Q. My father has a blood clot in the brain. Please suggest some proper treatment.

Answered by
Dr. Rahul Patil
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 12, 2020

Hi doctor,

Three months back, my father had a problem in balance, always even while sleeping. We consulted a doctor, and he asked for BMD, where he diagnosed a problem in the bones of the neck and back. A few days back, suddenly, while morning walk, the right leg turned numb, and my father could not move it or feel it. After 20 minutes, it got normal, then we went to the doctor, and he asked to do an MRI where the report came that there is blood clotting in the brain. I have all reports which I can show you for better understanding. Please suggest some proper treatment.

#

Hi,

Welcome to icliniq.com.

I feel sorry for all the pain your father is going through.

1) As from your history I come to a conclusion that you father had TIA (a type of stroke, that is temporary obstruction to the blood flow to a specific part of brain). MRI (magnetic resonance imaging) brain (stroke protocol) with MRA (magnetic resonance angiography) brain is the best investigation for it. Please do it as soon as possible, as further treatment depends on it.

2) There are two types of stroke (ischemic stroke and hemorrhage stroke). In your father's case, I suspect the first type of clinical history.

3) You said that you had attached an MRI report, ECG (electrocardiography), and 2D report, but unfortunately, I could not see them in the attachment (attachment removed to protect patient identity); it would be nice of you if you could send them again.

4) Admit him to a hospital with ICU (intensive care unit) setup and in house MRI and neuro-cath lab.

5) Meanwhile, control his blood pressure, blood sugar and give prophylactic Ecosprin (Aspirin) 150 mg start with Clopitab (Clopidogrel) 75 mg (but if the MRI report suggests bleeding in the brain, then will not give this Medicine). Other medicines include anticonvulsant, analgesic, and antacid.

6) Investigation like ECG, 2D echo, neck Doppler, BP monitoring, sugar monitoring, renal function and liver function, coagulation profile, and viral markers are done as a part to identify the cause of stroke, or as a part to plan the treatment.

7) Evaluate your father entirely as he was lucky this time as his sensation improved but take this as a warning sign as in the second episode he may not be that lucky and suffer a partial paralysis of his body.


Regarding follow up:

With MRI film and report.

Hi doctor,

Thank you for your reply.

I have attached the reports for your better understanding.

#

Hi,

Welcome back to icliniq.com.

Thanks for the follow-up.

1) As I strongly suspected, it is the same: ischemic stroke on the right side of the brain.

2) There are four main vessels to the brain (two internal carotid and two vertebral arteries). The internal carotid (ICA) forms the anterior circulation, giving rise to the anterior, middle, and posterior cerebral vessels and supplies the internal capsule, basal ganglia, thalamus, midbrain, the frontal, parietal, temporal, and occipital lobe. The vertebral artery supplies the brain-stem by posterior circulation.

3) In your father case, the right ICA is blocked segmental by >90% and is the cause of recurrent stroke. He needed an urgent intervention by a neurosurgeon (by carotid endarterectomy) or by a interventional specialist (intervention: radiologist or neurologist or neurosurgeon) who can do atherosclerosis plaque removal along with carotid stenting, by doing a DSA (digital subtraction angiography) procedure (diagnostic and therapeutic).

I would suggest you take your father to a center were in-house MRI, CT, neuro-cath lab, neurologist, neurosurgeon, and intervention specialist are available round the clock.

4) Remember the time is valuable in your father's case, as he may not be lucky the next time. For treatment, you require a team of doctors. Only this can minimize the risk of complications.

Hi doctor,

Thank you so much for your reply.

Could you please suggest the best treatment? I have consulted one more person; he says that stenting (angioplasty) or surgery to be done. Please tell me what you think is best.

#

Hi,

Welcome back to icliniq.com.

But as I said, get things to move fast, as it is not an emergency condition but may turn into an emergency at any time. Talk with doctors over there on the phone and the earliest appointment for cerebral DSA with stenting. Whoever gives you the most initial appointment shift him there. You can also talk with doctors over there from the private sector who can move on things fast. Remember, you are the one who decided whichever good doctor gives an early appointment should be your choice. It is a two to three-day admission (one to two hours procedure), with a post-procedure ICU stay of one to two days. The process is not complicated; the only thing is a team with proper backup facilities is needed.

Hi doctor,

Thank you for your reply.

In this is COVID-19 situation, at most places, doctors are not performing any surgery. I am perplexed. As a doctor, you can enlighten me with a better suggestion. Please help.

#

Hi,

Welcome back to icliniq.com.

The stroke unit comes under a neurologist in a hospital. They will have staffs and ground-level doctors specifically trained for stroke. I do not know about the vascular surgeon. They might be doing it very well, but if any neuro-related complication occurs, they will not be able to pick up in time.


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