Blood Clot in The Brain or Brain Haemorrhage
What is cerebral thrombosis or a stroke?
An ischemic stroke is the most common cause of stroke (stroke). Clot stops the blood and oxygen supply to the brain cells in the blood vessel supply area, and can cause sudden onset, unilateral paralysis and sensory disturbances. Similar symptoms may occur when brain cells are damaged due to bleeding from an artery in the brain.
Symptoms depend on which parts of the brain that is damaged by blood clots or bleeding. Cerebral thrombosis and stroke offers the same symptoms, and in both cases the symptoms are like totally without warning. At the stroke symptoms are often more difficult than for stroke.
Symptoms typically include:
• paralysis of the arm and leg on one side of the body
• hemifacial paralysis in the face
• Slurred speech and difficulty understanding others.
You may also have:
• problems controlling urination and defecation
• altered mental status (drowsiness, unconsciousness)
• changed psyche (confusion, crying trend)
• altered vision (visual field constriction)
• impaired concentration and memory
• Decreased ability to read and write.
How does the disease Occured?
When tiny blood clots (transient ischemic attack, TIA), the symptoms disappear within a day. For larger blood clots goods symptoms usually last long. For light to medium paralysis (paresis) you can usually regain viability after training, but total paralysis (paralysis) in an arm or a leg often leads to permanent disability. About 20% die within the first month, and among those who survive, approximately 35% become dependent on help from others.
After a stroke is the risk that you get a second stroke or die within the next 2 years 10-30% and highest in people with high blood pressure , diabetes , heart disease and longevity.
A common complication is the formation of blood clots in the paralyzed legs, a venous thrombosis. These clots can detach from the veins of the leg and be carried to the lungs and cause pulmonary embolism.
Other common complications are frequent falling and aspiration. Fall trend may be due to dizziness and trouble controlling arms and legs. Food and drink that end up in the trachea due to aspiration can cause pneumonia.
Who gets the disease?
The disease affects mainly older people. Stroke is the second most common blood clot disease – after heart attack.
What causes stroke or brain hemorrhage?
Stroke is because in most cases, a blood clot in the brain. Only about 10% of all strokes are caused by a brain haemorrhage. Both stroke and stroke causes the brain loses part of its normal blood supply, and thus keeps this part of the brain stops working. A stroke may be due to an aortic aneurysm of a blood vessel in the brain (aneurysm) bursts.
A blood clot which occurs in a calcified brain vasculature is called a thrombosis, while a blood clot that has led to the brain from the calcification of the carotid arteries or blood clots formed in the atria or ventricles, is called an embolus. Heart rhythm disturbance in the form of atrial fibrillation (atrial fibrillation) cause about a quarter of all cases of cerebral thrombosis.
The risk of having a stroke is increased by:
• cardiac arrhythmia (atrial fibrillation)
• high blood fat and cholesterol levels in the blood
Studies by stroke or brain hemorrhage
CT scan of the brain is an important examination for evidence of stroke. Blood clots do not always detectable change in the first days, but the study can be repeated later or supplemented with MRI for a final resolution of the diagnosis. Ultrasound examination of the heart (echocardiogram) and of the neck arteries can show if there are changes that might provide new blood clots.
Blood pressure is controlled, in part because high blood pressure is associated with increased risk of stroke, partly because the stroke often causes acute increase in blood pressure. Heart diagram (ECG) is used to detect heart rhythm disturbances. Blood samples examined include for blood sugar and cholesterol.
Treatment of stroke or brain hemorrhage
Treatment options include:
• antiplatelet drugs
• general care
• Prevention of new strokes.
It is very important to immediately get medical attention, partly to examine the possibility of getting clot-dissolving treatment, partly as quickly as possible to get started rehabilitation of lost functions.
It is possible to dissolve blood clots in the brain with medication, but treatment must be given within 4½ hours after the onset of symptoms, otherwise die brain cells. Treatment requires hospitalization, and to be made CT scan to exclude cerebral hemorrhage. In most cases, the symptoms have persisted for a long time for the clot-dissolving drugs may be used.
Instead, you then drugs that inhibit the growth of formed blood clots and prevents new ones. It can either be about antiplatelet or blood thinners (anticoagulants). In most cases, the best effect of the anti-platelet agents. Blood thinners do you give to patients who have had blood clots in the brain because one emboli from the heart. Embolism from the heart are often caused by cardiac arrhythmia (atrial fibrillation) or heart valve disease.
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The sooner rehabilitation starts, the better the result achieves man. The rehabilitation is done with the help of physiotherapists and occupational therapists. Through the training, the patient’s healthy areas of the brain may be called to take control of the lost abilities. Patients with speech difficulties is trained by speech therapist.
Clot-dissolving agents (thrombolytics) is medicine given into a vein, then in the blood formed an enzyme (plasmin), which can dissolve blood clots.
Antiplatelet agents are used only for the treatment of newly formed blood clots, as the treatment to be given before the blood clot has caused lasting damage to the surrounding tissue.
These agents inhibit clumping of platelets and therefore prevents blood clots. Platelets, which are small cells in the blood, affects the formation of blood clots in the arteries, especially the coronary arteries (heart attack) and in brain arteries (blood clot in the brain).
Acetylsalicylic acid is a widely used anti-platelet agent. To prevent blood clots required much smaller doses than when aspirin used as painkillers. 75 mg per day is sufficient. You do not achieve stronger preventive effect at higher doses, greater risk of side effects.
Dipyridamole is used with aspirin to prevent blood clots in the brain. Dipyridamole has a vasodilatory effect, which in some patients can cause headaches.
Clopidogrel is used to prevent blood clots in brain arteries as an alternative to aspirin and dipyridamole. Clopidogrel is also used with aspirin in certain people with heart attack and in cases where there used a stent during balloon expansion of the coronary arteries.
Glycoprotein inhibitors (Abciximab, Eptifibatide) is used to prevent blood clot formation in connection with balloon dilation of arteries. They are used only in hospitals.
Epoprostenol is only used to prevent the blood clump together in needles and tubes associated with dialysis treatment.
Prasugrel is used with aspirin for up 12 months to prevent new blood clots and to prevent complications of acute myocardial infarction in patients treated with balloon angioplasty (PCI, percutaneous coronary intervention).
Ticagrelor used to prevent blood clots in patients who have a heart attack. The treatment can last up to 12 months and is administered with aspirin.
Blood thinners (anticoagulants reduce blood clotting (coagulation).
When cardiac arrhythmia , especially atrial fibrillation and atrial flutter, reduced the risk of blood clots occur and the already formed clots grow further or comes loose and gets stuck somewhere in the circuit, for example in the brain’s arteries or other body arteries.
Blood thinning agents may be e.g.
• Heparins and fondaparinux
• Vitamin K antagonists
• Non-vitamin K antagonist oral anticoagulants (NOAK).