Embolic Stroke: Symptoms, Treatment and Prevention 2024

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Embolic Stroke: Symptoms, Treatment and Prevention

A stroke occurs when blood flow to part of the brain is interrupted or reduced, causing brain cells (neurons) in that area to die. The effects of a stroke depend on the location and amount of brain damage. Even a small stroke can have devastating effects like paralysis, speech difficulties, memory problems, and more.

Strokes are generally classified into two main categories:

Ischemic stroke – This type of stroke is caused by a blockage in a blood vessel that supplies blood to the brain. It accounts for about 87% of all strokes.

Hemorrhagic stroke – This type of stroke occurs when a blood vessel bursts and bleeds into or around the brain. It accounts for about 13% of strokes.

Within ischemic strokes, there are thrombotic, embolic, and systemic hypoperfusion strokes:

  • Thrombotic stroke– A blood clot (thrombus) forms in one of the arteries that supply blood to the brain. This type accounts for 50% of all strokes.
  • Embolic stroke– An embolus formed elsewhere in the body travels through the bloodstream and lodges in an artery leading to or in the brain. This accounts for roughly 30% of ischemic strokes.
  • Systemic hypoperfusion– Lowered blood pressure or shock impedes blood flow to the brain, leading to oxygen deprivation. This type accounts for only about 5% of all strokes but is more prevalent in chronically ill patients.

This article will focus specifically on embolic stroke, including its symptoms, causes, diagnosis, treatment, and prevention.

What is an Embolic Stroke?

An embolic stroke occurs when a blood clot or other debris forms elsewhere in the body, breaks free, and travels through the bloodstream to lodge in an artery in the brain. This cuts off blood supply to that area of the brain, rapidly killing surrounding brain cells.

The blood clot or debris causing the blockage is called an embolus. Sources of emboli include:

  • Blood clots in the heart due to conditions like atrial fibrillation
  • Atherosclerotic plaques in the aorta or carotids
  • Fat deposits
  • Air bubbles
  • Cancer cells

If the embolus lodges in a large artery, it can cause a major stroke with extensive damage. If it’s small or lodged in a smaller vessel, it may result in a mini-stroke or TIA with temporary symptoms.

According to the National Stroke Association, embolic strokes make up about 30% of all ischemic strokes in the United States. They tend to be more severe than thrombotic strokes.

Embolic Stroke Symptoms

Symptoms of an embolic stroke usually come on suddenly and without warning. They result from the brain area affected and how large of an artery the clot is blocking.

Some common signs and symptoms of embolic stroke include:

  • Sudden numbness or weakness– Usually affects one side of the body like the face, arm, or leg. This is the most common stroke symptom.
  • Confusion– Trouble speaking, understanding speech, and cognitive impairment.
  • Trouble seeing– Sudden blurred or decreased vision in one or both eyes.
  • Loss of balance and coordination– Dizziness, loss of balance, and lack of coordination.
  • Severe headache– A sudden, severe headache with no known cause.
  • Difficulty walking– Stumbling or inability to walk without assistance.
  • Drooping face– Facial droop or paralysis on one side. The smile may appear uneven.
  • Slurred speech– Impaired speech and difficulty saying words.
  • Nausea or vomiting– These can occur, especially with brain stem or cerebellar strokes.
  • Seizures– Seizures may happen in about 1 in 20 strokes.
  • Unconsciousness– In severe strokes, the person may pass out and be unresponsive. 911 should be called immediately.

The FAST method is an easy way to remember the most common signs of stroke:

  • Face – Facial droop on one side, uneven smile
  • Arms – Arm or leg weakness on one side
  • Speech – Slurred speech, trouble speaking
  • Time – Time is critical; call 911 if any symptoms appear

Causes and Risk Factors

An embolic stroke occurs when an embolus breaks free and gets lodged in an artery supplying blood to the brain. But what causes the embolus to form and break off in the first place?

