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Blood Clot in Brain: Survival, Treatment, Post-Op

It can block an artery or a vein

  • Emergency Symptoms
  • Risk of Delayed Treatment
  • Treatment in ER
  • Hospitalization
  • Rehabilitation
  • Lifestyle Changes

A blood clot in the brain can have serious consequences. Blood clots may form in arteries or veins of the brain. A blood clot in a vein in the brain is often called cerebral venous sinus thrombosis . This is a type of stroke that can cause permanent brain damage.

Most strokes are caused by an interruption of blood flow in an artery of the brain. Cerebral venous thrombosis is not as common as a blockage of arterial blood flow. The causes and risk factors of cerebral venous thrombosis include conditions or medications that increase the body’s tendency to form blood clots .

This article describes the symptoms, risk factors, diagnosis, treatment, and what to expect if you have a cerebral venous thrombosis.

Emergency Symptoms of a Blood Clot in the Brain 

A blood clot in the brain can cause sudden neurological symptoms and head pain. Usually, the head pain associated with a blood clot in the brain is intense and develops abruptly. It’s often described as “the worst headache of my life.”

The neurological symptoms correspond to ischemia (lack of blood supply) in the brain .

Some differences between symptoms of a blood clot in a vein or an artery are:

  • A headache is the most common symptom of cerebral venous thrombosis.
  • Neurological symptoms are not common with cerebral venous thrombosis.
  • With cerebral venous thrombosis, the ischemia affects both sides of the brain. If neurological symptoms develop, they may affect both sides of the body.
  • When blood flow is blocked in an artery, it usually affects one side of the brain, with symptoms experienced on the opposite side of the body.

Symptoms of a blood clot in the brain can include:

  • An intense headache
  • Blurred vision, loss of vision, or other vision changes
  • Weakness of one side of the body, affecting the arm, leg, or both
  • Slurred speech
  • Drooping mouth or eyelids on one side of the face
  • Difficulty finding words or understanding what other people are saying
  • A seizure (an episode of uncontrolled and erratic electrical activity in the brain)
  • Changes in consciousness
  • Numbness or tingling on one side of the body
  • Inability to walk
  • Impaired balance and coordination

Usually, a blood clot in the brain causes one or more of these symptoms, but it doesn’t usually cause all of them.

Risks of Delayed Blood Clot in Brain Treatment 

Any type of blood clot in the brain can cause severe brain damage, resulting in permanent disability. Arteries supply the brain with oxygen and nutrient-rich blood. When the blood supply is interrupted, ischemia results in brain cell death.

When a blood clot affects a large artery or vein in the brain , a substantial area of the brain can be affected. With large vessel blood clots, extensive swelling in the brain can develop, and it may be life-threatening.

A stroke of any type, including a cerebral venous thrombosis, is a medical emergency that requires prompt medical intervention. Without timely diagnosis and treatment, brain damage and swelling may continue to worsen over the course of hours.

Treatment can help stabilize a person who is having a stroke and can sometimes prevent a stroke from progressively damaging the brain.

At the ER: Treating a Blood Clot in Brain 

If you go to the emergency room with a possible blood clot in the brain, here is what you can expect:

  • A neurological examination that the healthcare provider will use to identify signs of a stroke
  • Assessment of your vital signs, which includes blood pressure, pulse, temperature, and respiratory rate
  • A brain imaging test if there’s a possibility of a stroke
  • Treatment to stabilize vital signs, including blood pressure control
  • Intravenous fluids, as needed
  • Intravenous blood thinners to prevent the blood clot from enlarging
  • An interventional procedure that can help dissolve or remove a blood clot

Before you arrive at the emergency room, it’s highly likely that a stroke team will be on call to begin evaluating your risk factors and to determine whether it is safe for you to have blood thinners or an interventional procedure.

Some people are unable to receive blood thinners or undergo a procedure due to a high risk of bleeding or other medical risk.

What Caused a Brain Clot to Form?

Several risk factors can contribute to blood clots in the brain. The risk factors that cause an arterial stroke include heart disease, high blood pressure, high cholesterol, diabetes, and vascular disease.

A cerebral venous sinus thrombosis has risk factors that differ from those of an arterial stroke. These blood clots are described as occurring in a "sinus" such as the dural sinus or the sagittal sinus . This type of sinus is a large vein in the brain—it is not the same as your respiratory sinuses that can become congested when you have a cold or allergies.

Some risk factors may include:

  • Blood disease or immunological disease that raises the risk of blood clots, such as lupus or factor five Leiden deficiency
  • Pregnancy, especially high-risk pregnancy
  • Certain medications, particularly hormonal therapies containing estrogen
  • A family history or a personal history of blood clots at a young age
  • Cancer or chemotherapy
  • Head trauma
  • Recent brain surgery

Diagnosis of a Blood Clot in the Brain

A blood clot in the brain is diagnosed with:

  • Medical history of symptoms and risk factors
  • Physical examination
  • Imaging tests

Hospitalization Time With a Blood Clot in Brain

The hospitalization time with a blood clot in the brain varies. Hospitalization may also be followed by inpatient or outpatient rehabilitation. Depending on the extent of damage and the effects of treatment, hospitalization may range from several days to a week or longer.

Factors that may prolong hospital stay include:

  • More than one blood clot in the brain
  • Edema (swelling and fluid) in the brain
  • Having a seizure
  • Bleeding in the brain or any other area of the body, such as gastrointestinal (stomach and intestines) bleeding
  • Unstable medical condition, which may include fluctuating blood pressure or blood sugar
  • Complications such as pneumonia (lung inflammation), a blood clot in the legs , or a blood clot in the lungs
  • Other medical problems, such as a heart attack occurring within a few days of the blood clot in the brain

Even after you are medically stabilized and able to go home, you will need medical follow-up within the first few weeks. You may also need an evaluation to identify the risk factors that could have led to your blood clot. Treatment for those risk factors will be initiated. You may need periodic medical surveillance to monitor the effects of your treatment.

Survival After a Blood Clot in the Brain

Survival is highly variable after a blood clot in the brain. Many people recover with minimal effects, but sometimes blood clots in the brain can be fatal. A study from Australia and New Zealand found 79.4% of people with a stroke were still alive three months later, and 52.8% had survived five years after the stroke.

Rehabilitation After Cerebral Blood Clot 

After recovering from a blood clot in the brain, you might need ongoing rehabilitation. This can include exercises to build strength, balance, and speaking and swallowing abilities. You might also need to relearn or adjust to self-care skills.

Your rehabilitation will be individualized for you, depending on what types of impairments you may have developed due to the blood clot. It’s important to understand that rehabilitation takes time and that most people experience a slow and beneficial improvement with rehabilitation.

You can work with your therapy team to assess your abilities and follow your improvement. You will likely be given a program that involves a stepwise progression, with increasing levels of difficulty throughout your rehabilitation.

Often, rehabilitation for severe strokes or brain damage from cerebral venous thrombosis may begin in an inpatient rehabilitation facility. With inpatient rehabilitation, you may receive assistance with daily tasks, such as using the toilet, bathing, or eating—as needed.

You will also have your vital signs checked regularly, and you may need some medication adjustments during this phase of your recovery.

As you become more independent, you will be able to go home. You may continue to receive home visits from healthcare professionals, who will provide additional physical therapy exercises and check to see how you are progressing.

Your family members or other caregivers would be instructed on how to help you with your daily tasks as needed.

Adapting to Lifestyle Changes

Many people can experience significant recovery after a blood clot in the brain. You might be able to go back to the activities you enjoyed before your blood clot. However, you might have to make some adjustments if you still have some level of disability.

Adjustments that you may need to make could include the following:

  • Using a walker or cane to get around safely if you have problems with balance, dizziness, or coordination
  • Adjusting your diet so that you eat and drink things that do not pose a high risk of choking
  • Using a splint or a brace on your foot or arm if you have developed low muscle tone (floppiness) of any of your extremities
  • Using muscle relaxant medication if you’ve developed spasms of your muscles
  • Getting an evaluation regarding your ability to drive if your vision has been impaired
  • Taking medication to prevent seizures if you have developed a seizure disorder due to the blood clot
  • Taking medication to control pain if you have developed chronic or persistent head pain

You may need periodic reevaluations. You should expect to experience some changes with time, so you will require adjustments in your lifestyle routines.

For example, many people have floppy tone in their muscles shortly after a stroke, but this can evolve into spasticity (abnormal muscle tightness) as time goes on. Similarly, if you take medication for head pain, the pain may go away after some time, and you might not need the medication anymore after a while.

Blood clots in the brain can occur in a vein or an artery. Both of these are types of strokes, but a blood clot in a vein in the brain is usually referred to as a cerebral venous sinus thrombosis, and a blood clot in a brain artery is commonly referred to as a stroke.

There are many risk factors for these types of blood clots. A blood clot in a vein of the brain can occur due to blood clotting disorders or risk factors that increase the likelihood of blood clots.

Any blood clot in the brain is a medical emergency that requires prompt medical evaluation and treatment. Interventions can help prevent long-term effects and can save your life. If you experience any neurological symptoms or sudden head pain, seek medical attention right away.

Recovery after a blood clot in the brain can take months or years, and you should expect a gradually progressive improvement over time.

Cole KL, Nguyen S, Gelhard S, Hardy J, Cortez J, Nunez JM, Menacho ST, Grandhi R. Factors associated with venous thromboembolism development in patients with traumatic brain injury . Neurocrit Care. 2023 Jul 8. doi:10.1007/s12028-023-01780-8

Happonen T, Nyman M, Ylikotila P, Kytö V, Laukka D, Mattila K, Hirvonen J. Imaging outcomes of emergency MRI in patients with suspected cerebral venous sinus thrombosis: a retrospective cohort study . Diagnostics (Basel) . 2023;13(12):2052. doi:10.3390/diagnostics13122052

Dias L, Carvalho M. Seizures in cerebral venous thrombosis - a retrospective analysis of a tertiary centre cohort . Clin Neurol Neurosurg . 2023;232:107840. doi:10.1016/j.clineuro.2023.107840

Sturiale CL, Auricchio AM, Valente I, Vacca A, Pennisi G, Ciaffi G, Albanese A, Olivi A, Trevisi G. Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications, and therapeutic considerations . Neurosurg Rev. 2023;46(1):161. doi:10.1007/s10143-023-02067-4

Yang J, He Z, Li M, Hong T, Ouyang T. Risk of intracranial hemorrhage with direct oral anticoagulation versus low molecular weight heparin in the treatment of brain tumor-associated venous thromboembolism: A meta-analysis . J Stroke Cerebrovasc Dis . 2023;32(8):107243. doi:10.1016/j.jstrokecerebrovasdis.2023.107243

Zhou Y, Jiang H, Wei H, Xiao X, Liu L, Ji X, Zhou C. Cerebral venous thrombosis in patients with autoimmune disease, hematonosis or coronavirus disease 2019: many familiar faces and some strangers . CNS Neurosci Ther. 2023 Jun 27. doi:10.1111/cns.14321

Peng Y, Ngo L, Hay K, Alghamry A, Colebourne K, Ranasinghe I. Long-term survival, stroke recurrence, and life expectancy after an acute stroke in Australia and New Zealand from 2008–2017: a population-wide cohort study .  Stroke . 2022;53(8):2538-2548. doi:10.1161/STROKEAHA.121.038155

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

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Cerebral Venous Sinus Thrombosis (CVST)

What is cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis (CVST) occurs when a blood clot forms in the brain’s venous sinuses. This  prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage.

This chain of events is part of a stroke that can occur in adults and children. It can occur even in newborns and babies in the womb. A stroke can damage the brain and central nervous system. A stroke is serious and requires immediate medical attention.

This condition may also be called cerebral sinovenous thrombosis.

What causes cerebral venous sinus thrombosis?

CVST is a rare form of stroke. It affects about 5 people in 1 million each year. The risk for this kind of stroke in newborns is greatest during the first month. Overall, about 3 out of 300,000 children and teens up to age 18 will have a stroke.  

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What are the risk factors for cerebral venous sinus thrombosis?

Children and adults have different risk factors for CVST.

