Cerebral thrombosis is a blood clot that forms in the cerebral vessels, causing a decrease in blood supply to the brain. It is responsible for 50% of all stroke cases and can be caused by factors such as endothelial cell damage, blood stasis, and hypercoagulability. Symptoms include weakness, paralysis, slurred speech, and confusion. Treatment involves thrombolytic therapy and anticoagulant drugs, while prevention involves modifying risk factors such as high blood pressure, diabetes, smoking, and alcohol consumption.
A cerebral thrombosis is a blood clot that forms inside one of the cerebral vessels, decreasing the supply of blood, oxygen and nutrients to the cerebral parenchyma. The two types of thrombosis are arterial thrombosis and venous thrombosis. Cerebral thrombosis most often refers to the formation of thrombi within the cerebral arteries, and cerebral venous thrombosis refers to the formation of clots within the cerebral veins and sinuses. It is also synonymous with brain attack and cerebral infarction and is responsible for approximately 50% of all stroke cases.
The classic triad, or Virchow’s triad, of thrombosis is endothelial cell damage, blood stasis, and hypercoagulability. Hypercoagulability, or thrombophilia, refers to the increased tendency to form clots and is usually secondary to deficiencies in anticoagulant factors and autoimmune diseases. Endothelial cell injury refers to injury to blood vessel walls, and this can occur due to trauma, infection, or surgery. Stasis can be due to long periods of lack of physical activity, which often occurs among people on long plane flights, bedridden patients, or the elderly. These factors that make up Virchow’s triad also contribute to clot formation and obstruction of cerebral vessels.
Most cases of arterial thrombosis result from the rupture of an atheroma, a lesion of lipids, macrophages and connective tissue accumulated on blood vessel walls, characteristic of atherosclerosis. The two types of cerebral thrombosis include small vessel thrombosis and large vessel thrombosis. Small vessel thrombosis is used for thrombosis of the smallest and deepest arteries, such as the lacunar arteries. Large vessel thrombosis is used for thrombosis of larger arteries, such as the middle cerebral artery and carotid artery.
The symptoms of cerebral thrombosis are also the symptoms of stroke. Depending on the blood vessel involved, an affected person may experience weakness or paralysis on one side of the body or face, slurred speech, and difficulty swallowing. Loss of muscle coordination, loss of balance, severe headache, sudden vision loss, and confusion may also occur.
To diagnose this condition, computed tomography (CT) or magnetic resonance imaging (MRI) may be done. Magnetic resonance imaging is the most specific test because it allows visualization of the thrombosed vessel even in the absence of concomitant hemorrhage. To detect large vessel thrombosis, carotid ultrasound or transcranial Doppler may be done. Magnetic resonance angiography or computed tomography angiography may also be done.
Treatment of cerebral thrombosis involves dissolving the thrombus through thrombolytic therapy, such as alteplase, tenecteplase, streptokinase, and anistreplase. These drugs are most effective when given within 60 minutes of the onset of symptoms. Anticoagulant drugs, such as heparin, may be given to prevent further blood clots from forming.
Prevention of cerebral thrombosis involves modifying its risk factors, which include high blood pressure, diabetes, smoking and alcohol consumption. People with high blood pressure should take antihypertensive medications, reduce salt intake, exercise regularly, and aim for a blood pressure below 120/80 millimeters of mercury (mmHg). Diabetic patients should achieve a hemoglobin A1c (HbA1c) level of less than or equal to 7%. Those who have elevated cholesterol, triglycerides, and low-density lipoprotein (LDL) levels should also control their lipid levels, preferably through diet modification, physical activity, and taking statins. People who smoke are advised to quit, while those who drink alcohol excessively are advised to eliminate or reduce their alcohol consumption.
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