What if a blood vessel to the brain becomes blocked? Let's talk about embolic stroke!

What happens if a blood clot that forms somewhere in our body breaks loose and gets stuck in a blood vessel in our brain? It's a scary thought, isn't it? Yes, this is what we call an 'embolic stroke'. This is a life-threatening medical emergency. When something like this happens, every second counts, so getting treatment as soon as possible is the most important thing.

What is an embolic stroke? Let's understand it simply.

Simply put, an embolic stroke is when a blood clot or something else (we call this an 'embolism' ) gets stuck in a blood vessel that carries blood to the brain, stopping the flow of blood to a part of the brain, causing damage to that part. This belongs to the larger category called 'ischemic stroke' . Think of it like a piece of debris getting stuck in a water pipe and stopping the flow. Here, this 'embolism', which means a blood clot, often forms in a large blood vessel elsewhere in the body, perhaps in the heart, and breaks free from there, travels through the bloodstream and gets stuck in a relatively small blood vessel in the brain. Then the part of the brain that is supplied with blood by that vein does not receive oxygen and nutrients.

What are the symptoms of an embolic stroke?

The symptoms are similar to other types of ischemic strokes. They can come on suddenly , so it's important for you and your loved ones to be aware of them.

• Aphasia is a condition in which the ability to speak is impaired or completely lost. You may not even be able to understand what is being said.
• Sudden blurring of vision , double vision (Diplopia), or loss of vision in one or both eyes.
• A sudden feeling of confusion and confusion, forgetting where you are and what time it is.
• In some severe cases , there is complete loss of consciousness (Coma).
• Vertigo is a feeling of spinning and loss of balance .
• A sudden, severe headache . This is different from a normal headache and can be unbearable.
• Amnesia is the sudden loss of memory .
• Sudden changes in behavior , like just getting angry or upset.
• Nausea and vomiting .
• Feeling a tightness in the neck .
• To be dragged and fall unconscious .
• Having a fit (Seizures) .
• Slurred speech and inability to pronounce words correctly (Dysarthria).
• The sudden reduction or complete loss of sensory sensations such as sight, hearing, smell, taste, and touch .
• Numbness, tingling, or weakness on one side of the face or body .

What are the warning signs of an embolic stroke? Remember to 'BE FAST'!

It's important to remember the meaning of the English words 'BE FAST' to recognize if you or someone you know is having a stroke. Every second counts at this time! The sooner you act, the less damage you can do.

• B - Balance: See if you suddenly lose your balance or if you stumble while walking.
• E - Eyes: Check for sudden loss of vision, blurred vision, or double vision .
• F - Face: Smile and look. See if one side of the face droops or looks pulled.
• A - Arms: Raise both arms forward. If you have a stroke, one arm may not be able to be raised properly and may fall down or may have difficulty holding it up.
• S - Speech: See if your or the other person's speech is slurred, has difficulty choosing the right words, or is difficult to understand .
• T - Time: Time is of the essence! If you notice any of these symptoms , call 911 immediately and get an ambulance . If possible, look at your watch or phone to remember the time your symptoms started. When you tell a doctor that time, it will be easier for them to choose the best treatment.

What causes embolic stroke?

The main cause of an embolic stroke is, as we mentioned earlier , an 'embolism' . This means that a blood clot (usually an air bubble, fat particle, or other object) that forms in one place in the body breaks away from there, travels through the bloodstream, and becomes stuck in a blood vessel in the brain.

There are several diseases that can cause blood clots to form:

• Atrial Fibrillation: This is a condition in which the upper chambers of the heart (atria) do not contract properly, but instead beat rapidly and irregularly. This causes blood to pool inside the heart, making it more likely that blood clots will form. These are the ones that are most likely to break loose and travel to the brain.
• Atherosclerosis: This is when fatty deposits like cholesterol build up inside the blood vessels (arteries), causing the walls of the arteries to harden and narrow. These fatty deposits (plaques) can break off and block the arteries in the brain.
• Clotting disorders: Some people may have a tendency to have their blood clot easily, either due to genetic factors or other diseases.
• Some infectious conditions, such as COVID-19 infection, also increase the risk of blood clots.
• Infections that cause tissue death . For example, in sepsis , a severe infection, bacteria or pieces of dead tissue can get into the blood and travel to the brain. This can also happen in heart valve infections (infective endocarditis).