Risk factors for children and infants include:

  • Problems with the way their blood forms clots
  • Sickle cell anemia
  • Chronic hemolytic anemia
  • Beta-thalassemia major
  • Heart disease — either congenital (you're born with it) or acquired (you develop it)
  • Iron deficiency
  • Certain infections
  • Dehydration
  • Head injury
  • For newborns, a mother who had certain infections or a history of infertility

Risk factors for adults include:

  • Pregnancy and the first few weeks after delivery
  • Problems with blood clotting; for example, antiphospholipid syndrome, protein C and S deficiency, antithrombin III deficiency, lupus anticoagulant, or factor V Leiden mutation
  • Collagen vascular diseases like lupus, Wegener’s granulomatosis, and Behcet syndrome
  • Low blood pressure in the brain (intracranial hypotension)
  • Inflammatory bowel disease like Crohn’s disease or ulcerative colitis

What are the symptoms of cerebral venous thrombosis?

Symptoms of cerebral venous sinus thrombosis may vary, depending on the location of the thrombus. Responding quickly to these symptoms makes it more possible to recover.

These are the physical symptoms that may occur:

  • Blurred vision
  • Fainting or loss of consciousness
  • Loss of control over movement in part of the body

How is cerebral venous sinus thrombosis diagnosed?

People who have had any type of stroke recover best if they get treatment immediately. If you suspect a stroke based on the symptoms, have someone take you immediately to the emergency room, or call 911 to get help.

Doctors typically take a medical history and do a physical exam. Family and friends can describe the symptoms they saw, especially if the person who had the stroke is unconscious. The final diagnosis, however, is usually made based on how the blood is flowing in the brain. Imaging tests show areas of blood flow. These tests may be used to diagnose venous sinus thrombosis:

  • Angiography
  • Blood tests

MRI Scan

How is cerebral venous sinus thrombosis treated?

Treatment should begin immediately and must be done in a hospital. A treatment plan could include:

  • Antibiotics, if an infection is present
  • Antiseizure medicine to control seizures if they have occurred
  • Monitoring and controlling the pressure inside the head
  • Medicine called anticoagulants to stop the blood from clotting
  • Continued monitoring of brain activity
  • Measuring visual acuity and monitoring change
  • Rehabilitation

What are the complications of cerebral venous sinus thrombosis?

Complications of venous sinus thrombosis include:

  • Impaired speech
  • Difficulty moving parts of the body
  • Problems with vision
  • Increased fluid pressure inside the skull
  • Pressure on nerves
  • Brain injury
  • Developmental delay

Can cerebral venous sinus thrombosis be prevented?

You can do a lot to prevent stroke by leading a heart healthy lifestyle:

  • Eat a low-fat diet, including lots of fruits and vegetables.
  • Get daily exercise.
  • Avoid cigarette smoke.
  • Control chronic health conditions, such as diabetes.

Living with cerebral venous sinus thrombosis

What you need to do to recover and then stay healthy after CVST will depend on how the stroke affected your brain. Everyone can benefit from a healthy diet and exercise.

You may also need to participate in a special rehabilitation program or physical therapy, if you have lost some movement or speech.

Other possible effects of the stroke, such as headaches or changes in vision, can be treated by specialists.

If you have had this type of stroke, you may need to avoid certain types of medicines, such as oral contraceptives. These can increase your risk for blood clots.

Cerebral venous sinus thrombosis (CVST) occurs when a blood clot forms in the brain’s venous sinuses

If you have cerebral venous sinus thrombosis:

  • Respond quickly to symptoms like headaches, blurry vision, fainting, losing control of a part of your body, and seizures.
  • If you have the above symptoms, have someone take you immediately to the emergency room or call 911 for help.
  • Take your medicines as prescribed, and check with your health are provider to make sure that none of your medicines increase your risk of having CVST.
  • Educate your loved ones about symptoms of CVST so they can be prepared in an emergency.
  • Lead a healthy lifestyle which includes eating a low-fat diet made up mostly of fruits and vegetables, low-fat meats and proteins, low-fat dairy products, and whole-fiber grains, breads, cereals, and pasta.
  • Exercise daily and avoid smoking.

Manage your other chronic health issues, such as diabetes or high blood pressure.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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Related Topics

Ischemic Stroke

  • • A type of stroke that occurs when blood clot or fatty plaque blocks a blood vessel in the brain
  • • Symptoms include drooping muscles on one side of face, numbness or weakness on one side of face or in one arm or leg
  • • Treatment includes medication, medical procedures, surgical procedures
  • • Involves stroke center, stroke telemedicine program, neurology, neurosurgery
  • Management of Acute Stroke
  • Cerebrovascular Accident, Stroke
  • Stroke Rehabilitation
  • Hemorrhagic Stroke

What is an ischemic stroke?

What causes an ischemic stroke, what are the symptoms of an ischemic stroke, what are the risk factors for an ischemic stroke, how is an ischemic stroke diagnosed, how is an ischemic stroke treated, what is the outlook for people who have experienced ischemic stroke, what makes yale unique in its treatment of ischemic stroke.

Everyone has heard of stroke , but many people are not familiar with its symptoms or causes. A stroke occurs either when a blood vessel in the brain bursts, allowing blood to pool in the brain, or when the blood flow to part of the brain is blocked. Either way, affected parts of the brain become damaged or die. An ischemic stroke is the most common type of stroke. It occurs when a blood clot or fatty plaque lodges in a blood vessel within the brain, blocking blood flow. Because brain cells begin to die within minutes of the interruption of blood flow, it’s crucial for an ischemic stroke to be diagnosed and treated as quickly as possible.  

In the United States, about 795,000 Americans experience some form of stroke each year, and most of those—about 87%—are ischemic strokes. Strokes are more common among adults aged 65 and older; the risk of stroke increases with age.  

People who have one stroke are at higher risk of more strokes in the future; about one-quarter of all strokes occur in people who have had one previously. Some people will recover fully from an ischemic stroke. Others will experience disability afterward, and still others will die from the event. Stroke is the fifth-leading cause of death in the U.S., and a leading cause of disability.

An ischemic stroke is a life-threatening emergency condition. It arises when blood flow to the brain is blocked by a blood clot or a piece of fatty plaque that has broken off from the inside of a blood vessel. When blood can’t reach brain tissue, the tissue is at risk of being damaged or dying. This is why an ischemic stroke may cause brain damage, disability, or death.  

In a healthy person, blood flows freely throughout the body, delivering oxygen to different body parts, including the brain. When a clot or piece of plaque disrupts the flow of blood to the brain, function is impaired. The symptoms this can cause depend on the area of the brain starved of blood. Sometimes, the disruption of blood flow can result in difficulty with speech, face or muscle weakness, or loss of coordination. Other times, it may cause cognitive problems. It’s important for ischemic stroke to be diagnosed and treated quickly to unblock blood flow before permanent damage can occur.

An ischemic stroke occurs when blood flow to the brain becomes blocked by a blood clot or a piece of fatty plaque. Some blood clots travel to the brain from the heart. In other circumstances, blood clots or pieces of fatty plaque may travel to the brain from a distant artery. It’s also possible for a piece of fatty plaque to originate in a brain artery, blocking the flow of blood.  

In rare instances, clotting disorders or estrogen-containing oral contraceptives may cause blood clots to form, which may increase the risk of clots reaching the brain.

Those experiencing an ischemic stroke may have the following symptoms:

  • Drooping muscles on one side of the face
  • Numbness on one side of the face or in one arm or leg
  • Weakness or paralysis in one arm, leg, or side of the body
  • Loss of sensation or abnormal sensations on one side of the body
  • Dizziness , balance problems
  • Slurred speech
  • Difficulty speaking and/or understanding speech
  • Vision loss and/or double vision in one or both eyes
  • Severe headache
  • Memory problems
  • Nausea or vomiting

People with the following health conditions may be at increased risk of ischemic stroke:

  • High blood pressure
  • Atrial fibrillation
  • Cardiomyopathy
  • Heart-valve disease
  • High cholesterol levels
  • Narrowing of the carotid artery in the neck
  • Insulin resistance
  • Sleep apnea
  • Heart attack
  • Having had recent heart surgery
  • An infection of the valves of the heart
  • A blood clotting disorder
  • A personal or family history of stroke

Additionally, these lifestyle habits may increase the risk of ischemic stroke:

  • Excessive alcohol intake
  • Physical inactivity
  • Eating a high-calorie diet that’s high in saturated fats and/or trans fats
  • Using cocaine or amphetamines

A stroke is a life-threatening emergency that is typically diagnosed in the emergency department. If you or a loved one is experiencing stroke symptoms, call 911 immediately. 

Doctors can make a diagnosis after learning about your medical history, performing a neurological exam, and running diagnostic tests. Because time is of the essence for stroke treatment, it’s important for the diagnosis to be made quickly.  

Doctors may rely on your relative for details about your medical history if you are experiencing confusion or having difficulty speaking. You or your loved one should discuss any history of high blood pressure, high cholesterol, diabetes, or a previous stroke. Lifestyle habits, including smoking and alcohol intake, should also be disclosed. 

In the emergency room, a dedicated stroke team will perform a rapid neurological assessment of your speech, facial muscles, strength and sensation in your arms and legs, and coordination and balance to see if you are having a stroke.  

A diagnosis may be obtained from these diagnostic tests:

  • An imaging test , such as a CT scan or MRI, to rule out other conditions, including hemorrhagic stroke, and diagnose the problem
  • A blood sugar test , because low blood sugar levels may cause symptoms that are similar to a stroke
  • CT angiography , which shows images of the blood vessels in the brain, which can be used to pinpoint the location of a blockage
  • CT perfusion, to determine how much brain tissue is permanently damaged and how much can be saved

One or more of the following treatments will be administered as quickly as possible to restore blood flow to the brain:

  • Tissue plasminogen activator (tPA) drugs, such as alteplase or tenecteplase, which are given intravenously within 3 hours (and for some patients up to 4.5 hours) of stroke onset to break apart a clot that is blocking blood flow within the brain. This is sometimes called thrombolytic therapy. Research has shown that the earlier a patient receives tPA, the more likely they are to have better outcomes.
  • Thrombectomy, a surgical catheter-based procedure during which a blood clot that is blocking blood flow within a large artery in the brain is removed. Similar to tPA, the earlier a blocked artery is opened, the better the chances are of recovery.

As you recover from a stroke, medications may be prescribed to lower the risk of another one. The type of medication prescribed varies, based on the type of stroke you had. Possibilities include:

  • Cholesterol-lowering drugs
  • Medication to decrease blood pressure
  • Antiplatelet therapy
  • Anticoagulant medications

Lifestyle changes may also be recommended, including:

  • Quitting smoking
  • Consuming less alcohol
  • Following a low-sodium Mediterranean diet
  • Getting regular physical activity
  • Losing weight and/or maintaining a healthy weight

To reduce the risk of additional strokes, doctors may recommend:

  • Carotid endarterectomy, a surgical procedure during which some of the fatty plaque from the interior of the carotid artery will be removed.
  • Stenting, a minimally invasive procedure during which a catheter is used to insert a mesh-wire, tube-shaped stent that helps to hold the carotid artery open, preventing future blockages.

People who seek immediate treatment in an emergency department for stroke symptoms are more likely to have better outcomes than those who avoid or delay treatment. Many people experience some degree of disability after an ischemic stroke, including muscle weakness, lack of coordination, difficulty with speech or swallowing, or cognitive symptoms. These symptoms can improve with aggressive physical, occupational, and speech therapies. The window for meaningful recovery is about six months but can be longer for some patients. 

“The Comprehensive Stroke Center at Yale provides expertise in the management of both ischemic and hemorrhagic strokes,” says Yale Medicine stroke specialist Hardik Amin, MD. “We have a stroke team ready 24-7 that can perform state-of-the-art imaging in the emergency room and provide rapid medical and surgical treatments to maximize the chance of recovery.”  

Our team of highly experienced stroke neurologists and neurosurgeons, dedicated trainees, specialized nurse practitioners, and nurse navigators provide comprehensive care for stroke patients from the moment they arrive at the emergency room, through their hospital stay, and when they are seen in our follow up clinics, he adds.  

