OVERVIEW

What is cerebral thrombosis?

Under normal circumstances, the human body transports nutrients to various parts of the body through blood vessels, maintaining bodily functions through blood circulation.

With age, factors such as atherosclerosis can cause thickening of blood vessel walls and narrowing of the vascular lumen, leading to the formation of blood clots. Alternatively, blood clots from other parts of the body may break off and travel through the bloodstream into the brain, blocking intracranial blood vessels and disrupting normal local blood flow. These conditions are collectively referred to as cerebral thrombosis.

Cerebral thrombosis can cause localized brain ischemia and hypoxia, leading to tissue necrosis and neurological symptoms. It is a common condition among middle-aged and elderly individuals, as well as those with rheumatic heart disease or hypertension.

Who is prone to cerebral thrombosis?

Cerebral thrombosis most frequently occurs in middle-aged and elderly individuals over 50 years old who have underlying conditions such as hypertension, hyperlipidemia, high blood sugar, or obesity.

SYMPTOMS

Which organs are usually affected by cerebral thrombosis to produce symptoms?

The brain controls nerves and governs the entire body. When cerebral thrombosis occurs, some patients experience precursor symptoms such as limb numbness and weakness due to transient cerebral ischemia, followed by sudden numbness and weakness in one-sided limbs, facial distortion, and slurred speech. Moreover, cerebral thrombosis often occurs during rest or sleep. If not detected and treated promptly, it can easily lead to stroke.

CAUSES

What are the causes and risk factors of cerebral thrombosis?

Atherosclerosis is the most direct cause of thrombosis. Conditions such as hypertension, hyperlipidemia, and diabetes can accelerate the progression of cerebral arteriosclerosis. Various cerebral arteritis, direct trauma to cervical arteries, congenital arterial stenosis, malformations, changes in blood composition, increased blood coagulability, decreased blood pressure, bradycardia, and cardiac insufficiency are all factors contributing to thrombosis.

In summary, the main risk factors for cerebral thrombosis include atherosclerosis, hypertension, diabetes, hemorheological disorders, as well as age, genetics, and other factors. Additionally, increased hematocrit and elevated fibrinogen levels are risk indicators for cerebral thrombosis.

DIAGNOSIS

What tests can confirm cerebral thrombosis?

The most helpful laboratory tests for diagnosing cerebral thrombosis are head CT and head MRI.
In most cases, a low-density infarct focus gradually appears on head CT 24 hours after onset.

Within 2–15 days after onset, uniform patchy or wedge-shaped low-density foci become visible. Large-area cerebral infarction may present with brain edema, mass effect, and hemorrhagic infarction showing mixed density. However, CT sometimes cannot detect small infarcts in the brainstem or cerebellum.

Head MRI can clearly reveal early ischemic infarcts, brainstem and cerebellar infarcts, and venous sinus thrombosis. Within hours of infarction, T1 hypointense and T2 hyperintense lesions appear, while hemorrhagic infarction shows mixed T1 hyperintensity. MRI enables early diagnosis of ischemic stroke, displaying ischemic lesions within 2 hours of onset, providing critical information for early treatment.

What other tests are needed for cerebral thrombosis?

Head CT and MRI are primarily used to confirm cerebral thrombosis. Additional auxiliary tests include:

• Digital subtraction angiography (DSA): Identifies vascular stenosis and occlusion sites, revealing arteritis, moyamoya disease, aneurysms, and arteriovenous malformations.
• Transcranial Doppler (TCD): Detects carotid or intracranial artery stenosis, atherosclerotic plaques, or thrombosis.
• Echocardiography: Identifies cardiac mural thrombi, atrial myxomas, and mitral valve prolapse.
• Carotid and subclavian artery ultrasound: Detects local plaques and stenosis.

What diseases should cerebral thrombosis be differentiated from?

