Thromboembolic stroke is a medical emergency. It occurs when blood flow to part of the brain is interrupted, causing brain cell damage. Prompt recognition of signs and understanding causes are important for reducing its impact. Swift medical intervention and a structured recovery process improve patient outcomes.
Understanding Thromboembolic Stroke
A thromboembolic stroke occurs when a blood clot blocks an artery supplying blood to the brain. This blockage deprives brain tissue of oxygen and nutrients, causing cellular damage and loss of function. These strokes are a type of ischemic stroke, accounting for about 87% of all stroke cases.
Thromboembolic strokes involve two types of clots. A thrombotic stroke occurs when a clot (thrombus) forms directly in a brain artery, often from plaque buildup. An embolic stroke happens when a clot (embolus) forms elsewhere, usually in the heart or large arteries, and travels to the brain, lodging in a smaller vessel. This differs from hemorrhagic stroke, which involves bleeding in the brain, not a blockage.
Recognizing the Signs
Quickly identifying stroke signs is important for timely medical intervention. The “FAST” acronym is a tool for rapid assessment.
“F” is for Face drooping: one side of the face may sag. “A” is for Arm weakness: one arm may drift downward when raised. “S” is for Speech difficulty: slurred speech or trouble speaking/understanding. “T” is for Time: call emergency services immediately if any signs are observed. Other indicators include sudden numbness or weakness on one side, abrupt vision changes, a sudden severe headache, or sudden issues with balance and coordination.
Causes and Prevention
Several conditions and lifestyle choices contribute to thromboembolic stroke risk. Atrial fibrillation, an irregular heartbeat, commonly causes embolic strokes by leading to blood pooling and clotting in the heart. High blood pressure (hypertension) is a major modifiable risk factor for both ischemic and hemorrhagic strokes; controlling it could prevent up to 40% of all strokes.
High cholesterol, diabetes, and smoking also elevate stroke risk. Smoking damages blood vessels, increasing susceptibility to clot formation. Obesity and a sedentary lifestyle further increase stroke likelihood by contributing to other risk factors like high blood pressure and diabetes. Prevention involves lifestyle modifications: a heart-healthy diet, regular physical activity (at least 150 minutes of moderate-intensity aerobic activity per week), maintaining a healthy weight, and quitting tobacco. Medical management of existing conditions, such as taking prescribed medications for hypertension, high cholesterol, or diabetes, is also important for prevention.
Medical Intervention and Recovery
Upon suspicion of thromboembolic stroke, rapid diagnostic imaging confirms the diagnosis and determines stroke type. Computed tomography (CT) scans are used initially to rule out hemorrhagic stroke and identify early ischemia. Magnetic resonance imaging (MRI) provides detailed views of brain tissue and detects smaller areas of damage. CT angiography (CTA) or MR angiography (MRA) also visualize blood vessels and locate the blockage.
Acute treatment for thromboembolic stroke is time-sensitive. Clot-busting medications, such as tissue plasminogen activator (tPA), are administered intravenously to dissolve the clot and restore blood flow. For tPA to be effective, it needs to be given within 4.5 hours of symptom onset.
For large vessel occlusion, mechanical thrombectomy may be performed. This procedure removes the clot directly from brain blood vessels. It can be performed up to 6 hours for most patients, and in select cases, up to 24 hours after symptom onset, depending on imaging findings indicating salvageable brain tissue.
Following acute treatment, hospital care focuses on stabilizing the patient and managing complications. Recovery progresses to rehabilitation, which involves physical therapy to regain strength, mobility, and balance; occupational therapy to relearn daily living activities like dressing and eating; and speech therapy to address communication and swallowing difficulties. These therapies are tailored to individual needs to maximize functional recovery.