“By pairing a thoughtful, individualized approach with state-of-the-art imaging and diagnostic testing, we work to understand the cause of each patient’s stroke and how to lower the risk of future events. Our physical, occupational, and speech therapists provide detailed patient evaluations to set patients on a path to reaching their full rehabilitation potential,” he says. “We also participate in national clinical trials to help further our understanding of stroke causes and treatments.”

blood clots travel to brain

Ischemic Stroke

  • Diagnosis |
  • Treatment |
  • Prognosis |

An ischemic stroke is death of an area of brain tissue (cerebral infarction) resulting from an inadequate supply of blood and oxygen to the brain due to blockage of an artery.

Ischemic stroke usually results when an artery to the brain is blocked, often by a blood clot and/or a fatty deposit due to atherosclerosis.

Symptoms occur suddenly and may include muscle weakness, paralysis, lost or abnormal sensation on one side of the body, difficulty speaking, confusion, problems with vision, dizziness, and loss of balance and coordination.

Diagnosis is usually based on symptoms and results of a physical examination and brain imaging.

Other imaging tests (computed tomography and magnetic resonance imaging) and blood tests are done to identify the cause of the stroke.

Treatment may include medications to break up blood clots or to make blood less likely to clot and procedures to physically remove blood clots, followed by rehabilitation.

About one third of people recover all or most of normal function after an ischemic stroke.

Preventive measures include control of risk factors, medications to make blood less likely to clot, and sometimes surgery or angioplasty to open blocked arteries.

(See also Overview of Stroke .)

Causes of Ischemic Stroke

An ischemic stroke typically results from blockage of an artery that supplies blood to the brain, most commonly a branch of one of the internal carotid arteries. As a result, brain cells are deprived of blood. Most brain cells die if they are deprived of blood for 4.5 hours.

Supplying the Brain With Blood

Common causes.

Commonly, blockages are blood clots (thrombi) or pieces of fatty deposits (atheromas, or plaques) due to atherosclerosis . Such blockages often occur in the following ways:

By forming in and blocking an artery: An atheroma in the wall of an artery may continue to accumulate fatty material and become large enough to block the artery. Even if the artery is not completely blocked, the atheroma narrows the artery and slows blood flow through it, like a clogged pipe slows the flow of water. Slow-moving blood is more likely to clot. A large clot can block enough blood flowing through the narrowed artery that brain cells supplied by that artery die. Or if an atheroma splits open (ruptures), the material in it can trigger formation of a blood clot that can block the artery (see figure How Atherosclerosis Develops ).

By traveling from another artery to an artery in the brain: A piece of an atheroma or a blood clot in the wall of an artery can break off and travel through the bloodstream (becoming an embolus). The embolus may then lodge in an artery that supplies the brain and block blood flow there. (Embolism refers to blockage of arteries by materials that travel through the bloodstream to another part of the body.) Such blockages are more likely to occur where arteries are already narrowed by fatty deposits.

By traveling from the heart to the brain: Blood clots may form in the heart or on a heart valve, particularly artificial valves and valves that have been damaged by infection of the heart's lining ( endocarditis ). These clots may break off and travel as emboli and block an artery to the brain. Strokes due to such blood clots are most common among people who have recently had heart surgery, who have had a heart attack, or who have a heart valve disorder or an abnormal heart rhythm (arrhythmia), especially a fast, irregular heart rhythm called atrial fibrillation .

Clogs and Clots: Causes of Ischemic Stroke

blood clots travel to brain

Blood clots in a brain artery do not always cause a stroke. If the clot breaks up spontaneously within less than 15 to 30 minutes, brain cells do not die and people's symptoms resolve. Such events are called transient ischemic attacks (TIAs).

If an artery narrows very gradually, other arteries (called collateral arteries—see figure Supplying the Brain With Blood ) sometimes enlarge to supply blood to the parts of the brain normally supplied by the clogged artery. Thus, if a clot occurs in an artery that has developed collateral arteries, people may not have symptoms.

The most common causes of ischemic stroke can be classified as

Cryptogenic stroke

Embolic stroke, lacunar infarction.

Large-vessel atherosclerosis (the 4th most common cause)

Stroke is classified as cryptogenic when no clear cause is identified despite a complete evaluation.

Blood clots can form in the heart, especially in people who have or have had the following:

Atrial fibrillation

Rheumatic heart disease (usually mitral stenosis )

Heart attack

Endocarditis

Atrial myxoma (a tumor)

Prosthetic heart valves

Mechanical circulatory assist devices (such as a left ventricular assist device )

Tiny pieces of these blood clots can break off and travel to small arteries in the brain (as emboli).

Lacunar infarction refers to tiny ischemic strokes, typically no larger than about a third of an inch (1 centimeter). In lacunar infarction, one of the small arteries deep in the brain becomes blocked when part of its wall deteriorates and is replaced by a mixture of fat and connective tissue—a disorder called lipohyalinosis. Lipohyalinosis is different from atherosclerosis, but both disorders can cause arteries to be blocked.

Lacunar infarction can also occur when tiny pieces of fatty material that has been deposited in arteries (atheromas or atherosclerotic plaques ) break off and travel to small arteries in the brain.

Lacunar infarction tends to occur in older people with diabetes or poorly controlled high blood pressure. Only a small part of the brain is damaged in lacunar infarction, and the prognosis is usually good. However, over time, many small lacunar infarcts may develop and cause problems, including problems with thinking and other mental functions (cognitive impairment).

Large-vessel atherosclerosis

In large-vessel atherosclerosis , atherosclerotic plaques develop in the walls of large arteries, such as those that supply the brain (cerebral arteries).

The plaques can gradually enlarge and cause the artery to narrow. As a result, tissues supplied by the artery may not receive enough blood and oxygen. Plaques tend to split open (rupture). Then material inside the plaque is exposed to the bloodstream. The material triggers the formation of blood clots (called thromboses). These blood clots can suddenly block all blood flow through an artery. Sometimes the blood clots break off, travel through the bloodstream and block an artery that supplies blood to the brain (called emboli). Both thromboses and emboli can cause a stroke by blocking the blood supply to an area of the brain.

Other causes

Several conditions besides rupture of an atheroma can trigger or promote the formation of blood clots, increasing the risk of blockage by a blood clot. They include the following:

Blood disorders: Some disorders, such as an excess of red blood cells ( polycythemia ), antiphospholipid syndrome , and a high homocysteine level in the blood ( hyperhomocysteinemia ), make blood more likely to clot. In children, sickle cell disease can cause ischemic stroke.

Oral contraceptives : Taking oral contraceptives, particularly those with a high estrogen dose, increases the risk of blood clots.

An ischemic stroke can also result from any disorder that reduces the amount of blood supplied to the brain. For example,

An ischemic stroke can occur if inflammation of blood vessels ( vasculitis ) or infection (such as herpes simplex , meningitis , or syphilis ) narrows blood vessels that supply the brain.

In atrial fibrillation , the heart does not contract normally, and blood can stagnate and clot. A clot may break loose, then travel to an artery in the brain, and block it.

Sometimes the layers of the walls of an artery that carries blood to the brain (such as arteries in the neck) separate from each other (called dissection) and interfere with blood flow to the brain.

Rarely, a stroke results from a general decrease in blood flow, as occurs when people lose a lot of blood, become severely dehydrated, or have very low blood pressure. This type of stroke often occurs when arteries supplying the brain are narrowed but had not previously caused any symptoms and had not been detected.

Occasionally, an ischemic stroke occurs when blood flow to the brain is normal but the blood does not contain enough oxygen. Disorders that reduce the oxygen content of blood include a severe deficiency of red blood cells ( anemia ), suffocation, and carbon monoxide poisoning . Usually, brain damage in such cases is widespread (diffuse), and coma results.

Sometimes a blood clot in a leg vein ( deep venous thrombosis ) or, rarely, small pieces of fat from the marrow of a broken leg bone move into the bloodstream. Usually, these blood clots and pieces of fat travel to the heart and block an artery in the lungs (called pulmonary embolism ). However, some people have an abnormal opening between the right and left upper chambers of the heart (called a patent foramen ovale). In such people, the blood clots and pieces of fat may go through the opening and thus bypass the lungs and enter the aorta (the largest artery in the body). If they travel to arteries in the brain, a stroke can result.

Risk factors

Some risk factors for ischemic stroke can be controlled or modified to some extent—for example, by treating the disorder that increases risk.

The major modifiable risk factors for ischemic stroke are

Narrowing (stenosis) of a carotid artery in the neck

High cholesterol levels

Coronary artery disease

High blood pressure

Insulin resistance (an inadequate response to insulin ), which occurs in type 2 diabetes

Cigarette smoking

Obesity , particularly if the excess weight is around the abdomen

Obstructive sleep apnea

Consumption of too much alcohol

Lack of physical activity

An unhealthy diet (such as one that is high in saturated fats , trans fats, and calories)

Depression or other mental stresses

Heart disorders that increase the risk of blood clots forming in the heart, breaking off, and traveling through the blood vessels as emboli (such a heart attack or an abnormal heart rhythm called atrial fibrillation )

Infective endocarditis (infection of the heart's lining and usually of the heart valves)

Use of or amphetamines

Inflammation of blood vessels ( vasculitis )

Clotting disorders that result in excessive clotting

Use of estrogen therapy, including oral contraceptives

Risk factors that cannot be modified include

Having had a stroke previously

Being older

Having relatives who have had a stroke

Symptoms of Ischemic Stroke

Usually, symptoms of an ischemic stroke occur suddenly and are often most severe a few minutes after they start because most ischemic strokes begin suddenly, develop rapidly, and cause death of brain tissue within minutes to hours. Then, most strokes become stable, causing little or no further damage. Strokes that remain stable for 2 to 3 days are called completed strokes. Sudden blockage by an embolus is most likely to cause this kind of stroke.

In about 10 to 15% of strokes, damage continues to occur and symptoms continue to worsen for up to 2 days, as a steadily enlarging area of brain tissue dies. Such strokes are called evolving strokes. In some people, symptoms affect one arm, then spread to other areas on the same side of the body. The progression of symptoms and damage usually occurs in steps, interrupted by somewhat stable periods. During these periods, the area temporarily stops enlarging or some improvement occurs. Such strokes are usually due to the formation of clots in a narrowed artery.

Strokes caused by an embolus often occur during the day, and a headache may be the first symptom. Strokes caused by a blood clot in a narrowed artery often occur at night and are first noticed when the person wakes up.

Many different symptoms can occur, depending on which artery is blocked and thus which part of the brain is deprived of blood and oxygen (see Brain Dysfunction by Location ).

When the arteries that branch from the internal carotid artery (which carry blood along the front of the neck to the brain) are affected, the following are most common:

Blindness in one eye

Loss of vision on either the left side or the right side of both eyes

Abnormal sensations, weakness, or paralysis in one arm or leg or on one side of the body

When the arteries that branch from the vertebral arteries (which carry blood along the back of the neck to the brain) are affected, the following are most common:

Dizziness and vertigo

Double vision or loss of vision in both eyes

Generalized weakness on one or both sides of the body

Many other symptoms, such as difficulty speaking (for example, slurred speech), impaired consciousness (such as confusion), loss of coordination, and urinary incontinence, can occur.

Severe strokes may lead to stupor or coma . In addition, strokes, even milder ones, can cause depression or an inability to control emotions. For example, people may cry or laugh inappropriately.

Some people have a seizure when the stroke begins. Seizures may also occur months to years later. Late seizures result from scarring or materials that are deposited from blood in the damaged brain tissue.

Occasionally, fever develops. It may be caused by the stroke or another disorder.

If symptoms, particularly impaired consciousness, worsen during the first 2 to 3 days, the cause is often swelling due to excess fluid (edema) in the brain. In large strokes, the swelling in the brain is typically at its worst about 3 days after the stroke begins. Symptoms usually lessen within a few days, as the fluid is absorbed. Nonetheless, the swelling is particularly dangerous because the skull does not expand. The resulting increase in pressure can cause the brain to shift, further impairing brain function, even if the area directly damaged by the stroke does not enlarge. If the pressure becomes very high, the brain may be forced sideways and downward in the skull, through the rigid structures that separate the brain into compartments. The resulting disorder is called herniation , which can be fatal.

Complications of stroke

Strokes can lead to other problems (complications):

If swallowing is difficult, people may not eat enough and become malnourished and dehydrated.

