What if a blood vessel in your brain gets blocked? Let's be aware of 'Thrombotic Stroke'!

Have you ever heard of a stroke that occurs when blood flow to the brain is blocked? Sometimes you suddenly lose your ability to speak, or you feel like you're losing control on one side of your body. This is what we call a 'thrombotic stroke.' This is a life-threatening emergency, so it's important for you and your loved ones to know what to expect.

What is 'Thrombotic Stroke'? Let's find out simply!

Simply put, a thrombotic stroke is a stroke that occurs when a blood clot (thrombus) forms inside a blood vessel in your brain and blocks it. Think of it like a piece of trash getting stuck in a water pipe and stopping the water from flowing. This blood clot prevents parts of the brain from getting the blood they need, which means oxygen and nutrients. Brain cells can't survive without oxygen for long, and if that happens, those cells start to die.

Any stroke caused by a blockage of a blood vessel like this is called an 'ischemic stroke'. 'Thrombotic stroke' is a special type of 'ischemic stroke'.

This is a medical emergency that can be life-threatening. So if you or someone you know is experiencing these symptoms, call 911 immediately and call an ambulance, or get them to the nearest hospital as soon as possible. Remember, every second counts. The sooner you get treatment, the more likely you are to reduce brain damage and save a life.

What are the symptoms of a 'thrombotic stroke'?

The symptoms of a thrombotic stroke are very similar to those of other types of ischemic stroke. One or more of these may occur suddenly, without warning :

• Double vision (diplopia) is when the vision in one eye suddenly becomes blurred.
• A sudden, unbearable headache.
• Loss of muscle control on one side of the face, such as a mouth pulled to one side, or an inability to close one eye properly.
• New onset nausea and vomiting.
• Passing out / Fainting.
• Slurring of words while speaking, as if stuttering, and slurring of words (Dysarthria).
• A sudden loss of sensation in one or more of your senses. This means that things like sight, hearing, smell, taste, and touch are suddenly lost.
• Difficulty speaking, or not being able to find the words to say, or even complete loss of speech (aphasia).
• Difficulty walking, feeling as if the body has lost its balance, as if it is not stepping on the ground properly (unsteady gait).
• Not responding to anything. There may be no response to talking or touching.
• Paralysis or weakness of one side of the face and body (right or left side).

Because these symptoms occur suddenly, it is very important to pay attention to this.

Warning signs of a stroke: Remember to 'BE FAST'!

To recognize if you or a loved one is having a stroke, remember these English letters that mean 'BE FAST'. Let's see what they mean:

• B - Balance: Check for sudden loss of balance or unsteadiness when walking.
• E - Eyes: Look for sudden loss of vision, blurred vision, or double vision in one or both eyes.
• F - Face: Ask the viewer to smile. See if one side of the face seems to droop or droop.
• A - Arms: Ask them to raise both arms straight out in front of them. See if one arm falls down or seems weak, unable to lift as high as the other.
• S - Speech: See if your words get jumbled, if you have difficulty choosing the right words, or if you can't speak at all. See if you can say a simple sentence correctly when asked.
• T - Time: Time is very, very valuable! Try to remember exactly when these symptoms started. If possible, look at a watch or phone and write down the time. This will help doctors choose a treatment. If you have any of these symptoms, call 1990 immediately without delay!

What are the causes of 'thrombotic stroke'?

We now know that a 'thrombotic stroke' is caused by a blockage in a blood vessel inside your brain. 'Thrombus' is the medical term for a blood clot. 'Thrombosis' is the process by which a blood clot forms. So, a 'thrombotic stroke' is a 'thrombus', meaning a stroke caused by a blood clot.

There are several health conditions that can contribute to blood clots forming in this way:

• Atherosclerosis (hardening/clogging of the artery walls): This is when cholesterol and fat build up inside our blood vessels, causing the walls of the arteries to gradually thicken and harden, narrowing the passage for blood. It's like rust building up inside an old water pipe. These narrowed areas are more likely to form blood clots.
• Atrial Fibrillation: This is a condition in which the heart beats irregularly. Because the heart does not beat properly, blood clots can form inside the heart, which can travel to the brain and block the arteries.
• Clotting disorders: Some people may have a tendency to clot easily, either from birth or due to diseases that develop later.
• Covid-19: Covid-19 infection has also been found to increase the risk of blood clots in some cases.
• High blood pressure (Hypertension): High blood pressure damages blood vessels and increases the risk of blood clots forming in them.
• High cholesterol / Hyperlipidemia: As cholesterol levels increase, the risk of developing atherosclerosis increases.
• Infections: Blood clots can also form due to things like certain bacterial or fungal infections, sepsis, and heart valve infections.

