Update: November 2018
Even a person far from medicine knows that a blood clot is something
dangerous. It is he who causes most cases.
sudden death. Like a healthy man was going to work in the morning,
suddenly fainted and died in five minutes. �“A thrombus broke off” –
hear from people later.
A blood clot in a blood vessel can block its lumen and cause
necrosis (tissue death) of the organ or part thereof that receives
blood supply from this vessel. In the arteries of the limbs, it can
lead to gangrene, in the heart – to heart attack, in the brain – to stroke, in
pulmonary artery – to acute pulmonary heart disease. AT
veins they are not so fatal, but can be a source of thromboembolism
(when pieces of venous thrombus come off and spread with
blood flow to the heart and other organs).
What is a blood clot?
Our body is programmed for self-preservation. He has
self-defense mechanisms against various injuries and infections.
One such protection mechanism is blood clotting. it
very complex system that is activated when damaged
эндотелия vessels. If you consider it oversimplified, the picture will be
- in case of damage of the inner layer of the vascular wall to this place
platelets rush in to seal the injury site and
stick together with each other;
- other blood cells get stuck in the clot of platelets –
- Fibrin strands are woven into it for even more
The formation of blood clots protects our body from blood loss
with bleeding. But there are situations when this mechanism
run and without bleeding. The main reasons for this are:
- rupture of the inner wall of the vessel with the growth of atherosclerotic
- infectious and non-infectious (autoimmune) inflammation,
affecting the vessels and valves of the heart;
- increased blood viscosity;
- slow blood flow;
- длительный спазм vessels.
How blood clots form in the head
- The most common process of their education –
atherothrombosis. It happens like this: as a result of lipid disorders
exchange in the intima of the vessel is deposited cholesterol – is formed
atherosclerotic plaque. At the initial stage, she does not
manifests. Gradually increasing, it narrows the lumen of the vessel,
blood swirls are created in this place. AT какой-то момент бляшка
can tear the artery wall (most often it happens when
sudden pressure surge). AT место надрыва устремляются тромбоциты
and a blood clot is formed.
The resulting clot can block the flow of blood in its place
location, and can come off and clog up another, smaller
- Infectious-inflammatory processes (sinusitis, otitis,
meningitis, boils, etc., can cause septic thrombosis
- Thromboembolism in the vessels of the head from other places. it именно то,
what is popularly referred to as a “thrombus.” Most often in the brain it
gets from the left parts of the heart (left ventricle – aorta –
brachiocephalic trunk – carotid artery – brain arteries). AT то же
time thrombus formation in the heart occurs when:
- myocardial infarction;
- valve damage (rheumatic defects, infectious
- the presence of artificial valves;
- heart aneurysms;
- atrial fibrillation. it наиболее частая на сегодня причина
thrombosis: in case of arrhythmia, the heart contracts with different frequency and strength,
blood flow slows down, clot forms.
But a thrombus can come off in the head itself – for example, from a common
or the internal carotid artery falls into smaller branches and
Risk factors for thrombosis and embolism
Что способствует тромбообразованию:
- Elevated levels of “bad” cholesterol. LDL (lipoproteins
low density) is the most atherogenic class of lipoproteins.
It is he who leads to the development of atherosclerosis and atherothrombosis.
- ATысокое артериальное давление (АД). Constantly high blood pressure numbers
lead to prolonged tension of the vascular wall and its increased
- Heart diseases (arrhythmias, myocarditis, endocarditis, defects
valves, heart failure).
- Smoking. Nicotine causes vasoconstriction and also increases
- Blood coagulation (with a lack of fluid in hot weather,
hobby bath, sauna, diuretic).
- Blood diseases for which the red blood cell level rises,
platelet count (polycythemia, erythremia, thrombocytosis).
- Sedentary lifestyle, long bed rest.
- Pregnancy and childbirth.
- Oncological diseases.
- Surgical intervention, angiography.
- Autoimmune diseases involving vessels (vasculitis,
systemic lupus erythematosus, periarteritis nodosa, disease
- Acceptance of certain drugs (for example, hormonal
Factors contributing to thromboembolism
If there is already a blood clot in the body (in the heart or in the vessels), then this
time bomb. AT какой-то момент он может оторваться
and clog the cerebral artery. Contribute to this can:
- Sharp pressure surge. And most often it is sharp
- Physical load.
- An attack of arrhythmia.
- Nervous stress.
- Hot bath or bath.
But quite often thromboembolism happens without any
provocative moments, for example in the morning after waking up.
Symptoms тромба в голове проявляются только тогда, когда он
completely covers the lumen of the vessel. The area of the brain stops
getting oxygen on and off from work. And the brain is ours
computer, he gives commands to all internal organs and our
the muscles. Each brain region is responsible for certain functions:
frontal cortex – for movement, thought processes, occipital part
– for vision, cerebellum – for balance, in the brain stem are
vital respiratory and vascular center, etc.
Therefore, when you turn off from the work of any part of the brain
the function it performs also falls out. ATозникает ишемический
stroke. AT 40% случаев он вызывается первичным тромбозом, в 55%-
thromboembolism, and only in 5% of cases – for other reasons.