Food, saliva, or vomit may be inhaled (aspirated) into the lungs, resulting in aspiration pneumonia .

Being in one position too long can result in pressure sores and lead to muscle loss, deconditioning, urinary tract infections, and permanent shortening of muscles (contractures).

Not being able to move the legs can result in the formation of blood clots in deep veins of the legs and groin ( deep vein thrombosis ).

Clots in the deep veins of the legs can break off, travel through the bloodstream, and block an artery to a lung (a disorder called pulmonary embolism ).

People may have difficulty sleeping.

The losses and problems resulting from the stroke may make people depressed.

Diagnosis of Ischemic Stroke

A doctor's evaluation

Computed tomography and sometimes magnetic resonance imaging

Laboratory tests, including those to measure blood sugar

Doctors can usually diagnose an ischemic stroke based on the history of events and results of a physical examination. Doctors can usually identify which artery in the brain is blocked based on symptoms. For example, weakness or paralysis of the left leg suggests blockage of the artery supplying the area on the right side of the brain that controls the left leg’s muscle movements.

Doctors often use a standardized set of questions and commands to determine how severe the stroke is, how well people are functioning, and how symptoms are changing over time. These test helps doctors evaluate the person's level of consciousness, ability to answer questions, ability to obey simple commands, vision, arm and leg function, and speech.

When Specific Areas of the Brain Are Damaged

Doctors measure the blood sugar level. A low blood sugar level ( hypoglycemia ) can cause similar symptoms.

Computed tomography (CT) is usually done next. CT helps distinguish an ischemic stroke from a hemorrhagic stroke, a brain tumor, an abscess, and other structural abnormalities. However, during the first hours after some strokes, the CT scan may be normal or show only subtle changes. As a result, diagnosis may be delayed. So if available, diffusion-weighted magnetic resonance imaging (MRI), which can detect ischemic strokes within minutes of their start, may be done next.

As soon as possible, doctors may also do other imaging tests ( CT angiography or magnetic resonance angiography ) to check for blockages in large arteries. Prompt treatment of these blockages can sometimes limit the amount of brain damage caused by the stroke.

Tests to identify the cause

Identifying the precise cause of an ischemic stroke is important. If the blockage is a blood clot, another stroke may occur unless the underlying disorder is corrected. For example, if blood clots result from an abnormal heart rhythm, treating that disorder can prevent new clots from forming and causing another stroke.

Tests for causes may include the following:

Electrocardiography (ECG) to look for abnormal heart rhythms

Continuous ECG monitoring (done at home or in the hospital) to record the heart rate and rhythm continuously for 24 hours (or more), which may detect abnormal heart rhythms that occur unpredictably or briefly

Echocardiography to check the heart for blood clots, pumping or structural abnormalities, and valve disorders

Imaging tests— color Doppler ultrasonography , magnetic resonance angiography , CT angiography (CT done after a contrast agent is injected into a vein), or cerebral angiography (done using a catheter inserted into an artery to inject the contrast agent)—to determine whether arteries, especially the internal carotid arteries, are blocked or narrowed

Blood tests to check for anemia , polycythemia , blood clotting disorders , vasculitis , and some infections (such as heart valve infections and syphilis ) and for risk factors such as high cholesterol levels or diabetes

Urine drug screen for cocaine and amphetamines

Imaging tests enable doctors to determine how narrowed the carotid arteries are and thus to estimate the risk of a subsequent stroke or transient ischemic attack (TIA). Such information helps determine which treatments are needed.

For cerebral angiography, a thin, flexible tube (catheter) is inserted into an artery, usually in the groin, and threaded through the aorta to an artery in the neck. Then, a substance that can be seen on x-rays (radiopaque contrast agent) is injected to outline the artery. Thus, this test is more invasive than other tests that provide images of the brain’s blood supply. However, it provides more information. Cerebral angiography is done before any endovascular procedure that uses a catheter to treat a blocked or narrowed arteries. Cerebral angiography is also done when vasculitis is suspected.

Because CT angiography is less invasive, it has largely replaced cerebral angiography done with a catheter. The exceptions are when endovascular procedures are planned. These procedures involve using instruments threaded through a catheter to physically remove a clot ( mechanical thrombectomy ), to widen a narrowed artery (angioplasty), and/or to place a tube made of wire mesh (a stent) to keep the artery open.

Treatment of Ischemic Stroke

Measures to support vital functions, such as breathing

Medications to break up blood clots or make blood less likely to clot

Sometimes surgery to remove a blockage or angioplasty with a stent

Measures to manage problems that stroke can cause, such as difficulty swallowing

Measures to prevent blood clots in the legs

Rehabilitation

When a stroke occurs, minutes matter. The longer blood flow to the brain is reduced or stopped, the more brain damage there will be. People who have any symptom suggesting an ischemic stroke should immediately call 911 and go to an emergency department.

Treatment to remove or break up clots is most effective when done as soon as possible. For some medications (thrombolytic therapy) to be effective, they must be started within 4.5 hours of when the stroke began. Procedures to remove clots through a catheter (mechanical thrombectomy) can be effective up to 6 hours after a stroke began and sometimes even later. Starting treatment as soon as possible is crucial because the earlier blood flow is restored to the brain, the less brain damage there is and the better are the chances for recovery. Thus, doctors try to rapidly determine when the stroke began and confirm that the stroke is an ischemic stroke, not a hemorrhagic stroke, which is treated differently.

Generally, doctors do not immediately treat high blood pressure unless it is very high (over 220/120 mm Hg) because when arteries are narrowed, blood pressure must be higher than normal to push enough blood through them to the brain. However, very high blood pressure can injure the heart, kidneys, and eyes and must be lowered.

Specific treatment of stroke may include medications to break up blood clots (thrombolytic therapy) and medications to make blood less likely to clot (antiplatelet medications and anticoagulants), followed by rehabilitation. At some specialized centers, blood clots are physically removed from arteries in the brain (mechanical thrombectomy). Or angioplasty is done to widen the artery. For angioplasty, a catheter with a balloon at its tip is threaded into the narrowed artery (see figure Understanding Percutaneous Coronary Intervention (PCI) ). The balloon is then inflated for several seconds to widen the artery. To keep the artery open, doctors insert a tube made of wire mesh (a stent) into the artery.

Thrombolytic (fibrinolytic) medications

Because tPA can cause bleeding in the brain and elsewhere, it usually should not be given to people with certain conditions, such as the following:

Bleeding within the brain or a very large area of dead brain tissue detected by CT or MRI

A suspected hemorrhagic stroke , even if CT does not detect evidence of one

A tendency to bleed (indicated by a low platelet count or abnormal results of other blood tests)

Internal bleeding (hemorrhage)

A recent head injury (within the past 3 months)

A brain disorder that may increase the risk of bleeding, such as some cancers, an arteriovenous malformation (an abnormal connection between arteries and veins), or a cerebral aneurysm (a bulge in the wall of an artery)

Blood pressure that remains high after treatment with an antihypertensive medication

Brain or spinal surgery within the past 3 months

A tendency to bleed or bruise easily

Before tPA is given, CT is done to rule out bleeding in the brain. To be effective and safe, tPA, given intravenously, must be started within 3 hours of the beginning of an ischemic stroke. Some experts recommend using tPA up to 4.5 hours after an ischemic stroke begins.

But when tPA is given between 3 and 4.5 hours, additional conditions may prohibit its use. These conditions include

Being over age 80

Taking an anticoagulant by mouth (regardless of its effect on clotting)

Having a severe stroke that resulted in substantial loss of function

Having a history of both stroke and diabetes mellitus

After 4.5 hours, giving tPA intravenously increases the risk of bleeding.

Pinpointing when the stroke began may be difficult. So doctors assume that the stroke began the last time a person was known to be well. For example, if a person awakens with symptoms of a stroke, doctors assume the stroke began when the person was last seen awake and well. Thus, tPA can be used in only some people who have had a stroke. If advanced imaging identifies undamaged brain tissue, people may be given tPA even if doctors cannot determine when the stroke began—for example, if people wake up and have had a stroke sometime during the night.

Mechanical thrombectomy

For mechanical thrombectomy, doctors use a device to physically remove the blood clot in large cerebral arteries. This procedure is often done when people have had a severe stroke. New evidence suggests that mechanical thrombectomy can effectively treat people who have a stroke, regardless of its severity.

Mechanical thrombectomy is traditionally done within 6 hours of when symptoms began. However, the procedure can be done up to 24 hours after symptoms began if imaging tests show undamaged brain tissue. Thus, at some stroke centers, doctors are starting to use a special type of CT or MRI ( perfusion imaging ) and other imaging tests to determine how much a stroke has progressed, rather than going strictly by time. These tests can show how much blood flow has been reduced and indicate how much brain tissue may be saved. This approach (based on brain tissue status, not time) is especially useful when doctors are unsure of when the stroke began—for example, when people wake up in the morning and have symptoms of a stroke. If imaging tests show that blood flow is only somewhat reduced, treatment with mechanical thrombectomy up to 24 hours after symptoms start may still be able to save brain tissue. But if blood flow has been greatly reduced or has stopped, treatment after only 1 hour may be unable to save any brain tissue.

Different types of devices can be used. For example, the stent retriever may be used. It resembles a tiny wire cage. It can be attached to a catheter, which is inserted through an incision, often in the groin, and threaded to the clot. The cage is opened up, then closed around the clot, which is drawn out through a larger catheter. If done within 6 hours of the stroke's start, mechanical thrombectomy with a stent retriever can dramatically improve outcomes in people with a large blockage. Devices can restore blood flow in 90 to 100% of people.

Mechanical thrombectomy is done only in stroke centers.

Antiplatelet medications and anticoagulants

aspirin alone for reducing the risk of another stroke, but only if given within 24 hours after stroke symptoms began. It is given only for first 3 weeks after the stroke and reduces the risk of recurrence only for the first 3 months after a stroke. After that, the combination has no advantage over aspirin alone. Also, taking clopidogrel plus aspirin for more than 3 weeks increases the risk of bleeding by a small amount. However, the combination is sometimes given for 3 months in certain circumstances—for example, when people have a partial blockage of a large artery.

If people have been given a thrombolytic medication, doctors usually wait at least 24 hours before antiplatelet medications or anticoagulants are started because these medications add to the already increased risk of bleeding in the brain. Anticoagulants are not given to people who have uncontrolled high blood pressure or who have had a hemorrhagic stroke.

Carotid artery surgery

Once an ischemic stroke is completed, surgical removal of fatty deposits (atheromas, or plaques) due to atherosclerosis or clots in an internal carotid artery may be done (see figure Supplying the Brain With Blood ). This procedure, called carotid endarterectomy, can help if all of the following are present:

The stroke resulted from narrowing of a carotid artery by more than 70% (more than 60% in people who have been having transient ischemic attacks).

Some brain tissue supplied by the affected artery still functions after the stroke.

The person’s life expectancy is at least 5 years.

In such people, carotid endarterectomy may reduce the risk of subsequent strokes. This procedure also reestablishes the blood supply to the affected area, but it cannot restore lost function because some brain tissue is dead.

For carotid endarterectomy, a general anesthetic is used. The surgeon makes an incision in the neck over the area of the artery that contains the blockage, then an incision in the artery. The blockage is removed, and the incisions are closed. For a few days afterwards, the neck may hurt, and swallowing may be difficult. Most people stay in the hospital 1 or 2 days. Heavy lifting should be avoided for about 3 weeks. After several weeks, people can resume their usual activities.

Carotid endarterectomy can trigger a stroke because the operation may dislodge clots or other material that can then travel through the bloodstream and block an artery. However, after the operation, the risk of stroke is lower than it is when medications are used, and this risk is lower for several years. The procedure can result in a heart attack because people who have this procedure often have risk factors for coronary artery disease .

People should find a surgeon who is experienced doing this operation and who has a low rate of serious complications (such as heart attack, stroke, and death) after the operation. If people cannot find such a surgeon, the risks of endarterectomy may outweigh its expected benefits.

Carotid artery angioplasty and stenting

If endarterectomy is too risky or cannot be done because of the artery's anatomy, a less invasive procedure (carotid artery angioplasty) can be done to widen the artery.

