Neurology-Online

Blood clots in the head

What is a blood clot in the head?

The formation of blood clots in injuries and wounds is a vital reaction in our body. This achieves rapid hemostasis.
If we bleed, the body automatically and immediately ensures that the source of bleeding is closed with a blood clot. This plug is also called a blood clot.

On the one hand, the reaction is important to avoid high blood loss. On the other hand, it also prevents germs and bacteria from penetrating through the open wound. Last but not least, the primary wound closure with the blood clot is the first step in wound healing.

However, if there is no external injury, blood clots can form in the bloodstream, which block the blood vessels.

This becomes dangerous when the clots form or deposit in blood vessels that supply vital organs - for example the heart or the brain.
Such a blood clot can result in a heart attack or stroke.

diagnosis

When diagnosing a blood clot in the head, the symptoms are the most important clue to begin with.

It is important to note that an emergency doctor should always be called even if the symptoms only last a short time. Any stroke caused by a blood clot in the vessels of the brain is a life-threatening emergency where every minute counts. "Time is brain".

The most common symptoms include:

a sudden, usually unilateral paralysis
Reduced strength in the arms or legs
unilateral numbness
Visual disturbances
Speech disorders
Understanding disorders
Balance disorders
dizziness
unconsciousness
strong headache

The final diagnosis can then be made in the hospital with the help of imaging methods such as computed tomography or magnetic resonance tomography. The ultrasound of the cervical vessels, the so-called duplex sonography, can also indicate whether the symptoms are caused by calcification and an associated narrowing or occlusion of the cervical vessels.

Please also read: Stroke - What Are The Signs?

These symptoms will help you identify a blood clot in your head

A blood clot in the head can cause a variety of symptoms. The occurrence and course can also vary widely, in some cases the full clinical picture is heralded by harbingers and slowly increasing symptoms.

In the vast majority of cases, however, in the course of a stroke, a blood clot in the head leads to sudden, often very noticeable symptoms. The severity of the symptoms depends on the affected brain area, which is not supplied with sufficient oxygen due to the blood clot.

The most common symptoms include:

Sudden, severe headache, followed by failure of the affected areas, which can be expressed, for example, in speech disorders such as slurred or choppy speech, up to loss of speech
Sudden disturbances in consciousness ranging from disorientation to fainting
Paralysis in the form of immobility of one arm, leg or both or a drooping eyelid or corner of the mouth,
Sensory disturbances in the form of numbness, tingling sensation and pain in one side of the body,
Unsteady walking due to dizziness or swaying or even falling.
Even brief persistence of the symptoms described above or, for example, brief visual disturbances such as flicker, double vision or loss of vision over one eye can be the result of a blood clot and should be examined by a doctor as soon as possible.

The so-called FAST test, which includes and assesses the three typical symptoms, is used to quickly identify a stroke.
F-Face, A-Arms, S-Speech, T-Time.

If a stroke is suspected, the person concerned can be asked to perform three exercises based on these rules:

1. Face: Ask the person to smile - this is not possible with hemiplegia of the face, the affected corner of the mouth hangs limply.
2. Arms: Ask the person to raise both arms to the same height at the same time - here, too, paralysis of the arms can appear.
3. Speech: You ask the person to speak simple sentences or say sentences that should be repeated - slurred speech is a warning sign.
4. T-Time: if there is even the slightest suspicion of a stroke, an emergency doctor should be called as soon as possible, since the most important prognostic factor is time.

Read the detailed article on this What are the symptoms of a blood clot in my head?

causes

Blood clots can have a number of causes. The natural formation of blood clots as a result of an injury is the result of a series of reactions by the body to the external stimulus. First and foremost, the blood vessels constrict in order to reduce the flow of blood and thus keep blood loss as low as possible. The damage to the tissue activates the platelets that circulate in the blood, the so-called thrombocytes. They attach to the wound and form a plug that stops the bleeding for the time being. This then leads to a series of activations of other coagulation factors, which further stabilize the unstable plug of blood platelets with various proteins. After this, the wound is primarily closed, protected from contamination, bacteria and viruses and can heal secondarily.

However, blood clots can also develop from other causes. For example, if the blood in a blood vessel flows very slowly or even backs up, increased numbers of platelets can accumulate. The platelets stick together and form a blood clot - without any injury.

Another cause of the formation of blood clots is previous damage to the inner walls of the vessels. The so-called arteriosclerosis is one of the most common pre-existing diseases. Ultimately, the injured vessel wall leads to the platelets sticking together - a blood clot forms.

An equally important and frequent place of origin for blood clots is the heart, especially in the case of atrial fibrillation or an arrhythmia with very fast beating atria. The turbulence in the blood in the atrium of the heart can easily cause blood clots to form here.

Please also read: Recognize arrhythmias

A genetic and thus congenital mutation of the coagulation factors or a tumor disease can lead to an increased effect and tendency of the coagulation factors to bind and be the cause of a blood clot.