A mini-stroke - embolic transient ischemic attack (TIA)

Sometimes a transient ischemic attack (TIA), also known as a mini-stroke, can occur. This is similar to a stroke, in that the blood supply to the brain is temporarily interrupted. However, symptoms usually resolve within a few minutes to an hour or two as the clot dissolves or moves around and is released from the blockage. However, this is a warning sign that you are at high risk of having a major stroke in the future . A person who has had a TIA may need immediate medical attention to determine the cause and begin treatment to prevent a major stroke.

Who is at higher risk of developing embolic stroke?

Anyone can have an embolic stroke, but some people are at higher risk:

• For black people.
• For people over 65 years of age (the risk increases with age).
• For those who smoke or use other tobacco/nicotine products (e.g., vapers, chewers). Smoking damages blood vessels and contributes to blood clots.
• For those who use drugs (especially cocaine and amphetamines) .

Also, people with certain medical conditions are at higher risk:

• For those who drink excessively (Alcohol use disorder).
• For people with diabetes . Diabetes can damage blood vessels.
• For those with high blood pressure (hypertension) . If this is not controlled, it can cause long-term damage to the blood vessels.
• For people with high cholesterol (Hyperlipidemia) in the blood . This causes 'atherosclerosis'.
• People with heart disease (e.g. atrial fibrillation, heart valve problems, previous heart attacks).

How to recognize an embolic stroke? (Diagnosis)

A doctor is the one who can tell you for sure what an embolic stroke is. When you go to the hospital, the first thing they do is ask about your symptoms, like when they started. Then they do a neurological exam . This checks your speech, vision, strength, and reflexes. They also do a general physical exam and a few other tests.

Tests like these are used to confirm a stroke:

• Blood tests: Check for things like blood clotting problems, sugar levels, and cholesterol.
• CT scan: This takes pictures of the brain and can quickly determine whether there is bleeding or a blocked blood vessel (ischemic stroke).
• MRI scan: This gives more detailed images than a CT scan. It helps to see exactly what damage has occurred to the brain.
• ECG (Electrocardiogram - EKG) test: This tests the electrical activity of the heart to check for heart rhythm problems such as atrial fibrillation.
• EEG (Electroencephalogram - EEG) test: This can also be done to check the electrical activity of the brain, as conditions like seizures can sometimes be confused with a stroke.
• Carotid Ultrasound: Checks for fatty deposits and narrowing of the main blood vessels in the neck (carotid arteries).
• Echocardiogram: An ultrasound test of the heart. To check for blood clots in the heart and valve problems.

What are the treatments for an embolic stroke?

The most important thing when treating an embolic stroke is to restore blood flow to the brain as quickly as possible . Doctors do this as quickly as possible because this can reduce permanent brain damage and even save lives. There's a saying that goes, "Time is Brain," meaning that every moment that passes without time, brain cells die.

There are two main treatment methods that are often used:

• Thrombolytic therapy: These are blood-clotting medications (e.g., Alteplase). These medications are injected into a vein to dissolve the blood clot and restore blood flow. Doctors usually only give these if you arrive at the hospital within four and a half hours (4.5 hours) of the onset of stroke symptoms . Giving them later can increase the risk of bleeding inside the brain.
• Mechanical thrombectomy: This is a non-surgical procedure that uses a special device to remove a blood clot. A surgeon (interventional neuroradiologist) inserts a small, thin tube (catheter) through a large vein in the groin or arm and advances it to the blood clot in the brain under X-ray guidance. The clot is then retrieved using a mesh-like device called a stent retriever or a suction catheter. This can usually be done within 6 hours of the onset of stroke symptoms, but can be done up to 24 hours in some cases. This is best for people with a blood clot in a large vein.