For this procedure, a local anesthetic is given. Then a catheter with an umbrella filter at its tip is inserted through a small incision into a large artery near the groin or in the arm, and the catheter is threaded to the internal carotid artery in the neck. A substance that can be seen on x-rays (radiopaque contrast agent) is injected, and x-rays are taken so that the narrowed area can be located. Doctors use the catheter to widen the carotid artery, then insert a tube made of wire mesh (a stent) into the artery. Once in place, the stent is expanded to help keep the artery open. The filter catches any debris that may break off during the procedure.

After the stent is placed, the catheter and the filter at its tip are removed. People remain awake for the procedure, which usually takes 1 to 2 hours.

Placement of a stent appears to be as safe and as effective in preventing strokes and death as endarterectomy . For younger people and people who do not have risk factors for heart or blood vessel disorders (such as high blood pressure , high cholesterol levels , diabetes , and smoking ), carotid endarterectomy is usually done.

A similar procedure can be done for other types of large blocked arteries (see figure Understanding Percutaneous Coronary Intervention (PCI) ).

Long-term treatment of strokes

Long-term treatment of stroke includes measures to do the following:

Control problems that can make the effects of stroke worse

Prevent or treat problems caused by strokes

Prevent future strokes

Treat any disorders that are also present

During the recovery period, high blood sugar (hyperglycemia) and fever can make brain damage worse after a stroke. Lowering them limits the damage and results in better functioning.

Before people who have had a stroke start to eat, drink, or take medications by mouth, they are checked for problems with swallowing. Problems with swallowing can lead to aspiration pneumonia . Measures to prevent this problem are started early. If problems are detected, a therapist can teach people how to swallow safely. Sometimes people need to be fed through a tube ( tube feeding ).

If people cannot move on their own or have difficulty moving, they are at risk of developing blood clots in their legs ( deep vein thrombosis ) and pressure sores

Measures to prevent pressure sores are started early. For example, staff members periodically change the person's position in bed to help prevent pressure sores from forming. They also regularly inspect the skin for any sign of pressure sores.

Controlling or treating risk factors for stroke (such as high blood pressure, diabetes, smoking, consumption of too much alcohol, high cholesterol levels, and obesity) can help prevent future strokes.

Statins atherosclerosis ). Such therapy can help prevent strokes from recurring.

Antiplatelet medications , taken by mouth, may be used to reduce the risk of blood clots and thus help prevent strokes due to atherosclerosis. One of the following can be used:

aspirin alone, but only for the first 3 months after a stroke. After that, the combination has no advantage over aspirin alone. Also, taking clopidogrel plus aspirin

Anticoagulants

warfarin warfarin .

People who have atrial fibrillation or a heart valve disorder

If other disorders such as heart failure , abnormal heart rhythms, and lung infections are present, they must be treated.

Because a stroke often causes mood changes, especially depression , family members or friends should inform the doctor if the person seems depressed. Depression can be treated with antidepressants and psychotherapy .

Prognosis for Ischemic Stroke

The sooner a stroke is treated with a medication that breaks up blood clots (thrombolytic medication), the less severe brain damage is likely to be and the better the chances for recovery.

During the first few days after an ischemic stroke, doctors usually cannot predict whether a person will improve or worsen. Younger people and people who start improving quickly are likely to recover more fully.

About 50% of people with one-sided paralysis and most of those with less severe symptoms recover some function by the time they leave the hospital, and they can eventually take care of their basic needs. They can think clearly and walk adequately, although use of the affected arm or leg may be limited. Use of an arm is more often limited than use of a leg.

About 10% of people who have an ischemic stroke recover all normal function.

Some people are physically and mentally devastated and unable to move, speak, or eat normally.

About 20% of people who have an ischemic stroke die within 28 days. The proportion is higher among older people. About 25% of people who recover from a first stroke have another stroke within 5 years. Subsequent strokes impair function further.

Most impairments still present after 12 months are permanent.

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What You Should Know About Traveling Blood Clots

A blood clot in a deep vein that breaks off and travels to your lungs could be life-threatening. Here’s what you need to know about this type of traveling blood clot.

Ashley Welch

Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot develops deep in a vein. These clots typically occur in the leg, thigh, or pelvis, but may also develop in the arm.

DVT can become dangerous if the blood clot breaks off and travels through the bloodstream to the lungs. This causes a blockage called a pulmonary embolism (PE) and can be life-threatening.

The Connection Between DVT and PE

Think of pulmonary embolism as a complication of deep vein thrombosis , explains Roy Silverstein, MD , a professor and chair in the Medical College of Wisconsin’s division of hematology and oncology in Milwaukee. Some important things to know about DVT and PE:

  • You can have DVT and not know it, especially if the clot is small.
  • The most common symptoms of DVT are swelling in an arm or leg, tenderness that isn’t from an injury, and skin that feels warm and is red in the area of the clot.
  • A clot usually forms in just one leg or arm, not both.
  • You’re at a greater risk for a PE if you have deep vein thrombosis or a history of DVT.

Like DVT, you can have a PE and not know it.

“With a PE, one of three things happens,” says Andrea Obi, MD , a vascular surgeon at University of Michigan Health in Ann Arbor. “Sometimes it will plug up just a very small blood vessel in the lung, and the remainder of the lung will compensate and the person may not even know it happened.”

A second scenario, she says, is that “the clot will break off and travel to the lung and block a slightly larger blood vessel that impairs the ability of the lung to exchange blood that’s returning for blood that’s oxygenated.” This will cause oxygen saturation levels to drop.

Signs of PE might include the following:

  • Shortness of breath
  • A rapid heartbeat
  • Chest pain or discomfort that gets worse when you breathe deeply or cough
  • Coughing up blood
  • Feeling lightheaded or faint
  • Feeling anxious or sweating
  • Having clammy or discolored skin

“The third scenario is sudden death, and that’s really what we’re trying to prevent when we talk about making a timely diagnosis of DVT and getting patients on blood thinners right away,” Dr. Obi says.

Diagnosing DVT and PE

DVT and PE aren’t always detected for what they are. “The symptoms are quite subtle, and sometimes it’s a nagging pain in the leg that people don’t pay much attention to,” Dr. Silverstein says. “You think you pulled a muscle — you don’t think it could be a clot.”

However, because PE can lead to sudden death, it’s critical to seek medical treatment right away if you think you might be experiencing any of the telltale symptoms.

According to the Centers for Disease Control and Prevention , as many as 900,000 people in the United States develop DVT, PE, or both every year. An estimated 60,000 to 100,000 of them die, and most are sudden deaths because the fatal PE goes unrecognized. In fact, sudden death is the first symptom for a quarter of the people who have a pulmonary embolism, the CDC notes.

That need not be the case, however. “As long as we make a prompt diagnosis and treat it, patients do extremely well,” Silverstein says.

Most often, DVT can be diagnosed with duplex ultrasound. A sonographer uses an ultrasound machine, sending sound waves through the leg, to observe blood flow in your veins.

To diagnose PE, doctors may order a computed tomography (CT) scan or a specialized X-ray of your lungs, called a ventilation/perfusion scan; it can also show how much blood is getting to your lungs, notes Johns Hopkins Medicine . During the ventilation part of the scan, you inhale a small amount of a radioactive gas. Radioisotopes are injected into your bloodstream to allow doctors to see where blood flows to your lungs.

A blood test known as D-dimer measures a substance found in your blood when a clot dissolves, according to MedlinePlus . High levels may suggest blood clots. If your level is normal and you have few risk factors for PE, it could indicate that you don’t have PE.

Managing DVT and PE Blood Clot Disorders

Sitting while traveling long distances in a plane or car can increase your risk for DVT and PE, and the longer the trip, the higher the risk, Silverstein says.

Women who take hormones, whether birth control pills or estrogen therapy, are also at an increased risk, as are pregnant women and women in the six weeks after childbirth. People who have to spend an extended amount of time in bed, most often because of hospitalization and recovery from an illness or surgery, have a heightened risk, too.

Treatment involves medications that thin your blood and slow its ability to clot. Blood thinners won’t break up clots, Silverstein says, but they will stop the clot from growing and prevent further clots. “The body has a natural way of healing itself, and eventually the clot disappears on its own,” he says.

If a pulmonary embolism is life-threatening, your doctor can administer a thrombolytic, an agent that will dissolve the clot quickly. Because thrombolytics can cause you to bleed, they’re used only when your life is in danger. “Thrombolytic therapy has to be done in a hospital setting,” notes Silverstein.

Sometimes, though not often, surgery is required to remove the blood clot.

“If the blockage is big enough where it’s causing really severe deficits in oxygen or strain on the heart, then in those patients we do try to treat them by removing the blood clot,” Obi says.

Silverstein adds that the most worrisome complication of PE is death. If you have repeated clots, over time they can damage your lungs, and that can lead to chronic heart disease. Most of the time, that doesn’t happen, he says.

Once you’ve had a PE, you are at a greater risk of having more. Other factors that could further increase your risk, per Johns Hopkins Medicine :

  • Being sedentary or bedridden
  • Being overweight
  • Undergoing surgery or breaking a bone
  • Having a history of a stroke, chronic heart disease, high blood pressure, chronic obstructive pulmonary disease (COPD), or paralysis

In addition, research has also noted a link between DVT, PE, and COVID-19. A 2022 study concluded there was an increased risk of developing either DVT or PE in the months following a COVID-19 infection, although the researchers noted that the risk seemed to be higher during the first wave of the pandemic, and especially in people with multiple other chronic health conditions.

Age is also a risk factor. “The older you are, the higher your risk,” Silverstein says, “particularly after age 55.”

Never ignore DVT or PE symptoms, thinking they will go away, especially if you have risk factors. Because the signs — if any — will be subtle, err on the side of caution.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

  • Data and Statistics on Venous Thromboembolism.  Centers for Disease Control and Prevention . June 28, 2023.
  • Lung Scan. Johns Hopkins Medicine .
  • D-Dimer Test. MedlinePlus . November 8, 2021.
  • Pulmonary Embolism. Johns Hopkins Medicine.
  • Katsoularis I, Fonseca-Rodríguez O, Farrington P, et al. Risks of Deep Vein Thrombosis, Pulmonary Embolism, and Bleeding After COVID-19: Nationwide Self-Controlled Cases Series and Matched Cohort Study. BMJ . April 6, 2022.

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Signs and Symptoms of Blood Clots in the Brain

Treatment should be provided within 4.5 hours of the first symptom.

blood clots

Kimberly Goad,

Weakness or numbness in one arm, slurred speech, facial drooping on one side — these unmistakable signs serve as a clear warning that something is terribly wrong. Even experiencing just one of these symptoms could be a sign that you have a blood clot in the brain.

Understanding the gravity of these symptoms is crucial. Here’s what you need to know.

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What is a blood clot in the brain?

“A blood clot in the brain is a serious condition that can cause stroke or death by blocking or bursting blood vessels,” says Deepak Gulati, MD, a vascular neurologist and medical director of telestroke services at The Ohio State University Wexner Medical Center. “It is commonly referred to as ischemic stroke, but a blood clot in the brain could also mean a hemorrhagic stroke, which is less common.”

An ischemic stroke, which accounts for around 85 percent of strokes, “happens when a blood clot blocks the blood vessel” resulting in lack of blood flow to the brain, whereas during a hemorrhagic stroke, a blood vessel ruptures and leads to accumulation of blood inside the brain,” adds Gulati. 

“The word ‘ischemic’ means lack of blood flow,” says Jayne Zhang, MD, assistant professor of neurology at Johns Hopkins Medicine. “As you can imagine, if there’s a blood clot blocking flow to the brain, then you have a lack of oxygen, and that part of the brain dies. That’s when you end up with a stroke.”

There are two types of ischemic stroke: Cerebral thrombosis happens when a blood clot forms in one of the arteries supplying blood to the brain. The other kind, a cerebral embolism, is caused by a clot that forms elsewhere in the body, usually in the heart or neck arteries, and travels to a blood vessel within or leading to the brain.

Either way, the brain is deprived of what it needs to function.

Signs and symptoms

“Many blood clots send advance warning. Chest pain or shortness of breath can be symptoms of a blood clot in your lungs or heart; leg pain, swollen legs or a change in skin color may be symptoms of a deep vein blood clot,” says Zhang.  Conversely, when there is a blood clot in the brain, patients usually develop sudden onset neurological deficits, she says.