Read more about this at: Bleeding disorder

Fall as the cause

After a major operation, a broken bone or a serious illness, it often happens that the affected extremity is no longer sufficiently moved for a long time. The muscles play an important role in the transport of our blood back to the heart via our venous blood system. With the so-called muscle pump, the muscles support the return of the blood to the heart against gravity by compressing the veins.

If the muscles do not provide this support, the blood only slowly flows back to the heart and backs up in the veins. This build-up of blood leads to an accumulation of blood platelets and coagulation factors in a confined space. Over time, these can stick together to form a blood clot and a so-called venous thrombosis occurs.

These thromboses can become dangerous if parts of the blood clot loosen and are ejected into the bloodstream. The most common consequence of this is a spread of the thrombus into the pulmonary vessels, a so-called pulmonary embolism. But the path into the supplying vessels of the head is also possible if the atria of the heart are connected by a small hole, a so-called paradoxical embolism.

In arterial vessels, immobilization after a fall seldom or never leads to a blood clot, as there is a continuous blood flow in this vascular system due to the maintained blood pressure. Blood clots here usually have a different cause.

Please also read: Detect thrombosis

treatment

Therapy for a blood clot in the head is primarily to correct the circulatory disorder caused by the clot.
For this purpose, so-called lysis therapy is primarily used, in which a drug is introduced into the body's circulation via the vein, which dissolves blood clots. This drug is called rtPA (recombinant tissue plasminogen activator).

A distinction must be made between systemic thrombolysis and local thrombolysis. A limiting criterion for the treatment of a blood clot using lysis therapy is time.
Systemic thrombolysis can be used in a time window of approx. 4.5 hours after the onset of the stroke. Local thrombolysis, in which a catheter is advanced to the point of the blood clot and then a clot-dissolving drug is administered in the immediate vicinity, can be carried out up to 6 hours later.

Another therapeutic option for acute vascular occlusion is mechanical thrombectomy, in which a catheter is inserted through the vascular system and advanced to the vascular occlusion. Here the blood clot is then removed using the catheter, exposing the vessel and restoring blood flow.

Please also read:

Stroke measures
Stroke therapy

Blood thinning therapy

So-called secondary prophylaxis is carried out to prevent a new blood clot from forming again. An important part of this secondary prophylaxis is blood thinning, which causes the platelets to clump again (Platelets) should prevent. If there are no contraindications for this blood thinning therapy, it should be carried out for life.

The most commonly used medication for this is ASA (Aspirin®), which can be prescribed alone or in combination with other anticoagulant drugs.

Read more about this at: Thrombosis prophylaxis

When does the blood clot need to be surgically removed?

Surgical removal of a blood clot in the head is only an option for a relatively small proportion of affected patients. As this is a time-consuming and complicated operation, experienced specialists and appropriately equipped neurological centers are required.

Another requirement for the procedure is the location and accessibility of the blood clot. The further away a clot is from the larger vessels, the more difficult it is to access it and the more difficult it is to achieve surgically.

Long term consequences

The long-term consequences of a blood clot in the head can vary greatly and depend on the affected brain area and the duration of the shortage. In so-called transitory ischemic attacks, failure symptoms occur for a short period of time due to the reduced blood flow in a brain area. These completely regress within 24 hours without leaving any damage.

The most common consequences after a manifest stroke caused by a blood clot in the head are speech and swallowing disorders. They occur in around 70% of all those affected and often persist over the long term. Another very common consequence are symptoms of paralysis: for example in the face or on one side of the body (hemiplegia / hemiparesis).

Attention and memory disorders also persist in many sufferers as a long-term consequence. In addition to symptoms of failure, which do not regress after a stroke, other clinical pictures can also arise. For example, epilepsy (convulsions).

Further information on this topic can be found at: These are the consequences of a stroke!

Course of disease

The course of the disease is individual. How long you stay in hospital after successful therapy depends heavily on the general condition of the person affected and their regeneration. This is usually followed by rehabilitation treatment. Various disciplines work together here to make the patient fit for everyday life again. Physiotherapists and occupational therapists work together on movement and coordination skills, speech therapists help with speech and swallowing disorders.

The main goal of this treatment is to send the patient back to their familiar surroundings as independently as possible. Another important point of treatment in rehabilitation is psychological support, as many patients are prone to depression after a stroke. All in all, the treatment in the rehab clinic lasts between 4-6 weeks.

forecast

The localization of the blood clot and the duration of the resulting insufficient supply of the brain area are decisive for the prognosis and the course. Approx. 20% of all patients with blood clots in the head die within the first four weeks. In half of all those affected, irreversible damage remains after a stroke, which can lead to the need for care and severe disability. In general, the less brain mass has been damaged, the better the prognosis.

Therefore, the most important factor in the therapy of a blood clot in the head is always time, because "Time is Brain", the earlier the blood supply can be restored, the less brain mass is damaged and the more easily damaged brain mass can recover.