Embolic Stroke is a type of stroke which occurs due to embolism of thrombi inside the cerebral vessels. The first thing is the stroke. What is a stroke? A stroke or cerebrovascular accident is a focal neurological due to a cerebral vascular lesion. This neurological deficit is rapid in onset and persists for more than 24 hours if the patient survived. Patients of stroke or CVA present with the temporary or permanent weakness of one or both limb, one or both sides of the body. Stroke is common above 40 years, especially in males. Stroke or cerebrovascular diseases can be present as:
- Acute focal stroke due to hemorrhage or infarction
- The gradual decline in brain function due to cerebral ischemia
Some factors are responsible for cerebrovascular disease, which may be modifiable or non-modifiable.
These factors can be changed or remodeled by taking proper medication. These may include:
- Cigarette smoking
- Diabetes mellitus
- Heart failure
- Myocardial infarction
- High alcohol intake
- Family history
- Oral contraceptives
These factors can’t be changed or reversed. These are
- History of previous MI, stroke, etc
Mechanism of Occurrence
Stroke or CVA is divided into two major groups according to the mechanism of occurrence. These are
1- Ischemic Stroke
This type of major cerebral artery is occluded due to which blood flow to the brain is minimized resulting in ischemic injury to the brain called cerebral infarction. Occlusion of the cerebral vessels may be due to
Formation of a clot at the site of atherosclerosis in extracranial or intracranial arteries due to which vessels are blocked and result in brain ischemia and infarction.
Thrombus from any artery especially from the extracranial artery move towards the cerebral artery and causes the obstruction of that artery which results in infarction or ischemia. This type is also known as Embolic Stroke. Mobilized Thrombus is known as embolism. When the artery is occluded, the blood supply is compromised then cerebral tissues undergo ischemia within a minute. The damaged neurons and glia become edematous within some hours which progress prolonged and cause more damage to neurons.
2- Hemorrhagic stroke
This type of stroke occurs due to the rupturing of small perforation arteries or arterioles (Primary intracerebral hemorrhage) or rupturing of an aneurysm at the circle of Willis (subarachnoid hemorrhage).
Symptoms of Embolic Stroke
Embolic Stroke or CVA is rapid in onset, it happens suddenly. There are no warning signs. Embolic Stroke symptoms vary from patient to patient and stroke to stroke, depending on the part of the brain involved. Not all the symptoms are present in all the stroke patients, depends on the part of the brain involved in the patient along with the other comorbidities.
- Temporary or permanent paralysis
- The weakness of one or more limb
- difficulty speaking or aphasia
- Difficulty in understanding words
- Numbness in the limbs
- Difficulty in walking
- Muscle stiffness
- difficulty with coordination
How Embolic Stroke Is Diagnosed?
The investigation is very important before starting the treatment to rule out the type of stroke. Your doctor may use the Following investigations to find out the type of stroke, site of stroke, and the extent of brain damage.
This is the foremost test that is done to find out the type of ischemia. CT scan of your brain shows the vessels of your brain.
This test used radio waves to detect damaged or necrosed brain tissues.
This test used sound waves to detect any blood clots in the carotid artery.
This ultrasound shows the blood flow in the vessels and the visualized any deposit in your carotid artery.
Management Of Embolic Stroke
Embolic Stroke is managed in two ways i.e General measurement and specific measurement.
1- General measures
Here are the General Measures:
The position of the patient should be correct. Patients should be kept in a semi-prone position to prevent falling back of the tongue.
Maintenance of airway
In unconscious patients, the tongue should be kept forward to clear the airways.
Maintenance of fluid balance and nutrition
In unconscious patients, the NG tube is passed. In the first 24 hours, 5% glucose 2000 ml is enough.
Care of skin
The skin of stroke patients should be kept clear and dry. Areas of redness over the skin is an infection of impending bedsores (pressure necrosis).
Care of bladder and bowel
If the patient is unconscious or has urinary incontinence, catheterized the patient. If the patient has constipation, enemas 1 to 2 times a week is to be done.
Care of eyes
To prevent the keratitis in unconscious patients, antibiotics drops are given.
In Embolic Stroke, passive movements should be started from the first day to prevent contractures.
2- Specific Measures
Here are the Specific Measures:
Maintain blood pressure
In Embolic stroke, don’t give any hypotensive agent to the patient to lower the blood pressure. Maintain systolic blood pressure up to 150 mmHg and diastolic blood pressure up to 100 mmHg. If you give the anti-hypertensive drugs to lower the B.P, it will worsen the condition because there is already ischemia.
Aspirin is given to the ischemic stroke patients to prevent the platelet aggregation because it can form thrombus which can further occlude the vessel. Therefore, always give 300 mg/ day aspirin in ischemic stroke, provided that hemorrhagic stroke is ruled out.
Edema reducing agent
About 5-10% of patients may develop cerebral edema which manifests as an altered state of consciousness. If the size of the infarction is larger, edema will more present. Therefore, fluid restrictions should be recommended along with the steroids. Injections mannitol 5%, 200 ml over a period of 10-20 minutes is a good option to reduce cerebral edema.
There is no need to give any anticoagulants to the patient of ischemic stroke, except
- Patient have atrial fibrillation
- The patient has mild aphasia
Thrombolytic therapy with tissue plasminogen activator proven to be effective, if given within the first 3 hours after the onset of Embolic Stroke, provided that hemorrhagic stroke is ruled out.
Statin is given to the ischemic CVA patients, as it is a lipid lowering agent and helpful in atherosclerotic patients.
Antibiotics are also given to the patients to prevent the infection.