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How to know if you or someone you’re with is experiencing a stroke?

Remember B.E. F.A.S.T. (Balance, Eyes, Face, Arms, Speech, Time) for recognizing stroke symptoms :

  • Balance: Do you have a loss of balance or feel dizzy? Are you walking differently?
  • Eyes: Are you able to see out of both eyes? Take note of any sudden vision loss, blurry or double vision .
  • Face Drooping: Is your smile uneven? Weakness or numbness in the face — especially on one side of the body — are all signs of a stroke.
  • Arm Weakness: Try to raise both arms. Does one drift downward?
  • Speech Difficulty: Do you suddenly sound as if you’ve got a mouthful of cotton when you speak? Trouble talking, confusion and understanding speech are all tip-offs that you may be having a stroke and “that the part of the brain that controls these functions is compromised due to a blood clot that’s formed,” says Zhang.
  • Time to call 911: In the same way time is of the essence with a heart attack, the same goes with a stroke, often called a brain attack. “There is a precious window of four and a half hours” to receive treatment, says Zhang. “If you get to the hospital within that window, you may qualify for a clot-busting medicine that could make the symptoms of the stroke better or go away completely,” she says. That’s why the phrase “time lost is brain lost” holds great significance. On average, 1.9 million brain cells die every minute that a stroke goes untreated, according to the American Stroke Association.

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Other symptoms of a blood clot-induced stroke include a sudden and severe headache , trouble seeing, dizziness and a loss of balance or coordination that’s bad enough to affect walking.

Diagnosis and testing

A lot happens within that 4.5-hour time frame, which starts with the first symptom.

“When someone who’s potentially having a stroke comes to the ER, we first do an assessment of the symptoms and get a medical history of the patient,” says Zhang. “A bedside neurological exam follows to find out which blood vessel may be blocked and why they’re having symptoms.” 

CT (computed tomography) and MRI (magnetic resonance imaging) scans will then confirm the diagnosis. Both offer a picture of the brain showing the location of the stroke and the extent of damage, but an MRI is more detailed.

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Treatment options

The body will naturally absorb a blood clot on its own, but it takes days to weeks for it to do so, says Zhang. However, two treatments speed up the process considerably.

One, a clot-busting drug called tissue plasminogen activator (tPA), treats ischemic stroke by doing exactly as its name suggests: It breaks up the clot that’s stopping blood flow to the brain. To be considered a good candidate for tPA, you must receive treatment within 4.5 hours of the onset of stroke symptoms.

Outside that window, depending on the size and location of the blood clot, you may qualify for what’s known as a mechanical thrombectomy. In this procedure, doctors thread a catheter through an artery in the groin up to the blocked artery in the brain to grab the clot and retrieve it.

Both treatments have dramatically changed what life after stroke looks like. “It used to be much worse before the advent of the treatments we now have,” says Zhang. “Unless it’s a really big stroke where it ends up causing other organ damage, the survival rate for most strokes these days — if they come to the hospital in time and get the appropriate treatment — is over 90 percent.”

Recovery depends on a number of factors including “size, location and type of stroke,” says Gulati. “Most patients improve significantly in the first few weeks or months and then they continue to improve for up to one year.”

Editor’s note: This article, originally published July 18, 2017, has been updated to reflect new reporting from Kimberly Goad.

Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in  Women’s Health, Prevention, Health and Reader's Digest.

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North American Thrombosis Forum

Home / Patients / The Clot Connection: Thrombosis, H…

The Clot Connection: Thrombosis, Heart Attack, and Stroke

Last updated on June 2, 2022

Updated November 2020

Blood clots play a major role in myocardial infarction (MI), or heart attack. Over time, the coronary arteries can develop plaques—a buildup of cholesterol, fibrous tissue, and inflammatory cells—in a process called atherosclerosis. Smoking, high blood pressure, high cholesterol, and diabetes are risk factors for atherosclerosis; over time, they cause injury to the blood vessels and lead to more plaque formation. In some cases, these plaques become unstable and fracture, triggering the body to form a blood clot at that site. The blood clot may block the coronary artery and starve the heart muscle of oxygen and nutrients, resulting in a heart attack.

In deep vein thrombosis (DVT), blood clots develop in the leg or pelvis veins. Inflammation and underlying genetic factors likely predispose people to DVT. Other risk factors such as cancer or immobility also increase risk for DVT. If a portion of the DVT dislodges, it can travel through the veins and eventually reach the pulmonary arteries, becoming a pulmonary embolism (PE).

Blood clots also play a role in stroke. When the heart is in normal rhythm, blood flows briskly through each chamber. In a condition called atrial fibrillation (Afib), blood has more opportunity to pool in the top chambers of the heart. With less movement, blood is more prone to clotting. Once clots form, they can be pumped out of the heart and into the body’s arterial system. The arteries to the brain are some of the first pathways the blood reaches once it leaves the heart. A blood clot passing out of the heart and into these arteries can cause a stroke.

Aaron W. Aday, MD Instructor in Medicine Division of Cardiovascular  Medicine Vanderbilt University Medical Center Do you have a question for the expert?  Email [email protected]

Afib Atrial Fibrillation Blood Clot Deep Vein Thrombosis DVT Heart Attack Patients PE Pulmonary Embolism Stroke Thrombosis VTE

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Blood Clots and Travel: What You Need to Know

More than 300 million people travel on long-distance flights (generally more than four hours) each year. 1 Blood clots, also called deep vein thrombosis (DVT), can be a serious risk for some long-distance travelers. Most information about blood clots and long-distance travel comes from information that has been gathered about air travel. However, anyone traveling more than four hours, whether by air, car, bus, or train, can be at risk for blood clots.

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Blood Clots and Travel: What You Should Know

This podcast is designed to help people reduce their risk of blood clots during long-distance travel of four hours or more.

Blood clots can form in the deep veins (veins below the surface that are not visible through the skin) of your legs during travel because you are sitting still in a confined space for long periods of time. The longer you are immobile, the greater is your risk of developing a blood clot. Many times the blood clot will dissolve on its own. However, a serious health problem can occur when a part of the blood clot breaks off and travels to the lungs causing a blockage. This is called a pulmonary embolism, and it may be fatal. The good news is there are things you can do to protect your health and reduce your risk of blood clots during a long-distance trip.

Understand What Can Increase Your Risk for Blood Clots

Even if you travel a long distance, the risk of developing a blood clot is generally very small. Your level of risk depends on the duration of travel as well as whether you have any other risks for blood clots. Most people who develop travel-associated blood clots have one or more other risks for blood clots, such as:

  • Older age (risk increases after age 40)
  • Obesity ( body mass index [BMI] greater than 30kg/m 2 )
  • Recent surgery or injury (within 3 months)
  • Use of estrogen-containing contraceptives (for example, birth control pills, rings,patches)
  • Hormone replacement therapy (medical treatment in which hormones are given to reduce the effects of menopause)
  • Pregnancy and the postpartum period (up to 3 months after childbirth)
  • Previous blood clot or a family history of blood clots
  • Active cancer or recent cancer treatment
  • Limited mobility (for example, a leg cast)
  • Catheter placed in a large vein
  • Varicose veins

The combination of long-distance travel with one or more of these risks may increase the likelihood of developing a blood clot. The more risks you have, the greater your chances of experiencing a blood clot. If you plan on traveling soon, talk with your doctor to learn more about what you can do to protect your health. The most important thing you can do is to learn and recognize the symptoms of blood clots.

Amaris White in a hopital

My name is Amaris White and I want to share my personal experience with blood clots. My hope is that by sharing this information, you will learn the signs and symptoms of this potentially fatal condition and know how to protect yourself and others.

Recognize the Symptoms

Deep vein thrombosis (dvt).

About half of people with DVT have no symptoms at all. The following are the most common symptoms of DVT that occur in the affected part of the body (usually the leg or arm):

  • Swelling of your leg or arm
  • Pain or tenderness that you can’t explain
  • Skin that is warm to the touch
  • Redness of the skin

If you have any of these symptoms, contact your doctor as soon as possible.

Pulmonary Embolism (PE)

You can have a PE without any symptoms of a DVT. Symptoms of a PE can include:

  • Difficulty breathing
  • Faster than normal or irregular heartbeat
  • Chest pain or discomfort, which usually worsens with a deep breath or coughing
  • Coughing up blood
  • Lightheadedness, or fainting

If you have any of these symptoms, seek medical help immediately.

For more information on blood clots

Blood Clots and Long Distance Travel: Advising Patients

DVT Medscape Video screen shot

View this video to learn more about how healthcare providers can advise their patients on long-distance travel and blood clots.

Protect Yourself and Reduce Your Risk of Blood Clots During Travel

  • Know what to look for. Be alert to the signs and symptoms of blood clots.
  • Talk with your doctor if you think you may be at risk for blood clots. If you have had a previous blood clot, or if a family member has a history of blood clots or an inherited clotting disorder, talk with your doctor to learn more about your individual risks.
  • Move your legs frequently when on long trips and exercise your calf muscles to improve the flow of blood. If you’ve been sitting for a long time, take a break to stretch your legs. Extend your legs straight out and flex your ankles (pulling your toes toward you). Some airlines suggest pulling each knee up toward the chest and holding it there with your hands on your lower leg for 15 seconds, and repeat up to 10 times. These types of activities help to improve the flow of blood in your legs.
  • If you are at risk, talk with your doctor to learn more about how to prevent blood clots. For example, some people may benefit by wearing graduated compression stockings.
  • If you are on blood thinners, also known as anticoagulants, be sure to follow your doctor’s recommendations on medication use.

1 Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2011 Apr;6(2):113-6.

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blood clots travel to brain

What Is Cardiogenic Dementia? How Heart Disease Can Affect Your Brain

Key takeaways.

  • Cardiogenic dementia is a condition where heart disease can increase a person’s risk of cognitive problems. 
  • People with heart disease, chronic diseases of the cardiovascular system, and smokers have a higher risk of cardiogenic dementia, which affects the body’s ability to deliver oxygen and nutrients to the brain.
  • Improving heart health may improve cognitive function, but not for everyone—sometimes, the cognitive decline is irreversible if there has been permanent brain damage.

While dementia is usually thought of as a brain disease, a study released earlier this year showed that heart disease can increase a person’s risk for cognitive problems. Dementia driven by heart disease even has a name: Cardiogenic dementia. Researchers say it’s becoming more widely documented in preclinical and clinical studies.

If left untreated, cardiogenic dementia can negatively affect a person’s quality of life, underscoring the importance of early detection and treatment. Here’s what experts want you to know about how your heart health can affect your brain.

Related: Are Stroke and Dementia Connected?

The Link Between Your Brain and Heart

The relationship between heart disease and dementia is complex, but researchers have several theories about why cardiovascular health affects cognitive function.

During the initial stages of heart failure, calcium flow to the heart starts to falter. One study suggests calcium channels become overstimulated and fail to close properly, preventing sufficient calcium from getting to the cells of the heart. Because calcium particles help the heart to function, a lack of calcium can cause or exacerbate heart problems.

Since the brain has similar calcium channels, researchers think it’s possible that calcium leaks could also cause cognitive impairment. That might not be too far-fetched an idea: In the aforementioned study, mice with heart failure experienced calcium leaks that led to cognitive impairment.

Related: Comparing Symptoms of 13 Forms of Dementia

How Does Heart Disease Contribute to Dementia?

There are direct and indirect ways that heart disease can cause dementia. One direct example is heart failure .

The brain is an organ that requires sufficient oxygen and energy to function properly. When the heart is compromised by disease, “the heart becomes a less efficient pump, so the brain might not get enough blood, oxygen, and sugar to function normally,” Richard Lipton, MD , vice chair of neurology at Einstein and Montefiore Health System and the director of the Einstein Aging Study (EAS), told Verywell. 

Another way that the brain can become damaged is if the damage is caused by heart disease related to stroke .

“In stroke, brain cells die due to insufficient blood flow,” said Lipton. “ Blood clots may form in the heart or in the heart valves. If those clots break off, they can travel to the brain, block blood flow to specific brain regions, leading to death of brain tissue and cognitive problems.” 

