The stroke , also known as embolic stroke, is a stroke type, ie, a transient or permanent alteration of the blood flow in one or several areas brain.
In cerebral embolism, blood occlusion is the product of the presence of an embolus, a body of organic matter (blood, fat or gas clot) that is located in an encephalic blood vessel, preventing or hindering the normal blood flow and generating an ischemic or heart attack.
Clinically, stroke can produce a wide spectrum of neurological disorders: muscle numbness and paralysis, severe headache, confusion, loss of consciousness, etc.
Additionally, this type of stroke is a life-threatening medical condition. Up to approximately 20% of the affected people die in the first moments and, a good part of the survivors, have secondary disabilities for life.
Diagnostic procedures are usually adjusted to standardized hospital intervention protocols. They generally include an extensive neurological examination, essentially based on the use of neuroimaging tests (computerized tomography, magnetic resonance imaging, etc.).
Furthermore, therapeutic interventions in the acute phase usually include a pharmacological and / or surgical approach, with the fundamental objective of reestablishing cerebral blood flow. On the other hand, interventions in the post-acute phase focus on physical and neuropsychological rehabilitation.
Characteristics of cerebral embolism
A cerebrovascular accident or stroke is a neurological disorder in which the cerebral blood supply is suddenly interrupted, either by an obstruction or by a blood spill.
Our brain, unlike other structures, does not have the ability to accumulate or store energy reserves, for this reason, the supply Consistent blood flow is critical to its efficient functioning.
Under normal conditions, glucose and oxygen circulate through our bloodstream reaching all the structures of the body, including the brain. Thus, the necessary cerebral blood perfusion is 52ml / min / 100g.
Therefore, any event that alters this flow placing it below 30ml / min / 100g, will significantly interfere with brain cell metabolism.
In this way, if one or more areas of the brain receive little or no oxygen supply (hypoxia) or none (anoxia) and glucose, as a result of an obstruction or massive entry of blood material, a large part of the affected cells may be damaged and, consequently, die immediately and generate a zone infarcted (area of dead tissue).
Although there are different types of cerebrovascular accidents, cerebral embolism is classified within the ischemic type events.
Ischemic attacks or accidents constitute a medical event in which a cerebral blood vessel closes or blocks, preventing the passage of the blood and, as a consequence, oxygen and glucose to different brain areas.
Furthermore, ischemic events can be divided into two groups: thrombotic accidents (occlusion due to the formation of a clot blood in brain areas) and embolic accidents (occlusion due to the presence of a blood clot, fragment of fatty matter or air intake, coming from an extra-cerebral area).
The cerebral embolism is classified within the accidents of the embolic type.
An embolus is an accumulation or mass of a liquid, solid or gaseous character that is generated inside the blood vessels and flows through the system circulatory, hindering or preventing the passage of blood.
In the case of cerebral embolism, the material that hinders or prevents the normal flow of blood is generated in other places of the circulatory system, it is that is, outside the brain, accessing the brain through the cerebral arteries.
Types of cerebral embolism
In addition, cerebral embolism can be classified according to its characteristics or the type of embolus:
– Cardiac embolus: in this case, the formation of a blood clot occurs that is formed from the increase in the thickness of the blood. This hardens into a mass. It usually forms within the veins or arteries of our circulatory system, thus, they tend to detach and travel through the bloodstream to the brain.
– Fatty plunger: in this case, there is an accumulation of fatty material in the form of a deposit or plate, which, like the material clotted blood, can break off and travel, through the circulatory system, to the brain.
– Air embolus: the event that obstructs blood circulation is an air bubble. Normally, it results from leaking vessels blood vessels or surgical accidents.
– Septic embolus: the material that causes the obstruction is derived from the accumulation of tissue or purulent material, product of a process infectious.
– Tissue embolus: in this case, a piece of cancerous or neoplastic tissue detaches from its source of origin and travels to the brain obstructing blood circulation in its path.
– Foreign body embolus: when other types of bodies foreign to the body (eg: Bullet), access it, they can also cause obstruction of cerebral blood circulation, when they reach these areas.
Who can get a stroke?
Despite the fact that anyone can suffer a stroke and, in particular, a cerebral embolism, these neurological alterations are more frequent in the population over 55 years of age, in addition its occurrence increases exponentially with age.
Apart from this, there are some personal and environmental factors that can increase the risk of suffering them, some of these include: belonging to the male sex, having a family history, suffering from hypertension, diabetes, sedentary life, consumption of toxic substances, etc.
Signs and symptoms
When cerebral blood flow is temporarily or permanently interrupted, different identifiable pathological events may appear at the level Clinical symptoms that, although they may vary depending on the affected brain areas, in most cases usually include:
– Progressive development or sudden appearance of tingling sensations, muscle weakness, numbness or paralysis in one or more areas of the body, especially in the extremities or facial areas.
– Progressive development or sudden appearance of spatial-temporal and personal confusion, difficulties in speaking or alteration of the level of alertness and state of consciousness.
– Progressive development or sudden appearance of visual disturbances, generally associated with loss of vision.
– Progressive development or sudden onset of feelings of tiredness, sleepiness, fatigue, imbalance and even dizziness or nausea.
– Progressive development or sudden onset of a severe headache, in the form of a severe headache.
When we observe this set of symptoms in a person, it is essential to go to the emergency medical services, since they may be suffering a stroke and thus medical intervention is critical to your survival and future functional prognosis.
After the acute phase of the stroke, that is, the initial moments after hospitalization and emergency medical intervention, When the vital signs of the affected person are stabilized and present a level of functional consciousness, it is possible to observe a series of sequelae or secondary medical complications. The most commons are:
– Paralysis or muscle weakness: the inability to move with one or more limbs is one of the medical sequelae more frequent after cerebral embolisms. For the most part, it usually affects unilaterally, that is, one side of the body. We can identify both a significant difficulty in performing motor acts with the affected areas (hemiparesis), and a complete disability (hemiplegia).