The most common sources of emboli that can lead to stroke include:

Atrial Fibrillation

Atrial fibrillation (AFib) is the leading cause of embolic stroke. In AFib, the upper chambers of the heart beat irregularly and don’t pump blood effectively. This allows blood to pool and clot. If a clot breaks loose it can travel to the brain, blocking a vessel and resulting in stroke.

AFib causes between 15-20% of all ischemic strokes. The risk of stroke goes up nearly 5 times for people with AFib. Treatment focuses on preventing clots from forming through blood thinners.

Atherosclerosis

Atherosclerosis is the buildup of cholesterol, fats, and plaque inside artery walls. This can cause several problems:

  • Plaque buildup can directly block blood vessels in the neck and brain, causing a thrombotic stroke.
  • Plaque can rupture, causing a blood clot to form at the rupture site. This clot can dislodge and travel to the brain.
  • Half of all stroke-causing emboli originate from atherosclerotic plaques in the aorta and carotid arteries. Bits of plaque can break off and flow towards the brain.

Controlling risk factors like high cholesterol can help prevent atherosclerosis and atherosclerosis-related stroke.

Blood Clots

Blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism) can break loose and travel through the heart to lodge in an artery in the brain. Treating clots with blood thinners helps lower the chance of an embolic stroke.

Heart Valve Disease

Certain heart valve abnormalities and infections increase clot formation. These clots can become emboli. Irregular heart valves also allow clots to pass from the veins to the arteries, traveling to the brain.

Paradoxical Embolus

This rare type of embolic stroke happens when a venous clot passes through a hole between the right and left heart chambers (patent foramen ovale). Normally blood flows in one direction, but sometimes the clot crosses over and can enter the brain circulation.

Risk Factors

Certain factors raise your risk of having an embolic stroke. The major risk factors include:

  • Atrial fibrillation– The biggest risk factor, it raises the chance of stroke 4-5 times.
  • Heart disease– Conditions like coronary artery disease increase clot formation.
  • Previous stroke– Once you have a stroke, the risk of recurrence is higher.
  • Diabetes– Damages blood vessels and increases atherosclerosis.
  • High blood pressure– Can cause artery damage and aneurysms. Leading risk factors for all stroke types.
  • Smoking– Raises blood pressure and doubles stroke risk.
  • Birth control pills– Slightly increase risk, especially if other risk factors are present.
  • Age– Stroke risk doubles every decade after age 55.
  • Race– African Americans have a higher risk of stroke than Caucasians.
  • Family history of stroke– Genetic factors can increase risk.
  • Prior DVT or PE– Increased risk of paradoxical embolus.

Knowing your risk factors allows you to take action to reduce your risk through lifestyle changes, medications, or surgery if needed.

Diagnosing Embolic Stroke

Getting a quick and accurate diagnosis is vital when every minute counts. If you have sudden stroke symptoms, call 911 or go to the hospital right away. Doctors will:

  • Take Medical History– Important to know your risk factors, medications, symptoms onset, and progression.
  • Physical Exam– Check for signs like facial drooping, arm/leg weakness, and speech issues to determine the affected brain area.
  • Blood Tests– Check blood counts, clotting time, cholesterol and other biomarkers.
  • CT or MRI Scan– CT is quicker while MRI provides more detailed images. Used to rule out bleeding and identify affected brain regions.
  • Carotid Ultrasound– Looks for blockages or narrowing in the carotid arteries in the neck.
  • Echocardiogram– Uses sound waves to produce images of the heart’s structure and rhythms. Check for sources of clots like AFib.
  • Cerebral Angiogram– Dye is injected into arteries supplying the brain. X-ray images identify blockages.
  • Electrocardiogram– Records the heart’s electrical activity. Can detect arrhythmias like AFib.

Based on test results and exams, doctors can definitively diagnose an embolic stroke and pinpoint the likely source of the embolus. This informs urgent treatment decisions.

Treating an Acute Embolic Stroke

The main priorities when treating an acute embolic stroke are:

  1. Restore Blood Flow– Getting blood to the affected area quickly is crucial to save brain tissue.
  2. Prevent Further Damage– Stabilizing the patient and taking measures to prevent the stroke from worsening or recurring.
  3. Early Rehabilitation– Starting PT, OT, and speech therapy in the hospital to facilitate recovery.