Dementia can also be indirectly caused by inflammation in the body, according to Jason Cohen, MD , a neurologist at Montefiore-Einstein Center for the Aging Brain. 

According to Cohen, cardiogenic dementia is bidirectional, meaning brain problems can cause heart issues and vice versa.

Related: What Is the Connection Between Anxiety and Heart Disease?

Who Is At Risk for Cardiogenic Dementia?

It’s probably not surprising that people with heart failure or congestive heart failure are among the most high-risk groups for cardiogenic dementia. Cohen added that “people who have AFib (atrial fibrillation) have a higher risk of having dementia” as well.

Other at-risk groups include people who smoke, people who use drugs, people with sleep apnea, and people with high blood pressure, high cholesterol, or diabetes.

“If you have high cholesterol, you have a higher chance of having heart problems,” said Cohen. That “bad” cholesterol can build fatty deposits in the arteries, leading to heart disease and restricted blood flow to the brain.

How to Protect Your Brain From Heart Disease

Sometimes, the damage that is done to the brain that leads to cognitive problems is not reversible, so prevention is key. While you can’t really “target” your mind with specific measures, what you can do is take some general health-related steps to protect your heart and your brain.

G. Peter Gliebus, MD , a neurologist and medical director of the cognitive and behavioral neurology program at Boca Raton Regional Hospital, recommends focusing on improving your heart health, which ultimately affects your cognitive function.

“That means controlling your blood pressure, blood sugar, cholesterol, smoking, and body weight will promote healthy heart and brain aging,” said Lipton. 

If you have high blood pressure, cholesterol, or blood sugar levels , taking the medication you’ve been prescribed, and making lifestyle changes are key to getting those levels in check and keeping them within a healthy range.

What This Means For You

Research shows that heart disease may affect cognitive function, even leading to cardiogenic dementia. So, taking care of your heart health may help with your brain health, too.

Read the original article on Verywell Health .

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ScienceDaily

Distinct population of 'troublemaker' platelet cells appear with aging, lead to blood clotting, disease

Targeting this population of platelets could help better treat blood clotting-related diseases.

As people age, they become more prone to blood clotting diseases, when blood cells called platelets clump together when they don't need to and can cause major issues such as strokes and cardiovascular disease. For decades, scientists have studied why older people's blood cells behave in this way, using their insights to develop the myriad of blood-thinning drugs now on the market for treating the leading cause of death in the United States.

Now, UC Santa Cruz Professor of Biomolecular Engineering Camilla Forsberg and her research group have discovered a distinct, secondary population of platelets that appears with aging and have hyperreactive behavior and unique molecular properties, which could make them easier to target with medication. The researchers traced this population of platelets to its stem cell origins, finding what they identify as the first-ever-discovered age-specific development pathway from a stem cell to a distinct mature platelet cell.

"The question for decades and decades has been: why are aging people at such high risk for excessive blood clotting, stroke, and cardiovascular disease?" Forsberg said. "We have this discovery of a whole new pathway that progressively appears with aging -- troublemakers! That was never part of the discussion."

The research group presented their findings in a paper published in the  journal Cell . First author Donna Poscablo, Forsberg's former Ph.D. student who is now a postdoctoral scholar at Stanford University, and her peers carried out these experiments with the resources and training environment at the Institute for the Biology of Stem Cells (IBSC) at UC Santa Cruz.

Understanding platelets

Platelet cells are one of three types of blood cells produced by the body, with red and white blood cells being the other two. Millions of these cells float around in the blood at all times, and when an injury occurs either internally or externally, they clot together to form a natural, living bandaid. Platelet dysregulation, which is known to increase with age, occurs when these cells are either hyperreactive and form clots too often, or are underperforming. In both cases the body can't properly manage bleeding and clotting, although hyperreactivity is a much more widely-seen problem.

All blood cells begin as hematopoietic stem cells, a special class of stem cells, and then mature through a series of intermediary steps called a "differentiation pathway" that lead them to their fate as either platelets, red blood cells, or white blood cells. It's been known for decades that these hematopoietic stem cells decline with age, but that presents a contradiction for scientists: if the hematopoietic cells are less healthy, then why are the platelets they create hyperreactive?

A 'shortcut' pathway

As stem cell biologists, the researchers at UC Santa Cruz approached this question by investigating the hematopoietic stem cells.

They conducted experiments that allowed them to trace the lineages of these stem cells in mouse models, and discovered that in aged mice some of their platelets did not travel along the differentiation pathway. Instead, they took what the UCSC researchers dubbed a "shortcut" pathway, skipping over the intermediary steps and immediately becoming megakaryocyte progenitors, the blood cell stage immediately before platelet production. To the researchers' knowledge, this is the first age-specific stem cell pathway ever discovered.

"People think of [platelets and red blood cells] as one lineage that shares regulation and intermediate stages until the very end," Forsberg said. "To see that [the secondary platelet population] were completely separated all the way from the stem cell level, only in aged mice, was really surprising."

While the population of platelets produced from the shortcut pathway are hyperreactive, the platelets produced from the main pathway continue to behave like the platelets in a young person.

"The gradual differentiation cascade maintains a youthful property, and I feel like that is also surprising within itself," Poscablo said.

They found that the hyperreactive secondary platelets start to be produced around midlife for the mice, with their population growing progressively with aging. As of now, the researchers have not found a trigger that begins the production of this secondary pathway. Unexpectedly, however, it does not seem to be triggered by the aging environment itself: when a young hematopoietic stem cell is transferred into an aged environment, it doesn't seem to trigger the shortcut pathway; and when an aged hematopoietic stem cell is put into young environment, the old stem cells continue to operate as old stem cells.

"That was surprising, the age resilience of the other pathway," Forsberg said. "One of the platelet populations is not affected at all [by aging], whereas the one we have discovered is -- so the whole phenomenon is not primarily induced by the environment, but by the differentiation path."

Choosing better treatments

Knowing that this secondary population of platelets exists will help researchers find new ways to target and regulate these problematic cells via their stem cells. Before this, researchers have not tried to target these upstream cells.

"From our expertise, we can ask the questions of how to target the hematopoietic stem cell and now the megakaryocyte progenitor, which has never really been highlighted before as a place to target," Poscablo said.

Targeting these cells may not require the creation of new medications, but more simply inform the prescription of existing blood thinners such as Aspirin, which treat different patients to varying degrees even if they present with similar clotting-related symptoms. Using their mouse models, the researchers will identify which of the two populations of stem cells are more sensitive to Aspirin and the myriad of other platelet drugs on the market.

The UCSC researchers are also currently working on finding this secondary population of platelets in human cells with the support of a grant from the California Institute for Regenerative Medicine (CIRM). In the mouse models, they will continue to study how to manipulate and control the shortcut pathway, with funding from the National Institutes of Health (NIH) .

Collaborators on this research included UCSC Assistant Professor of Applied Mathematics Vanessa Jönsson and University of Michigan Medical School's Reheman Adili and Michael Holinstat. Current and former IBSC scholars on this project included Atesh Worthington (now at UC San Francisco), Stephanie Smith-Berdan, Marcel Rommel, Bryce Manso, Lydia Mok, Roman Reggiardo, Taylor Cool, Raana Mogharrab, Jenna Myers, Steven Dahmen, Paloma Medina, Anna Beaudin (now at the University of Utah, Salt Lake City), and Scott Boyer.

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Materials provided by University of California - Santa Cruz . Original written by Emily Cerf. Note: Content may be edited for style and length.

Journal Reference :

  • Donna M. Poscablo, Atesh K. Worthington, Stephanie Smith-Berdan, Marcel G.E. Rommel, Bryce A. Manso, Reheman Adili, Lydia Mok, Roman E. Reggiardo, Taylor Cool, Raana Mogharrab, Jenna Myers, Steven Dahmen, Paloma Medina, Anna E. Beaudin, Scott W. Boyer, Michael Holinstat, Vanessa D. Jonsson, E. Camilla Forsberg. An age-progressive platelet differentiation path from hematopoietic stem cells causes exacerbated thrombosis . Cell , 2024; DOI: 10.1016/j.cell.2024.04.018

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AstraZeneca vaccine: Everything we know so far about the rare side effects of the Covid jab

Person getting vaccinated

AstraZeneca has faced a number of claims of vaccine injury linked to its Covid jab

Adam Chapman

By Adam Chapman

Published: 13/05/2024

Updated: 13/05/2024

AstraZeneca has faced a number of claims of vaccine injury linked to its Covid jab, although complications post-vaccination are extremely rare and the benefits of getting vaccinated vastly outweigh the risks

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AstraZeneca's Covid vaccine has come under scrutiny ever since reports first emerged that it could lead to a rare and dangerous side effect .

The vaccine, sold under the brand names Covishield and Vaxzevria, has been shown to confer substantial protection against COVID-19 and is estimated to have saved more than six millions lives since it was first distributed.

However, in documents lodged with the High Court in February, AstraZeneca admitted that the vaccine "can, in very rare cases, cause TTS" - Thrombosis with Thrombocytopenia Syndrome.

It must be emphasised that the risk to the general population remains vanishingly low and the benefits of getting vaccinated far outweigh the risks.

The benefits of getting vaccinated vastly outweigh the risks for the majority of people

What is TTS and how rare is it? 

Thrombosis with Thrombocytopenia Syndrome (TTS) is characterised by blood clots and low platelet levels happening at the same time.

TTS seems to occur because the body's immune system reacts to the vaccine by making antibodies that attack a protein involved in blood clotting, although the exact causal mechanism are not known.

TTS can also occur in the absence of the AstraZeneca vaccine (or any vaccine for that matter).

"Causation in any individual case will be a matter for expert evidence," AstraZeneca has said in relation to the rare side effect of its vaccine.

The rare syndrome occurred in about two to three people per 100,000 who were vaccinated with the Vaxzevria vaccine.

AstraZeneca vaccine side effect timeline

On April 7 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) issued updated information on the “possible risk of extremely rare and unlikely to occur specific types of blood clots” following vaccination with the AstraZeneca jab.

The regulator said the benefits of vaccination “continue to outweigh any risks” but advised “careful consideration be given to people who are at higher risk of specific types of blood clots because of their medical condition”.

AstraZeneca has faced a number of claims of vaccine injury linked to the jab.

Last year lawyers acting on behalf of father-of-two Jamie Scott told the High Court that he has suffered brain injury after receiving the vaccine.

It must be stressed that the risk to benefit ratio leans heavily in one direction.

Or, As Doctor Michael Head, senior research fellow in global health at the University of Southampton, succinctly put it: “It has been an excellent and vital vaccine , a key part of the pandemic response for most countries around the world.

“There would have been far more deaths, hospitalisations, illness and transmission, if we hadn’t had the AstraZeneca vaccine, alongside the other key vaccines such as Pfizer and Moderna."

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Estimates suggest that the rollout of the jab saved 6.3 million lives around the world.

And the benefits of getting vaccinated still overwhelmingly outweigh the risks posed by Covid.

A 2023 study by the University of Oxford analysed the health records of 29.1 million people in England and estimated that for every 10 million people who are vaccinated with AstraZeneca, there are 66 extra cases of blood clots in the veins and seven extra cases of a rare type of blood clot in the brain.

Infection with COVID-19, in contrast, is estimated to cause 12,614 extra cases of blood clots in the veins and 20 cases of rare blood clots in the brain.

The safety of the vaccines has been extensively reviewed in both adults and children by the independent Medicines and Healthcare products Regulatory Agency (MHRA).

AstraZeneca maintains that patient safety remains its top priority and emphasises that regulatory authorities have stringent standards to ensure the safety of vaccines.

NHS England is urging at-risk groups to get vaccinated against COVID-19 this spring.People at increased risk from severe illness can get the vaccine, including those aged 75 or over (on 30 June 2024), people with a weakened immune system or who live in an older adult care home.

UKHSA surveillance data on last spring’s programme showed that those who received a vaccine were around 50 percent less likely to be admitted to hospital with Covid-19 from two weeks following vaccination, compared to those who did not receive one.

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Guest Essay

Doctors Need a Better Way to Treat Patients Without Their Consent

blood clots travel to brain

By Sandeep Jauhar

Dr. Jauhar is a cardiologist in New York who writes frequently about medical care and public health.

