Guidelines for Thrombolytic Therapy for Cerebral Embolism

Written by Zhang Hui
Neurology
Updated on September 20, 2024
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Cerebral embolism is a particularly dangerous type of ischemic cerebrovascular disease. Patients present with a very abrupt onset, typically with a history of atrial fibrillation. Acute onset rapidly leads to limb paralysis, and may also cause disturbances in consciousness and seizures, among other clinical manifestations. Current guidelines for thrombolytic treatment of cerebral embolism do not address extensive cerebral embolism, as thrombolysis in extensive cerebral embolism carries a certain risk of bleeding and is not generally advocated in clinical practice. Mainly, arterial thrombectomy treatment can be administered within an eight-hour window, which can provide significant therapeutic effects for some patients. Additionally, if the cerebral embolism is considered small and the patient's consciousness is relatively intact, intravenous thrombolytic treatment can be given. The time window for intravenous thrombolysis is generally within four and a half hours, so it is crucial to get to a hospital as quickly as possible in the event of a suspected cerebral embolism.

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Written by Liu Yan Hao
Neurology
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Auxiliary examinations for cerebral embolism

Patients with cerebral embolism need to undergo a cranial MRI to observe the location of the embolism, the area of brain tissue necrosis, and the age of the lesion, which is helpful in assessing the severity of the disease and prognosis. Additionally, it is necessary to examine the cervical vasculature with Doppler ultrasound to check for the presence of carotid artery plaques, especially soft plaques which are prone to detachment and can form emboli, blocking cerebral vessels and potentially causing recurrence or exacerbation of cerebral embolism. Furthermore, an echocardiogram of the heart is required because another common source of emboli in cerebral embolism is mural thrombi in the heart, particularly in patients with arrhythmias or atrial fibrillation, who are more prone to form mural thrombi. Therefore, patients with cerebral embolism need to have an echocardiogram to check for the presence of mural thrombi. If present, anticoagulant medication is required for treatment. (Please use medications under the guidance of a professional physician.)

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Written by Liu Yan Hao
Neurology
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Can people with cerebral embolism eat mutton?

Patients with cerebral embolism can eat lamb, but should do so in moderation and not excessively. This is because a common cause of cerebral embolism is the formation of atherosclerotic plaques in the neck arteries, particularly soft plaques. When these soft plaques detach, they form an embolus that, carried by the bloodstream, can block cerebral vessels and cause a cerebral embolism. Thus, many of these patients often have hyperlipidemia, with a basis of arteriosclerosis and arterial plaques. Therefore, their diet should be low in salt and low in fat, and overall light. Foods that are overly greasy or high in fat should be avoided as much as possible, such as animal organs and fatty meats which are high in fat. Lamb can be eaten in proper amounts. Other dietary considerations include avoiding overly salty foods, as excessive salt intake can lead to increased blood pressure, further aggravating arteriosclerosis and arterial plaques, and leading to the onset of cerebral embolism.

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Written by Zhang Hui
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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Written by Liu Yan Hao
Neurology
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What are the symptoms of cerebral embolism?

Brain embolism usually begins suddenly and develops rapidly, often reaching a peak in a very short time. This can cause patients to quickly become comatose or experience weakness in limbs on one side of the body, with some presenting with complete paralysis or speech impairments. These symptoms occur because a major blood vessel in the brain is blocked abruptly, leading to ischemia and tissue necrosis in the supplied area. Common sources of the emboli include plaques in the cervical arteries, where soft plaques can dislodge and form emboli that block cerebral vessels with the bloodstream. Alternatively, patients with atrial fibrillation may suffer from embolism when thrombi attached to the inner walls of the heart dislodge and block cerebral vessels through circulation. Brain embolism is generally a severe condition with a rapid onset.

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Written by Zhang Hui
Neurology
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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.