What are the treatment options for a blood clot in the brain?

Question

Hi doctor,

Three months back, my father had a problem with balance, always even while sleeping. We consulted a doctor, and he asked for BMD (bone mineral density), where he diagnosed a problem in the bones of the neck and back. A few days back, suddenly, while on a 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 (magnetic resonance imaging), where the report came that there is blood clotting in the brain. I have all the reports that I can show you for better understanding.

Please suggest some proper treatment.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

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

From your history, I come to the conclusion that your father had a TIA (transient ischemic attack) (a type of stroke, which is a temporary obstruction to the blood flow to a specific part of the 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. There are two types of stroke (ischemic stroke and hemorrhagic stroke). In your father's case, I suspect the first type of clinical history. 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.

Admit him to a hospital with an ICU (intensive care unit) setup and an in-house MRI and neuro-cath lab. Meanwhile, control his blood pressure, blood sugar, and give prophylactic Ecosprin (Aspirin) 150 mg, starting with Clopitab (Clopidogrel) 75 mg (but if the MRI report suggests bleeding in the brain, then will not give this Medicine).

Other medicines include anticonvulsants, analgesics, and antacids. Investigations like ECG (Echo cardiogram), 2D echo, neck Doppler, BP monitoring, sugar monitoring, renal function and liver function, coagulation profile, and viral markers are done as part of the identification of the cause of stroke, or as part of the planning of the treatment.

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.

Thank you for choosing iCliniq.

I am happy to help you and will always be available whenever you need me at icliniq.com.

Answer 2

Hi,

Welcome back to icliniq.com.

As I strongly suspected, it is the same: ischemic stroke on the right side of the brain. 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 lobes. The vertebral artery supplies the brain stem through the posterior circulation.

In your father's case, the right ICA is blocked segmentally by more than 90 percent and is the cause of recurrent stroke. He needed an urgent intervention by a neurosurgeon (by carotid endarterectomy) or by an interventional specialist (intervention: radiologist, neurologist, or neurosurgeon) who can do atherosclerotic 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 where in-house MRI, CT (computed tomography), neuro-cath lab, neurologist, neurosurgeon, and intervention specialist are available round the clock. Remember that 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.

Thank you for choosing iCliniq.

Take care.

Answer 3

Hi,

Welcome back to icliniq.com.

I understand your concern.

But as I said, get things moving 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 (digital subtraction angioplasty) 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 things fast. Remember, you are the one who decided that 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 (intensive care unit) stay of one to two days. The process is not complicated; the only thing needed is a team with proper backup facilities.

Thank you for choosing iCliniq.

Take care.

Answer 4

Hi,

Welcome back to icliniq.com.

I understand your concern.

The stroke unit comes under a neurologist in a hospital. They will have staff 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 on it in time.

Thank you for choosing iCliniq.

Take care.