His clinic develops in time from a few minutes to
a few hours. The first signs of a blood clot in the head are a feeling
stunned, disorientation. Headache for ischemic
stroke is not very characteristic. Loss of consciousness is possible only when
lesion of the trunk or extensive lesion of the hemispheres. To the fore
there is a focal neurological symptoms, which increases in
for several hours, sometimes days.
The main focal symptoms that can be with a stroke:
- Paralysis and paresis of the limbs.
it нарушение движений в конечностях. Total lack of movement
– this is paralysis. If movements persist, but significantly weaken
– this is paresis. Motor function falls on the side
opposite to brain damage: with thrombosis in the middle cerebral
left artery – right-sided paralysis, with a lesion of the right
arteries – left side. Movements may be absent in both
limbs on the one hand (hemiparesis), or suffers only
arm or leg only (upper and lower, respectively)
- Decrease in sensitivity (a hypesthesia, a paresthesia) one
half body, or one limb.
- Disturbance of speech (aphasia). Aphasia occurs with the defeat
dominant hemisphere of the brain (in right-handers – left). She may be
motor (the patient understands speech, but can not say it himself) or
sensory (man does not understand the word, cannot synthesize
- Double vision (diplopia).
- Violation of memory, orientation in time and space.
- Limit the field of view.
- Imbalance – ataxia.
- Eating when eating is a violation of swallowing.
- More rarely, but there may be headache, nausea, vomiting, seizures,
disturbance of consciousness.
Clinic depending on the location of thrombosis
|Average brain||Disturbance of speech, paralysis of the upper or lower extremities.
Impaired sensitivity. Reduced vision.
|Anterior cerebral||Paralysis of the arm or leg, right or left, paresis of facial muscles
faces. ATозможны изменения психики
|Back brain||ATыпадение полей зрения, зрительные галлюцинации|
|ATертебро-базиллярная||Signs of cranial nerve damage, dizziness,
If the thrombus is localized in the extracranial (extracranial) department
the carotid artery, the symptoms “flicker”, that is, they
can independently disappear and appear with varying severity and
Thrombosis in the veins and venous sinuses of the brain
Thrombosis of the veins and sinuses of the brain occurs most often when
purulent processes in the sinuses, in the middle ear, in the brain
shells, at least – with the spread of infection from other organs.
Contribute to this pathology and surgery, postpartum
The clinical signs of a vein thrombosis can appear abruptly, and
may develop gradually. If such a complication occurs on
background meningitis or purulent sinusitis, it is not immediately possible
to recognize. The main symptoms of cerebral thrombosis are:
- arching headache, aggravated in position
- nausea, vomiting;
- temperature rise;
- dilation of the saphenous veins on the head;
- puffiness, redness of the face;
- tension and soreness of the occipital muscles;
- visual impairment;
- stupor of consciousness, spoor;
- paresis, paralysis.
How to diagnose
AT первую очередь, по симптомам. Suspect a stroke can even
not a medic. If a person suddenly becomes ill, you need to ask
- Smile. A person with a stroke will get a smile
only one corner of the mouth will rise, the second will remain
- Raise up both hands. With paresis, one of them will be
- Ask for your name, age, address, date, and
month. With a stroke, he will not be able to answer at all, or the speech will be
blurred and incomprehensible.
itт тест называется FAST(Face Arm Speech Test) –
If there is at least one of the signs, you must call
ambulance, while clearly and clearly list the symptoms.
What to do before the arrival of the ambulance
If you suspect that a patient has a cerebral infarction, it is advisable to
slightly lifting the head end, calm. Not recommended sharply
reduce the pressure, it is better not to let the doctors arrive no
antihypertensive drugs. It is enough to dissolve a few
If you suspect a stroke, the patient is delivered in an emergency.
order to the nearest vascular center or neurological department.
If no more than 6 hours have passed since the onset of symptoms.
The patient is sent to the neuro-resuscitation unit. Transportation – to
a stretcher with a raised head end.
Thrombosis is an emergency, and the faster the patient will be
delivered to a specialized hospital, the greater the chance of
What to do in the hospital
- CT scan (computed tomogram) of the brain. This is the first thing
should do if you suspect a catastrophe in your head. This
the study allows to exclude intracerebral hematoma, see
ischemia center (but not always, sometimes it is formed only through
- Examination by a neurologist with an assessment of the severity of the condition.
- Ultrasound vascular scanning.
- In some cases, CT scan or MRI angiography of the cerebral
- Spinal puncture.
- Common, biochemical and coagulogram analyzes.
- Consultations of medical specialists (therapist, cardiologist,
endocrinologist, ophthalmologist, neurosurgeon).
Treatment of thrombus. Thrombolysis
If a blood clot occurs in the head, treatment should begin as soon as possible.
rather There is a so-called “therapeutic window”, that is
the time during which you can dissolve it medically and
get a full regress of symptoms.
This time – up to 4.5 hours after the first signs,
maximum – up to 6 hours.
Thrombolysis (введение препаратов для растворения сгустка крови)
performed in specialized units in the intensive care unit.
