about the turmoil that you are feeling. Make sure that you take rest and allow yourself the time you need to recover. There is no competition, and you always need to remember that.

    You can join a support group. If you are not so keen on meeting people then you can join online support groups. You should make it a habit to get out more often. Trying to get out of the house at least once a day will boost your morale and it will make you feel good. Go out for yourself. Make sure you have open communication with your loved ones so they know how they can help. Talking about your feelings can help you feel better. You can go celebrate the fact that you survived a stroke. Make your life about celebration, not about regret and sadness.

Q.   I have heard of the term ‘silent stroke’, what is that?

  1. A silent stroke is when a stroke takes place but you don’t know that you had a stroke. The reason is that the symptoms are not easy to spot. This does not mean that they don’t cause any brain damage because they do. In fact, they cause permanent brain damage. People who have had silent strokes are prone to memory problems and thinking problems. Silent strokes can lead to other types of strokes for which symptoms are easier to recognize. How do you know that you had a silent Stroke? While you cannot detect the stroke, brain scans will show the damage to the brain if you happen to have one.

    Your doctor will be able to tell if you are having a silent stroke without even testing. While silent strokes can affect many things, therapy can help. In this manner, you can regain your abilities over time.

Q.   Can you die from a brain stroke?

  1. Although strokes are a leading cause of death, it is not mandatory that every stroke is fatal. The severity of the effect of a stroke depends on the location and how fast one receives treatment.

    A constant supply of blood and oxygen is necessary for the brain to function. As blood flow to the brain is obstructed, the brain cells begin to die within minutes leading to permanent disability. A stroke can affect language, moods, vision and movement. It can lead to death if the brain is deprived of oxygen and blood for too long. Hence, early treatment is essential to increase the chances of surviving a stroke with little or no disability.

Q.   What does a stroke feel like?

  1. A stroke may feel like a severe headache in some, while others may not feel any pain. Recognizing the signs early can help save a life and prevent permanent brain damage. Some of the symptoms to watch out for include:
    • Feeling of numbness or weakness in the face. It may also be present on one or both sides of the body.
    • Difficulty speaking or understanding speech
    • Having trouble to see out of one or both eyes
    • Loss of balance or coordination and inability to walk

Q.   What are the risk factors of stroke?

  1. Some of the risk factors of stroke include:
    • High blood pressure
    • Smoking and exposure to second-hand smoke as well
    • Diabetes
    • High cholesterol
    • Obstructive sleep apnoea
    • Obesity
    • Physical inactivity
    • Heavy drinking
    • Drugs like cocaine or methamphetamine
    • Personal or family history of stroke, heart attack or transient ischemic attack
    • Cardiovascular diseases, such as atrial fibrillation, heart failure and other heart defects.

Q.   What preventive medications can you take?

  1. Your doctor may prescribe certain medications to reduce your risks of having a second stroke if you had an ischemic stroke. Some of the medications include:
    • Anti-platelet drugs: Platelets help to form clots. But if you had a stroke, you have to take anti-platelet drugs to make the platelet cells less likely to clot. Aspirin is the most commonly used antiplatelet medication.
    • Aggrenox is another medication that can be used to reduce the risk of blood clotting. Aggrenox is a combination of low-dose aspirin and the anti-platelet drug dipyridamole. If you can’t take aspirin, clopidogrel may be prescribed.
    • Anticoagulants: Anticoagulant drugs work to reduce blood clotting. Heparin is a fast-acting may be used short-term in the hospital. For long-term use, the slow-acting warfarin drug can be used. Warfarin is a powerful blood-thinning drug, so it needs to be taken as directed. Other medications include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). These drugs are shorter acting than warfarin and usually don’t need regular blood tests or monitoring. These drugs are also associated with a lower risk of bleeding complications.

Q.   How likely is a second stroke?

  1. Stroke is a serious medical condition and is the second leading cause of death in the world. Surviving one stroke won’t ensure that the individual is not likely to get another one. To prevent its recurrence, lifestyle changes and medications are necessary. Some of the ways to prevent it are:

    Stop smoking: Smoking is the leading cause of several illnesses including strokes. Cutting out on tobacco products prevents the stress that it puts on the blood vessels in the brain, heart and other body parts. This will also reduce the chances of getting cancers. Medications: It is recommended to not skip doses or slack off on the medicines that were prescribed to control your cholesterol, blood pressure or diabetes.

    Mediterranean dietary habits: Studies have proven that including lots of fruits and vegetables can lower the chances of stroke by twenty-one per cent. Another study found out that the dietary patterns consumed along the Mediterranean consisted of fruits, vegetables, whole grains, low processed foods, olive oil, which are constantly associated with a reduced rate of stroke.

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