In addition, other treatments may be needed:

• Controlling blood pressure and blood sugar levels: Your doctors will monitor your blood pressure and blood glucose levels regularly to help your brain heal. To reduce brain damage, they may prescribe medication to lower or (in some cases) raise your blood pressure.
• Blood thinners: Anticoagulant (e.g., Warfarin, Apixaban) or antiplatelet (e.g., Aspirin, Clopidogrel) medications stop the blood from clotting easily. You may need to continue taking these medications after thrombolytic therapy, depending on the cause of the stroke, to help prevent another stroke.
• Endarterectomy or stent placement: If the carotid arteries in the neck are severely narrowed by fatty deposits (carotid stenosis), the fatty deposits can be surgically removed (endarterectomy) or a stent can be inserted through the artery to open it up. This can reduce the risk of another blood clot (embolism).
• Mild intentional hypothermia: In some cases, doctors can safely lower your body temperature slightly. Some studies show that this may help reduce brain damage during and after a stroke, but this is not yet a standard treatment.
• Oxygen therapy: During a stroke, the brain doesn't get enough oxygen. If your blood oxygen levels are low, doctors may give you extra oxygen through a nasal cannula or a face mask. This makes it easier to breathe and helps send oxygen to your body and brain.

How is rehabilitation after an embolic stroke?

Stroke rehab is a very important part of treatment. It is essential for you to adjust to the changes in your brain and body after a stroke and to regain as much of your lost ability as possible. The rehabilitation program is tailored specifically to you, based on your needs. This may involve the help of therapists such as:

• Physical therapy: Strengthen your muscles, improve your balance, and regain the ability to walk and use your arms and legs.
• Occupational therapy: Helps you learn to do your daily tasks (like eating, dressing, and bathing) independently again. It also helps you safely perform household and work tasks, especially those that require fine body movements.
• Speech therapy: Helps you regain or improve your language and speaking skills (Aphasia, Dysarthria). It also trains you to control the muscles that help you speak, breathe, eat, and swallow (Dysphagia).
• Cognitive rehab: Improve your memory, attention, problem-solving skills, and other mental abilities (if affected by stroke).
• Psychiatric counseling may also be necessary, as it is common to experience depression, anxiety, and mood swings after a stroke.

What are the chances of surviving an embolic stroke?

The number of people surviving a stroke is increasing every day, as we find new, faster treatments. However, there is no single recovery time or prognosis that works for everyone.

Experts say that about 80% of people who have an embolic stroke survive for at least a month . After your first stroke, your risk of having another stroke increases. People who have had multiple strokes have a lower survival rate. That's why it's so important to prevent another stroke.

How long does it take to recover from an embolic stroke?

Everyone's body responds differently to an embolic stroke. What you can expect (`prognosis`) depends on several factors:

• How quickly you received treatment .
• Which parts of the brain were affected and to what extent .
• Your age and overall health (whether you have other medical conditions).
• How well you participate in the rehabilitation program .

It can take months to a year or more for most people to achieve some level of recovery. Some people may have to live with permanent disabilities. Your doctor will tell you what to expect. They will help you set goals and expectations for your recovery that are appropriate for your health and condition.

How do we prevent an embolic stroke?

The best way to prevent embolism and embolic stroke is to maintain your overall health and control your risk factors . Try to do these things:

• Exercise regularly (at least 30 minutes 5 days a week).
• Eat a well-balanced, nutritious diet (more fruits, vegetables, legumes, and whole grains with fiber, less salt, sugar, and fat). Maintain a healthy weight. Your doctor may recommend that you follow a diet plan like the Mediterranean diet .
• Check your blood pressure, cholesterol, and blood sugar levels regularly and keep them under control . Take your medications exactly as prescribed by your doctor.
• Quit smoking completely and avoid being in places where others smoke.
• Limit or stop drinking alcohol completely.
• If you have a heart condition like atrial fibrillation, get the proper treatment for it.

See a doctor every year (or as your doctor recommends) for a check-up . Many diseases and problems that can cause embolic strokes develop over time. They may even make you feel better. Your doctor can help you recognize and manage warning signs before they increase your risk of stroke.

How do I take care of myself after an embolic stroke?