The main interventions for acute ischemic stroke are:

Thrombolytic Drugs

Powerful IV drugs called thrombolytics, like tPA, can rapidly dissolve clots blocking brain arteries if given within 3-4.5 hours of symptoms starting. This urgently restores blood supply to save threatened brain tissue.

Not all patients can receive thrombolytics due to the risks of bleeding, but the benefits often outweigh the potential risks. Patients must get scanned first to rule out hemorrhagic stroke.

Endovascular Procedures

If thrombolytics aren’t an option or don’t dissolve the clot, endovascular thrombectomy may be performed. This involves threading a catheter through arteries to the clot and directly removing it.

It has a longer treatment window than IV thrombolytics and can dramatically improve outcomes, especially for major blockages.

Anticoagulants/Antiplatelets

Medications that prevent new clots from forming and existing clots from growing larger are started. This prevents the extension of the stroke or recurrence.

Anticoagulants like heparin inhibit clot formation. Antiplatelets like aspirin prevent platelets from sticking together.

Blood Pressure Control

Lowering severely elevated blood pressure but avoiding dropping it too suddenly. This prevents further damage by stabilizing arteries.

Medical Monitoring

Close monitoring of vital signs, neurological status, breathing, heart rhythms, oxygen levels, and hydration. Preventing complications is key.

Early Rehab

Getting patients moving as early as possible – even passive range of motion – can help limit disability. Speech, physical, and occupational therapy are crucial.

The goal of acute treatment is to protect viable brain tissue and improve long-term outcomes and function.

Embolic Stroke Recovery and Rehabilitation

How well a patient recovers after an embolic stroke depends on the severity and location of brain damage. Recovery is gradual, varies widely between patients, and may plateau at some level of disability.

With rehabilitation, many patients regain some or full function over weeks to months. Keys include:

  • Early mobility– Getting moving improves neuroplasticity and recovery.
  • Speech therapy– For regaining language, swallowing, and communication skills.
  • Physical/Occupational therapy– Re-learning everyday tasks and improving mobility/coordination.
  • Home exercise program– Continuing exercises when discharged home.
  • Supportive devices– Canes, walkers, braces, or wheelchairs to assist with activities.
  • Communication tools– Devices to aid speech if needed.
  • Psychological support– Coping with disabilities.
  • Community reintegration– Returning to hobbies, social activities, and work.
  • Secondary stroke prevention– Taking meds and controlling risk factors.

Family support is extremely beneficial. Patience and realistic expectations are necessary through the challenges of stroke recovery.

Preventing Embolic Stroke

The best approach is preventing a first or recurrent stroke through:

Controlling medical conditions like high blood pressure, diabetes, AFib, and atherosclerosis. Follow the doctor’s advice for medications, diet, and exercise.

Taking preventive medicines like blood thinners or aspirin if recommended.

Eating a healthy diet low in salt, fat, and refined sugar. Eat plenty of vegetables and lean protein.

Exercising for 30 minutes daily can dramatically lower stroke risk.

Quitting smoking and avoiding secondhand smoke reduces stroke risk.

Limiting alcohol to 1-2 drinks daily maximum.

Knowing stroke signs and acting FAST if any appear. Call 911 right away.

Reducing stress through meditation, yoga, music, or other relaxation techniques.

Awareness, education, and active steps to reduce modifiable risks are key to preventing an embolic stroke. Consult a doctor about your specific stroke risk profile.

Summary: Key Points About Embolic Stroke

  • An embolic stroke happens when a traveling clot or debris blocks an artery supplying blood to the brain.
  • It accounts for about 30% of ischemic strokes. AFib is the most common cause.
  • Symptoms like numbness, confusion, and trouble speaking or seeing occur suddenly. Acting FAST is crucial.
  • Causes include AFib, atherosclerosis, paradoxical embolus, and DVTs/PEs.
  • Restoring blood flow quickly via thrombolytics or thrombectomy can save brain tissue. Rehab should start early.
  • Prevent through lifestyle changes and medications. Controlling stroke risk factors is key.
  • Embolic strokes can cause severe disability, but recovery is possible with time and rehabilitation. Support is essential.

