Can cerebral embolism be treated with thrombolysis?

Written by Zhang Hui
Neurology
Updated on September 30, 2024
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Cerebral embolism is a relatively common ischemic cerebrovascular disease. If the area of cerebral embolism is very large and it exceeds the time window for thrombolysis, and if the patient is elderly with multiple underlying diseases, then thrombolysis is not recommended. Patients with large-area cerebral embolism have a higher probability of transitioning to cerebral hemorrhage, thus the risk of thrombolysis is very high. However, if it is within the time window for arterial thrombectomy, it is advocated to undergo arterial thrombectomy treatment. Family members can communicate more with the doctor to choose the appropriate treatment plan. If the symptoms of cerebral embolism are relatively mild, the affected area is considered small, and it is within three hours, then intravenous thrombolysis treatment could be considered. Patients undergoing intravenous thrombolysis must ensure that a cranial CT is rechecked within 24 hours to exclude any secondary bleeding.

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Written by Zhang Hui
Neurology
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Symptoms and manifestations of cerebral embolism

The so-called cerebral embolism primarily refers to the presence of abnormal substances in the arteries, which block the smaller arteries leading to arterial occlusion, causing severe cerebral ischemia and hypoxia, and resulting in the necrosis of brain tissue. It generally occurs in patients with atrial fibrillation, where atrial fibrillation can form larger emboli that detach from the heart and can easily cause cerebral embolism. The symptoms of the onset are very sudden and rapidly reach their peak. Patients may experience coma and consciousness disorders, fixed staring of the eyes, paralysis of limbs, numbness of limbs, and an inability to sense pain and temperature in the limbs. Additionally, some may experience epileptic seizures and urinary and fecal incontinence. Cerebral embolism is a very dangerous disease, and once these symptoms appear, it is crucial to seek hospital treatment as soon as possible.

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Neurology
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Does cerebral embolism require surgery?

Most cases of cerebral embolism in patients are caused by heart diseases, especially in patients with atrial fibrillation. Thrombi form in the atrium, detach, and travel to the cerebral arteries, causing a cerebral embolism. If the area affected by the cerebral embolism is small and the symptoms are mild, surgical treatment may not be necessary. Patients should rest, engage in rehabilitation exercises, and be treated with medications that invigorate the blood, remove blood stasis, protect brain cells, and use anticoagulants. However, if the embolism affects a large area, such as the middle cerebral artery, interventional surgical thrombectomy can be performed according to current medical advancements, which may be effective for some patients but also carries risks of bleeding and potential surgical failure. (Please use medications under the guidance of a doctor and do not self-medicate.)

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Neurology
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What is a brain embolism?

Cerebral embolism refers to various abnormal emboli that enter the intracranial arteries with blood circulation, causing acute occlusion of the cerebral arteries and leading to ischemic hypoxic necrosis of the brain tissue in the supplied area. The onset is usually very sudden and dangerous, with patients rapidly developing limb paralysis, speech dysfunction, facial paralysis, and in some cases, coma, seizures, and other clinical manifestations. The most common source of embolism is the heart, such as atrial fibrillation or myocardial infarction forming mural thrombi that dislodge and enter the brain causing an embolism. Additionally, there are non-cardiac sources of embolism, such as the detachment of atherosclerotic plaques causing an embolism, as well as air embolisms and cancer cell embolisms. Cerebral embolism is an emergency and severe condition that requires prompt medical attention.

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Can cerebral embolism be treated with thrombolysis?

For patients with cerebral embolism, if the onset is not particularly severe and the area of the embolism is not very large, for example, if the patient's consciousness is still clear, then thrombolysis can still be feasible. It is now also relatively advocated because the risk of cerebral hemorrhage is relatively small in such cases. However, if the area of the cerebral embolism is large, especially if the patient has fallen into a coma or other consciousness disorders, and shows conjugate gaze palsy, then the risk of thrombolysis is very high, and there is a very likely risk of conversion to cerebral hemorrhage. In such cases, thrombolysis is not recommended, and arterial thrombectomy can be performed instead, which can greatly save the patient's life and improve the quality of life. Besides thrombolysis and thrombectomy, anticoagulant therapy should also be administered after the condition stabilizes, as most cases of cerebral embolism are caused by atrial fibrillation, and anticoagulant therapy can prevent future attacks.

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Which department should I go to for a cerebral embolism?

The patient has experienced a cerebral embolism, and it is definitely recommended to seek appropriate medical care in neurology. Neurologists have seen many patients with cerebral embolism and have rich experience in the pathogenesis, diagnosis, and treatment of this disease. The onset of cerebral embolism is quite severe, and patients generally may have a history of cardiac diseases, such as atrial fibrillation. It is crucial to go to the hospital as soon as possible if a cerebral embolism occurs. If within the time window for thrombectomy, such as within eight hours, relevant thrombectomy treatment can be performed. Additionally, some hospitals carry out thrombectomy treatments in neurosurgery or interventional departments. Therefore, if a cerebral embolism requires surgical treatment, one can also visit the interventional department or neurosurgery. After the condition of a cerebral embolism patient stabilizes, routine anticoagulation therapy is necessary to prevent a recurrence of the cerebral embolism.