Recovering and rehabilitating after a stroke can be a long, drawn-out process. Once you and your doctor have developed a treatment plan, stick to it as closely as possible. In general, you should:

• Be sure to attend your rehab and other therapy classes . Do the exercises your therapists give you at home. Tell your therapists if you feel uncomfortable or unsafe doing anything. Rehabilitation is hard work, but you don't have to be in pain or discomfort all the time.
• Think about your mental health too . Depression and anxiety are very common after a stroke. It's normal to think things like, "Why did this happen to me?" "Will I ever be the same again?" Feeling sad or disappointed doesn't make you weak or a failure. Your mental health is just as important as your physical health. If you feel like you need help figuring something out during your recovery, talk to a doctor or a mental health professional (counselor, psychiatrist). Support from family and friends is also very important at this time.
• Take your medications exactly, on time, and in the correct dosage . This is especially important if you are taking blood thinners, high blood pressure, cholesterol, or diabetes medications. It is important to reduce the risk of blood clots in the future, and taking your medications as your doctor tells you to do will help your body heal.

When do I need to go to the Emergency Department (ETU) again?

If you think you are having another stroke (remember to BE FAST!) , call 911 or your local emergency number immediately . The risk of serious complications and death is even higher if you have another stroke . Don't delay in asking for help or going to the emergency room.

People who have had an embolic stroke are at risk for more serious complications, such as:

• Blood clots in the deep veins of the legs (Deep vein thrombosis - DVT): swelling, redness, pain in the leg.
• Heart attack: Chest pain, difficulty breathing.
• Pneumonia: Fever, cough, difficulty breathing (especially in people with difficulty swallowing, food can enter the lungs - Aspiration Pneumonia).
• Pulmonary embolism: Sudden shortness of breath, chest pain, and rapid heartbeat. This may be caused by a blood clot that breaks free from a DVT.
• Having a fit (Seizures).

If you experience symptoms of these complications, call emergency services immediately or go to the emergency room.

What questions should I ask my doctor?

After you have had a stroke, you and your family may have many questions. Don't be afraid to ask your doctor about them.

• "Why did I have this stroke? Where did the blood clot (embolism) form?"
• "What disease or problem caused this?"
• "What is my risk of having another stroke?"
• "What medications do I need to continue taking, how do I take them? What are their side effects?"
• "What changes do I need to make in my daily life? Things like diet, exercise, etc."
• "How long will I have to do rehabilitation?"
• "Will I be able to drive and go to work again? When will that be?"

"Having a stroke can change your life. But that doesn't mean you're not you. Remember to give yourself credit for how much you're achieving during your rehabilitation and recovery. Even if it doesn't always feel like it, every little success is worth celebrating."

Talk to your doctors about what you can do to prevent another stroke in the future. They can help you adjust your daily routine to reduce your risk of having another stroke. Don't be afraid to ask questions. You are the best advocate for yourself and your health , and you have the right to understand everything they tell you.

Some things that I think are important for you (Take-Home Message)

Okay, so let's simply look at some of the things we need to remember from what we've talked about.

• An embolic stroke is when a blood clot that forms elsewhere in the body (often in the heart) becomes lodged in a blood vessel in the brain. This is a medical emergency!
• Be aware of the 'BE FAST' signs (loss of balance, changes in vision, drooping of the face, numbness in an arm, slurred speech). If you see these signs , call 1990 immediately . Time is of the essence.
• High blood pressure, diabetes, heart disease (especially atrial fibrillation), high cholesterol, and smoking are major risk factors for this.
• It is very important to start treatment as soon as possible. Thrombolytic therapy and mechanical thrombectomy are the main treatments.
• Rehabilitation is essential after a stroke. Speech therapy, physical therapy, occupational therapy, and cognitive therapy can help with this.
• To prevent another stroke, it is very important to make healthy lifestyle changes (a good diet, regular exercise, complete cessation of smoking, and limiting alcohol) and follow medical advice exactly.
• You are not alone . There are doctors, therapists, family, and friends who can help you on this journey. Ask your doctor anything, ask for help. Mental health is just as important as physical health.

I hope you find this information useful, dear friends. Stay healthy and happy everyone!

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