Let's also learn about 'Transient Ischemic Attack' (TIA).

A 'transient ischemic attack' is also called a 'mini-stroke' by some. It is like a stroke, but the symptoms are temporary. These symptoms usually go away in less than 24 hours, often within a few minutes. The symptoms of a TIA are similar to those of a stroke.

A TIA is not just a small thing. It is a very serious warning! A person who has had a TIA is at a much higher risk of having a real stroke in the near future. Therefore, if the symptoms of a TIA occur, even if they disappear, it is essential to seek medical advice immediately.

Who is at higher risk of 'thrombotic stroke'?

Although anyone can have a thrombotic stroke, some people are at higher risk:

• People over the age of 65. The risk increases with age due to changes in blood vessels.
• Some ethnic groups around the world have also been found to be at higher risk. (The original article mentions "Black" people; it's better to generalize this for a Sri Lankan audience unless specific local data is being cited.)
• For those who smoke or use other tobacco/nicotine-based products (like vaping). Smoking is very harmful to blood vessels.
• For those who use illegal drugs.

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

• For those who drink excessively (Alcohol use disorder).
• For those with high blood pressure (Hypertension).
• For people with diabetes. Diabetes can also damage blood vessels.

How do doctors diagnose a 'thrombotic stroke'?

If you suspect you're having a stroke, doctors will first do a neurological exam. This means they'll check your memory, speech, strength, and balance. They'll also do a physical exam and a few other tests. If you're brought to the emergency room, the doctors there will start these tests right away.

Tests like these can be used to confirm a stroke:

• Blood tests: Check for things like blood clotting problems, sugar levels, and cholesterol levels.
• Carotid ultrasound: This helps to see if there are any blockages in the main blood vessels in the neck (carotid arteries).
• CT scan and/or CT angiogram: This takes pictures of the brain and can quickly determine if there is bleeding, a blood clot, or brain damage. A CT angiogram can clearly see the condition of the blood vessels.
• Echocardiogram: This test is done to check the function of the heart and whether there are blood clots in the heart.
• MRI and/or MRI angiogram: This can also take detailed pictures of the brain and blood vessels. It can show brain damage more clearly than a CT scan.

What are the treatments for a 'thrombotic stroke'?

The most important thing when treating a thrombotic stroke is to restore blood flow to the brain as quickly as possible. Doctors try to do this to reduce the risk of permanent brain damage, new disabilities, and death.

There are two main treatment methods used:

1. Mechanical thrombectomy: This involves removing the blood clot using a small, thin tube (catheter). A doctor inserts the tube into a vein in your wrist or groin and threads it into the blood clot in your brain. The doctor then either removes the clot immediately or breaks it into pieces and removes the pieces. This treatment can be done within 24 hours of the onset of symptoms.

2. Thrombolytic therapy: These are medications that dissolve blood clots. However, these medications can only be given within four and a half (4.5) hours of the onset of symptoms. That is why they say time is of the essence.

In addition to these main treatments, you may need other treatments:

• Blood sugar management: Keeping your blood glucose levels in check helps your brain heal.
• Blood thinners: Antiplatelet medications, such as aspirin, are often used. If you have atrial fibrillation or a blood clotting disorder, you may be given stronger anticoagulant medications. These reduce the risk of blood clots forming again.
• Endarterectomy: This is a surgery to remove plaque from narrowed or blocked blood vessels. This can reduce the risk of another blood clot forming.
• Mild intentional hypothermia: In some cases, doctors safely lower your body temperature slightly. This can reduce brain damage during and after a stroke.
• Oxygen therapy: After a stroke, the brain doesn't get enough oxygen. So doctors may give you extra oxygen through a tube that's placed in your nose. This makes it easier to breathe and helps your body get more oxygen to your brain.
• Stenting: A stent is a very small mesh-like tube that is placed inside a blood vessel and helps keep it open, allowing blood to flow more easily.

How important is rehabilitation after a thrombotic stroke?