While frightening, embolic stroke is treatable if caught early. Being aware of signs, acting quickly and focusing on prevention gives the best outcome. With rehabilitation and support, recovery continues long after leaving the hospital.

Frequently Asked Questions About Embolic Stroke

  1. What are the most common symptoms of an embolic stroke?

The most common symptoms of an embolic stroke are sudden numbness or weakness on one side of the body, confusion, trouble speaking or understanding speech, vision problems, trouble walking or maintaining balance, drooping on one side of the face, and difficulty coordinating movements.

  1. How is an embolic stroke diagnosed?

Doctors diagnose an embolic stroke based on medical history, a physical exam checking for signs of stroke, blood tests, brain imaging such as CT or MRI scans, and other tests like carotid ultrasound or EKG. Imaging shows the affected brain area and tests help pinpoint the likely source of the embolus.

  1. What’s the difference between an embolic stroke and a thrombotic stroke?

In an embolic stroke, the blockage is caused by a blood clot or debris that forms elsewhere in the body and travels through the bloodstream to the brain. In a thrombotic stroke, the clot forms directly inside an artery in the brain. Embolic strokes tend to be more severe.

  1. How quickly must an embolic stroke be treated?

Emergency treatment is critical within the first several hours after onset of symptoms. The faster blood flow can be restored, the more brain tissue can be saved. IV thrombolytics like tPA are most effective within 3-4.5 hours. Endovascular procedures may be done up to 24 hours after symptoms start.

  1. What disabilities can result from an embolic stroke?

Embolic strokes can lead to paralysis or weakness on one side of the body, speech/language problems like aphasia, vision loss, trouble swallowing, balance issues, memory loss, and more depending on the part of the brain affected. Some of these may improve with rehabilitation.

  1. What medications help prevent embolic stroke?

Medications that help prevent clots like anticoagulants and antiplatelets, along with statins to lower cholesterol, ACE inhibitors for blood pressure, and heart rhythm control medications for AFib may be prescribed. Lifestyle changes are also extremely important.

  1. Can embolic stroke patients recover language skills with rehabilitation?

Yes, many patients can regain some or full language abilities with speech therapy after an embolic stroke, even if aphasia is initially severe. However, recovery varies based on the extent of brain damage. Intensive speech therapy and practice are key.

  1. Is fatigue common after an embolic stroke? How long might it last?

Yes, fatigue after a stroke is very common. It may persist for weeks or even months during the recovery process. Getting plenty of rest is important. Light exercise can help build endurance when approved by your doctor. Allow time for normal energy levels to return.

  1. Does taking aspirin help prevent embolic stroke?

Daily aspirin can help prevent clots from forming and reduce the risk of first or recurrent embolic stroke in those with certain risk factors. However, aspirin also poses risks like bleeding, so talk to your doctor before starting. Not everyone benefits from aspirin.

  • If my parent had an embolic stroke, does that mean I’m at higher risk?

Yes, having a parent or other close relative who had an embolic stroke raises your risk to some degree. Make sure to discuss

Conclusion

Embolic stroke is a serious condition that requires emergency medical treatment and long-term prevention strategies. While an embolic stroke can cause severe disability, recovery is possible through rehabilitation, determination, and support.

The key is acting FAST when stroke symptoms appear – seeking treatment immediately gives the best chance of restoring blood flow before extensive permanent brain damage occurs. Advances in emergency clot removal procedures have also significantly improved outcomes.

Patients and family members should learn to recognize the signs, be aware of personal risk factors, and take steps to minimize stroke risks through lifestyle changes and medical management.

Although frightening, embolic strokes are largely preventable. Increased public awareness and proactive prevention make a major difference in avoiding stroke-related disability and death. With newer treatments, support, and rehabilitation, more positive outcomes are now possible after an embolic stroke.

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