– Apraxia: inability or significant difficulty to voluntarily perform and execute learned coordinated motor acts previously.
– Aphasia: inability or significant difficulty to produce or understand language.
– Dysphagia: inability or significant difficulty in swallowing, that is, swallowing food, external liquids, or saliva efficient.
– Neuropsychological deficits: normally, one of the most prevalent sequelae after cerebrovascular accidents is the presence of deficits related to spatial orientation, attention or problem-solving ability, however, problems with memory , associated with events before or after the stroke.
– Emotional disorders: the impact of physical and cognitive complications, the cerebrovascular event, can generate in the person affected irritability, mood swings, behavioral problems and even feelings of sadness, which is why it is possible for them to develop some psychological disorders related to these.
As we pointed out in the initial description of cerebral embolism, this pathology has its etiological origin in the occlusion of the blood circulation by the presence of a plunger.
This is an abnormal accumulation of a foreign and / or biological material, of cardiac or non-cardiac origin, that is originated in another point of the system and is transported through the arterial system to brain areas.
An embolus, therefore, can be a blood clot, an air bubble, fat, or tumor-like cells. Therefore, there is a wide variety of diseases or pathologies that can generate them and, therefore, contribute to the occurrence of cerebral embolism.
The disorders most frequently associated with the formation of emboli are cardiac pathologies, especially myocardial infarctions or atrial fibrillation. In the case of fatty emboli, the pathology most related to its formation is arterioscrorisis or levels elevated blood cholesterol
One of the fundamental objectives of the diagnostic intervention is the identification of the etiological causes and the affected areas, with the aim of designing the best treatment.
Beginning with the physical and neurological examination, the diagnosis of stroke focuses primarily on the results obtained through various laboratory tests:
– Computerized Tomography (CT): it is considered one of the best tests to detect the presence of bleeding or areas infarcted in the brain, it offers us visual information about its structural integrity. In addition, it can also provide information about blood perfusion and therefore identify those areas where there is significantly poor flow.
– Magnetic Resonance Imaging (MRI): like the previous one, it offers visual information about the areas affected, it also offers reliable results even after several minutes from the beginning of the first clinical signs and symptoms.
– Angiography: this type of test is used to examine the integrity of the blood vessels that make up our system circulatory system, in the case of embolism, those that nourish the brain areas are specifically examined. Angiography can tell us if any of the blood vessels studied is blocked by some foreign body.
– Carotid duplex: in the case of this test, the results can indicate whether or not there is an arteriosclerotic process, that is, presence of a narrowing of the blood vessels due to the adhesion of plaques.
– Transcranial Doppler (TCD): it is used for the same purpose as the test described above, in addition, it can also show the presence of obstructive blood clots.
– Echocardiogram: this type of test is mainly used to detect the presence or formation of blood clots in areas that can become detached and travel to other areas of the circulatory branches.
Regarding the treatment of cerebral embolism, the first phase of care will be fundamentally medical, with the aim of controlling the accident and the possible consequences.
When a person goes to the emergency medical services with a symptomatological picture compatible with the suffering of a cerebral embolism, both The center as well as the health professionals in charge of the case, are coordinated through the “Stroke Code”, a hospital protocol that encourages recommended medical procedures and therefore facilitates diagnosis and initiation of treatment.
Although, in the initial moments -in the acute phase-, there is a high percentage of death, at present the improvement and improvement intervention procedures, technical measures and treatments, has considerably reduced the number of cases.
Generally, the most indicated therapeutic intervention in this phase is focused on pharmacological therapy, beneficial for the control of the event embolic, prevention of recurrent seizures, alterations of consciousness or secondary symptoms.
Once the patient is able to overcome the medical complications, the clinical severity of the sequelae will depend fundamentally on a series of factors related to the characteristics of the lesions and the patient, some of the most relevant factors being the location and extent of the injury.
In general, recovery takes place in the first three months in more than 90% of cases, however, there is no exact time criterion.
In addition, an important part of the therapeutic approaches will be the measures that help the individual to control their posture, movements, speech and functions. cognitive.
- Balmesada, R., Barroso and Martín, J., & León-Carrión, J. (2002). Neuropsychological and behavioral deficits of cerebrovascular disorders. Spanish Journal of Neuropsychology, 4 (4), 312-330
- HANDLE. (sf). Stroke. Obtained from Stroke Association.
- NIH. (2014). Arterial embolism. Obtained from MedLinePlus.
- NIH. (2015). Stroke. Retrieved from MedlinePlus.
- NIH. (2015). Stroke: Hope Through Research. Obtained from the National Institute of Neurological Disoerders and Stroke.
- NIH. (2016). What Are the Signs and Symptoms of a Stroke? Obtained from National Heart, Lung, and Blood Institute.
- Martínez-Vila, E., Murie Fernández, M., Pagola, I., & Irimia, P. (2011). Cerebrovascular diseases. Medicine, 10 (72), 4871-4881.
- SEN. (2016). WHAT IS STROKE? WHAT ARE ITS CAUSES? Obtained from Study Group for Cerebrovascular Diseases.
- Neurological disorders. (nineteen ninety five). In J. León-Carrión, Manual of Clinical Neuropsychology. Madrid: Siglo Ventiuno Editores.
- TISC. (2016). Ischemic Stroke. Obtained from The Internet Stroke Center.
- University, JH (2016). Stroke. Obtained from Johns Hopkins University Medicine.
- Washington, U. o. (2016). Embolic Stroke. Obtained from UW Medicine.