Rehabilitation is very important after a stroke. A stroke causes changes in your brain and body. Rehabilitation treatments can help you adjust to those changes, regain your previous abilities, or learn to live with new disabilities. You may need one or a combination of the following treatments:

• Cognitive rehab: This helps improve mental skills like your memory, attention span, and problem-solving skills.
• Occupational therapy: This treatment helps you safely perform your daily activities, especially tasks that require fine movements (e.g., eating, dressing, writing).
• Physical therapy: This helps strengthen the muscles of the body, improve balance, and regain the use of the arms and legs.
• Speech therapy: This treatment helps you regain your language and speaking skills, as well as control the muscles that help you speak, breathe, eat, and swallow.

The rehabilitation process can be a bit difficult, but the results are worth it.

What are the chances of surviving a 'thrombotic stroke'?

Fortunately, as new, faster treatments for stroke are developed, the number of people surviving a stroke is increasing. But it's hard to say what the right recovery time or outlook is for everyone.

Thrombotic strokes (and other types of ischemic strokes) are generally more likely to survive than hemorrhagic strokes, which are caused by a burst blood vessel in the brain. But that doesn't mean you're more likely to survive than others. Everyone's body responds differently to a stroke, so it's hard for doctors to give a precise prognosis that works for everyone.

What is the prognosis?

What kind of situation you can expect depends on several factors:

• How quickly you received treatment.
• Which parts of the brain were damaged?
• How is your overall health?

It often takes several months to fully recover. For some, it can take longer. Your doctor will tell you what to expect. Don't worry, they will help you set and achieve recovery goals that are right for you.

Can a thrombotic stroke be prevented?

Yes, you can! Maintaining good overall health is the best way to prevent thrombotic strokes and the blood clots that cause them. Try these things:

• Eat a healthy diet. Eat more fruits, vegetables, whole grains, and fiber. Reduce oil, salt, and sugar. Maintain a healthy weight that suits you.
• Engage in regular physical exercise. Do some form of exercise that makes you sweat, at least 30 minutes a day, 5 days a week.
• Keep your cholesterol levels, blood pressure, and other health conditions (like diabetes) under control. Take your medications as directed by your doctor.
• If you smoke, stop completely. If you need help quitting, seek help from a doctor or from programs that offer this.

See a doctor at least once a year (or as your doctor recommends) for a complete health checkup. Many health problems that cause 'thrombotic strokes' develop gradually. You may not notice their symptoms. Therefore, medical tests can identify such warning signs early and control them.

How do I take care of myself after a 'thrombotic stroke'?

Recovering and rehabilitating after a stroke is not easy, it's a big effort. Follow the treatment plan that you and your doctor develop together as closely as possible. In general, take care of these things:

• Be sure to go to your rehab and other treatment appointments. If anything makes you feel uncomfortable or unsafe, tell your therapist. Rehab is hard, but you don't have to be in pain all the time.
• Don't forget about your mental health. Depression and anxiety are very common after a stroke. Your mental health is just as important as your physical health. Don't think that feeling sad or anxious makes you weak. If you feel like you need help in your recovery, talk to a doctor or mental health counselor .
• Take your medications exactly as prescribed, at the right times, and in the right doses. Especially if you are taking blood thinners, be sure to do so correctly. Taking your medications correctly is important to reduce your risk of developing blood clots in the future.

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

If you think you are having another stroke (like the BE FAST symptoms we talked about earlier), call 1990 without delay, or go to a hospital immediately. If you have a second stroke, the risk of serious complications and loss of life is much higher.

A person who has had a thrombotic stroke is at risk of developing other serious complications, such as:

• Blood clots in the deep veins of the legs (Deep vein thrombosis - DVT)
• Heart attack
• Pulmonary embolism
• Pneumonia
• Epileptic conditions/ seizures

If you experience symptoms of this type of complication, call emergency services or go to a hospital immediately.

What questions should I ask my doctor?

• What changes do I need to make in my daily life?
• Why did I have this stroke?
• Where in my brain did the blood clot form?
• What kind of medications should I take and how should I take them?
• What is my risk of having another stroke? What can I do to reduce it?

Finally, what to remember! (Take-Home Message)

Although a thrombotic stroke is a sudden emergency, the problems that cause it usually develop slowly over time. That's why it's important to see your doctor at least once a year to check your health. That way, you can recognize and manage warning signs early, rather than waiting for a blood clot to form and cause a stroke. Talk to your doctor about your risk of stroke. He or she can help you take care of your overall health and manage your risk factors.

If you have had a stroke and are currently recovering, celebrate every little step you take in your recovery journey. Some days will be harder than others, but be proud of yourself. Recovery is a big effort, and you should respect yourself for it. Don't worry, you are not alone. There are doctors, therapists, family, and friends who can help you.

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