Not long ago, I took care of a middle-aged man at my hospital who had severe heart failure requiring life support. When he was disconnected from machines after a few days of treatment, he began to display psychotic symptoms, including delusional thinking, tangential speech and paranoia. He had a long history of untreated schizophrenia, I learned, which had estranged him from family members and friends, with whom he had virtually no contact.

My patient demanded to leave the hospital. However, sending him home was going to be a problem. He could not take care of himself. There was little chance he would take his medications, including a blood thinner to dissolve a clot in his heart before it caused a stroke. He was even less likely to take psychiatric drugs that he did not believe he needed.

My colleagues and I didn’t know what to do, so we called the treating psychiatrist. The psychiatrist immediately declared that our patient lacked the capacity to discharge himself from the hospital. The patient could not grasp the implications of this choice, for instance, or properly weigh its risks and benefits. The psychiatrist said the patient should remain in the hospital to receive psychiatric treatment, even against his will.

The psychiatrist’s opinion made sense to me. Patients with untreated schizophrenia have a higher rate of death than those who undergo treatment. Hopefully treatment would restore my patient’s judgment to the point where he would take his medications when he went home — or even decide not to take them, but to make that risky decision in the full appreciation of the likely consequences. (If autonomy means anything, it means that patients have the right to make bad decisions, too.) Treating him, even over his objections, seemed to be in his best interests.

However, according to New York law — and the law of other states — such involuntary treatment would require a court order. As doctors, we would have to plead our case before a judge. But was a judge without medical or psychiatric expertise the best person to decide this man’s fate?

In this case and also more generally, I think the answer is no. The law ought to be changed to keep such decisions in hospitals — in the hands of doctors, medical ethicists and other relevant experts.

Doctors don’t always have to resort to the courts to treat patients without their consent. There are some notable exceptions, such as during a life-threatening emergency (if a competent patient has not previously refused such treatment) or when there is a pressing societal interest (such as requiring patients with communicable tuberculosis to take antibiotics).

But judicial review has been the cornerstone of “treatment over objection,” as it’s known, for the past four decades or so. Appellate courts in the 1980s ruled that judicial hearings in such cases are needed to safeguard patients’ rights. For example, in 1983, in Rogers v. Commissioner of Department of Mental Health, the Massachusetts Supreme Judicial Court declared that a judge could override medical judgments favoring involuntary psychiatric treatment.

The underlying motivation behind judicial review was and remains laudable: to avoid the sort of paternalistic abuses that have characterized too much of medical history. Doctors often used to withhold bad news from patients, to cite just a small example. Involuntary treatment, even with benevolent intentions, reeks of such paternalism.

But though medical practice is by no means perfect, times have changed. The sort of abuse dramatized in the 1975 movie “One Flew Over the Cuckoo’s Nest,” with its harrowing depiction of forced electroconvulsive therapy, is far less common. Doctors today are trained in shared decision-making. Safeguards are now in place to prevent such maltreatment, including multidisciplinary teams in which nurses, social workers and bioethicists have a voice.

In addition to being less necessary to prevent abuse than they once were, courts are by nature poorly suited for making decisions about treatment over objection. For one thing, they are slow: Having to go to court often results in delays, sometimes up to a week or more, which can harm patients who need care urgently.

Moreover, judges have neither the experience nor the expertise to properly evaluate psychological states, assess decision-making capacity or determine whether a proposed treatment’s benefits outweigh its risks. It is no surprise that by some estimates 95 percent or more of requests for treatment over objection are approved by judges, who invariably haven’t met the patient and must rely on information provided by the treating medical team.

A better system for determining whether a patient should be treated over his or her objection would be a hospital hearing in which a committee of doctors, ethicists and other relevant experts — all of whom would be independent of the hospital and not involved in the care of the patient — engaged in conversation with the medical team and the patient and patient’s family. Having hearings on site would expedite decisions and minimize treatment delays. The committee would make the final decision.

Of course, such a committee would have to be granted immunity from legal liability (as with judges in our current system), so that experts would be willing to serve and speak candidly. Patients’ interests could be safeguarded by requiring the committee to publish its reasoning. Periodic audits by a regulatory body could ensure that the committee’s deliberations were meeting medical and ethical standards.

In the event that the committee could not reach a consensus on the best course of action (or if there were allegations of wrongdoing), then the parties involved could appeal to a judge. But that would be the exception rather than the rule.

In the case of my patient with heart failure, the decision ultimately didn’t have to go before a judge. Multiple discussions involving the patient, the hospital ethics and palliative care teams, social workers, nurses, psychiatrists and other doctors — discussions that in many respects served the function of a formal committee of the sort I’m proposing — yielded an agreement with the patient that his interests would be best served by sending him home with hospice care.

Capacity must be judged relative to the decision being made, and it became clear over the course of hospitalization that our patient understood the terminal nature of his condition and had the capacity to choose hospice care. Forced treatment was unlikely to significantly improve his psychiatric symptoms before the natural progression of heart failure caused his death.

So he was discharged home. It was the best decision under the circumstances, one reached by expert deliberation, not legal procedure. He passed away a few weeks later without, fortunately, ever setting foot in court.

Sandeep Jauhar ( @sjauhar ) is a doctor at Northwell Health in New York and the author, most recently, of “ My Father’s Brain : Life in the Shadow of Alzheimer’s.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

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  1. Blood Clot in Brain: Survival, Treatment, Post-Op

    When blood flow is blocked in an artery, it usually affects one side of the brain, with symptoms experienced on the opposite side of the body. Symptoms of a blood clot in the brain can include: An intense headache. Blurred vision, loss of vision, or other vision changes. Weakness of one side of the body, affecting the arm, leg, or both.

  2. Ischemic Stroke (Clots): Causes, Symptoms & Treatment

    An ischemic stroke is a life-threatening medical condition that happens when there's a lack of blood flow to a part of your brain. These usually happen because of blood clots, but they can also happen for other reasons. Ischemia (pronounced "iss-key-me-uh") is when cells in your body don't have enough blood flow, which causes them to die.

  3. Traveling blood clot: How long does it take?

    For instance, blood clots that originate in veins can travel to the lungs, leading to pulmonary embolism (PE). Blood clots that originate in the arteries can travel to the brain, causing a stroke.

  4. 6 Blood Clot Signs You Shouldn't Ignore

    Embolisms are blood clots that break free and travel to other parts of your body. Less common, thankfully, are arterial clots. ... "The clot can block oxygen from reaching the heart or brain ...

  5. Ischemic Stroke (Clots)

    Part of the blood clot breaks loose, enters the bloodstream and travels through the brain's blood vessels until it reaches vessels too small to let it pass. A main cause of embolism is an irregular heartbeat called atrial fibrillation. It can cause clots to form in the heart, dislodge and travel to the brain.

  6. Brain embolism: Definition, symptoms, treatment, and more

    Some potential causes of brain embolism are:. Blood clots. Blood clots can form anywhere in the body. Once formed, a blood clot or a fragment of the blood clot can travel through the bloodstream ...

  7. Cerebral Venous Sinus Thrombosis (CVST)

    410-955-5000 Maryland. 855-695-4872 Outside of Maryland. +1-410-502-7683 International. Find a Doctor. Cerebral venous sinus thrombosis occurs when a blood clot forms in the brain's venous sinuses. This prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage.

  8. Ischemic Stroke > Fact Sheets > Yale Medicine

    Some blood clots travel to the brain from the heart. In other circumstances, blood clots or pieces of fatty plaque may travel to the brain from a distant artery. It's also possible for a piece of fatty plaque to originate in a brain artery, blocking the flow of blood. In rare instances, clotting disorders or estrogen-containing oral ...

  9. Cerebral venous thrombosis: Causes, treatment, and diagnosis

    Summary. Cerebral venous thrombosis (CVT) is when a blood clot forms in a vein of the brain. This can lead to blood vessels breaking, causing blood to leak into brain tissues. The cerebral veins ...

  10. Ischemic Stroke

    Blood clots in a brain artery do not always cause a stroke. If the clot breaks up spontaneously within less than 15 to 30 minutes, brain cells do not die and people's symptoms resolve. ... Usually, these blood clots and pieces of fat travel to the heart and block an artery in the lungs (called pulmonary embolism). However, some people have an ...

  11. The Truth About Traveling Blood Clots

    Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot develops deep in a vein. These clots typically occur in the leg, thigh, or pelvis, but may also develop in the arm ...

  12. Atrial Fibrillation and Blood Clots

    From there, the clot will move throughout the arteries, which carry blood from your heart to other parts of your body. If you have AFib, the most common place your blood clot may travel is your brain.

  13. Blood Clot Symptoms: How to Tell if You Have One

    In other cases, a clot that starts out in a different part of your body, like your chest or neck, might enter your bloodstream and travel to your brain, where it can cause a stroke. Watch out for ...

  14. Warning Signs and Symptoms of Brain Blood Clots

    Signs and symptoms. "Many blood clots send advance warning. Chest pain or shortness of breath can be symptoms of a blood clot in your lungs or heart; leg pain, swollen legs or a change in skin color may be symptoms of a deep vein blood clot," says Zhang. Conversely, when there is a blood clot in the brain, patients usually develop sudden ...

  15. Recovering from a Blood Clot: What's Mental Health Got to Do With It?

    Kerstin de Wit, MBChB, MD, MSc. Having a blood clot can be a life-altering event. Research shows that in addition to physical symptoms (such as pain or swelling), patients may experience a range of mental health issues after a clot, including anxiety, depression, and post-traumatic stress disorder (PTSD). Last month (May 2021) was Mental Health ...

  16. The Clot Connection: Thrombosis, Heart Attack, and Stroke

    Inflammation and underlying genetic factors likely predispose people to DVT. Other risk factors such as cancer or immobility also increase risk for DVT. If a portion of the DVT dislodges, it can travel through the veins and eventually reach the pulmonary arteries, becoming a pulmonary embolism (PE). Blood clots also play a role in stroke.

  17. Blood clot and stroke: What's the link?

    The most common cause is an irregular heartbeat or atrial fibrillation, which can cause a clot to form in the heart, dislodge, and travel through the bloodstream to the brain. Once the blood clot ...

  18. Blood Clots and Travel: What You Need to Know

    More than 300 million people travel on long-distance flights (generally more than four hours) each year. 1 Blood clots, also called deep vein thrombosis (DVT), can be a serious risk for some long-distance travelers. Most information about blood clots and long-distance travel comes from information that has been gathered about air travel.

  19. What Is Cardiogenic Dementia? How Heart Disease Can Affect Your Brain

    "Blood clots may form in the heart or in the heart valves. If those clots break off, they can travel to the brain, block blood flow to specific brain regions, leading to death of brain tissue ...

  20. Distinct population of 'troublemaker' platelet cells ...

    Nov. 12, 2021 — A team of researchers has developed a new technique to open the blood-brain barrier temporarily to deliver medication to the brain. Getting medication past the brain's unique and ...

  21. Olsson making 'significant progress' after diagnosis of blood clots in

    Former Arsenal midfielder Kristoffer Olsson has made "significant physical progress" after being diagnosed as having multiple small blood clots on both sides of his brain, his club ...

  22. But How Does the Worm Get in Your Brain?

    The organisms enter through the nose when people swim in lakes and rivers, and then travel to the brain. People have also been infected through using neti pots or other sinus rinses with untreated ...

  23. AstraZeneca vaccine side effects: Blood clots explained

    A 2023 study by the University of Oxford analysed the health records of 29.1 million people in England and estimated that for every 10 million people who are vaccinated with AstraZeneca, there are 66 extra cases of blood clots in the veins and seven extra cases of a rare type of blood clot in the brain. Infection with COVID-19, in contrast, is ...

  24. Balance omega-3 and 6 intake to cut early death risk, study suggests

    CNN —. Eating enough healthy fats is great for brain and heart health, but new research has possibly provided even more evidence for adding them — particularly omega-3s — to your diet. "We ...

  25. Opinion

    Sandeep Jauhar is a doctor at Northwell Health in New York and the author, most recently, of "My Father's Brain: Life in the Shadow of Alzheimer's." The Times is committed to publishing a ...