To conduct it, doctors must ensure that a stroke does not
hemorrhagic, namely ischemic, and also to exclude
- (low blood clotting,
- lowered platelets
- high blood pressure numbers
- low or very high blood sugar.
Introduction of thrombolytic agents (streptokinase, urokinase, metalysis, and
can be administered intravenously or selectively in
affected artery (selective thrombolysis). Last method
performed in a special x-ray
operating and refers to high-tech medical care.
Under all conditions, thrombolysis gives a remarkable
result: all symptoms can go away within 24 hours.
But more often these conditions are not observed:
- patient delivered too late
- the exact time of the disease is unknown,
- the hospital has no specialists
- to a specialized center far, etc.
In such cases, it should be expected that the hearth formed
ischemia in the brain will cause prolonged loss of function.
- Sometimes symptom regress can occur independently in
during the day, it is called TIA (transient ischemic
- In mild cases, improvement occurs in a few days and
within two months the patient is fully restored.
- With deeper strokes, the symptoms disappear more slowly,
the recovery period may take up to 2 years.
- In severe brain damage, the effects of a blood clot (symptoms
neurological deficit) persist until the end of life, a person can
Treatment of brain thrombosis without thrombolysis
According to statistics, thrombolysis is used only in 3-6% of cases.
ischemic stroke. In other cases, held
conservative treatment that can be differentiated and
Дифференцированное лечение тромба в голове – это
measures to stabilize the focus of ischemia and prevent
its progression. Appointed:
- drugs that lower blood clotting – heparin, aspirin,
- dilution of blood to reduce its viscosity – intravenous
infusion of saline, reopoliglukina;
- drugs that improve blood circulation at the border of ischemia –
pentoxifylline, instenon, vinpocetine, neuroprotectors – glycine,
Cerebrolysin, Mexidol, Semax.
Недифференцированное лечение тромбоза – это
measures aimed at maintaining vital organs and systems
prevention of complications:
- maintaining blood pressure levels in numbers
exceeding the working;
- treatment of heart failure, arrhythmias;
- maintaining optimal blood sugar levels in patients with
diabetes. It is desirable for the duration of the acute period the appointment of insulin
instead of pills;
- sedatives with increased nervous excitement;
- bedsore prophylaxis, pneumonia;
- feeding through a tube in patients with impaired swallowing.
What happened happened – a blood clot did its job and turned off
brain area. It is known that nerve cells do not regenerate.
Does this mean that paralysis or speech disorder will remain forever?
Not at all. It all depends on the extent of the defeat. For small
the foci of necrosis, the neighboring areas of the brain are gradually “retrained” and
take on the function of dead neurons.
This process takes time, effort and attitude of the patient himself and
his loved ones.
Rehabilitation after stroke includes medication
treatment, as well as massage, physiotherapy, physiotherapy,
classes with a speech therapist and other remediation activities.
Последствия могут исчезнуть без следа, могут значительно
decrease, may remain for life.
Thanks to modern advances in medicine can significantly
reduce the risk of thrombosis. Prevention may be primary (in individuals
with risk factors for thrombosis) and secondary (in patients
already experienced thrombosis or TIA).
The main preventive measures:
- Reducing cholesterol and LDL (taking lipid-lowering
- Reception of the means reducing blood clotting. Depending
anticoagulants are prescribed for the level of the risk of thrombosis
(warfarin, fenilin, pradaksa, ksarelto) or antiplatelet agents
- Selection of adequate doses of blood-lowering drugs
- To give up smoking.
- Maintain normal blood sugar levels.
- Weight loss.
- Thorough examination and, if necessary, prompt
treatment (removal of blood clots from the heart, from the carotid arteries).
- Electropulse therapy to restore the correct rhythm
Surgical treatment of thrombosis in the head
Many are interested in the question: is it possible to remove a blood clot from the head?
surgically? Theoretically, such an operation (thrombectomy)
you can hold. Доступом из бедренной артерии под МРТ –
a catheter with a special
spray that sucks it. But practically
in the acute period of brain thrombosis almost no manipulation is performed.
An alternative to it is selective thrombolysis, i.e.
bringing directly to a clot of thrombolytics and dissolving
If we talk about the acute period of thrombosis, then surgical
the intervention is often carried out with clots in the venous sinuses:
craniotomy, sinus dissection and removal of thrombotic masses.
Basically, all surgical interventions are aimed at
prevention of thrombosis: both primary and secondary. Thats
they are not held in the acute period.
- Carotid endarterectomy. This is a delete operation.
atherosclerotic plaque in the carotid artery. It is carried out to persons with
significant arterial stenosis after several transient
- Carotid stenting. To the place of stenosis is supplied
special device that expands the lumen of the vessel.
- Тромбэктомия из камер hearts.
- Replacing affected heart valves.
Thrombosis in the vessels of the head is a terrible complication that can
lead to irreversible consequences. Mortality from this pathology
ranges from 20 to 30%. More than half of the surviving patients remain
At the same time, this complication can be prevented if
be attentive and serious about your health.
It’s also obvious that you don’t have to despair if the trouble is already
happened The right mood and a radical change in lifestyle
can help the brain utilize all of its reserves and