Cerebral thrombosis requires differentiation from the following conditions:

• Cerebral hemorrhage: Symptoms may resemble small cerebral hemorrhages, but sudden onset during activity, rapid progression, and hypertension history suggest hemorrhage. CT confirms diagnosis.
• Cerebral embolism: Sudden onset with focal signs peaking within seconds to minutes. Often caused by cardiac emboli (e.g., rheumatic heart disease, atrial fibrillation). Middle cerebral artery embolism may lead to large infarcts, cerebral edema, and seizures.
• Intracranial space-occupying lesions (e.g., tumors, subdural hematomas, abscesses): May mimic stroke with focal deficits. CT or MRI is diagnostic.

TREATMENT

Which department should I visit for cerebral thrombosis?

Cerebral thrombosis is usually treated in the Department of Neurosurgery or Neurology.

What are the common treatments for cerebral thrombosis?

For the treatment of cerebral thrombosis, early thrombolysis is the priority. Treatment should be administered as soon as possible after the formation of a cerebral thrombus, ideally within 4.5 hours of onset. Thrombolytic therapy can help reopen blood vessels, reduce cerebral edema, shrink the infarcted area, restore blood flow to the blocked region, and minimize neuronal damage.

Additionally, medications like Shuxuetong may be used to prevent hypertensive cerebral thrombosis. Measures to prevent cerebral edema and anticoagulation therapy are also employed to reduce the risk of early recurrence of ischemic stroke, prevent thrombus extension, and stop the formation of secondary thrombi in distal small vessels, thereby promoting collateral circulation. Anticoagulation therapy is suitable for patients with progressive cerebral thrombosis but is contraindicated in cases of hemorrhagic infarction or hypertension.

What complications can cerebral thrombosis cause?

As blood vessels gradually narrow, thrombi may detach due to hemodynamic forces and travel with the bloodstream. Depending on where they lodge, they can cause infarctions in corresponding organs, leading to clinical signs of embolism in other areas. Examples include:

• Pulmonary embolism: Symptoms may include shortness of breath, cyanosis, chest pain, hemoptysis, and pleural friction rub.

• Renal embolism: Manifestations may include lower back pain and hematuria.

• Mesenteric embolism: Symptoms may include abdominal pain and bloody stools.

• Cutaneous embolism: Signs may include petechiae or ecchymosis.

Many patients also have concurrent conditions such as rheumatic heart disease, coronary artery disease, severe arrhythmias, or a history of cardiac surgery, long bone fractures, or intravascular interventional therapy.

Can cerebral thrombosis be completely cured?

Cerebral thrombosis has a sudden onset and a high rate of disability and mortality. Generally, if medical attention is sought within 3–6 hours of onset, early arterial thrombolysis can be performed, significantly improving the chances of recovery from cerebral infarction.

However, cerebral thrombosis cannot be completely cured. Once it occurs, ischemic damage to brain tissue leads to necrosis or irreversible pathological changes. Even if blood flow is restored, the function of the affected tissue may not fully recover, resulting in sequelae. Mild cases treated promptly and correctly may leave no lasting effects.

Is recurrence of cerebral thrombosis likely?

Recurrence refers to the reappearance of the same condition. The likelihood of recurrence depends heavily on post-diagnosis care. Adhering to medical advice, adjusting lifestyle habits, and strengthening care can greatly reduce the risk of recurrence. Poor care, however, increases the chances of recurrence. Preventing relapse requires effective intervention against the risk factors that trigger cerebral thrombosis.

Is cerebral thrombosis hereditary?

Cerebral thrombosis is not a hereditary disease and thus is not inherited. However, some risk factors for cerebral thrombosis, such as hypertension and diabetes, often have genetic links. If parents have these conditions, lifestyle and dietary habits should be carefully managed to reduce risk.

DIET & LIFESTYLE

Does cerebral thrombosis affect pregnancy?

Cerebral thrombosis is an acute cerebrovascular disease characterized by high incidence, disability, mortality, recurrence rates, and numerous complications.

Cerebral thrombosis mostly occurs in middle-aged and elderly people over 50 years old. For this age group, pregnancy itself already qualifies as advanced maternal age, and the decline in physical function along with underlying conditions can impact pregnancy. If cerebral thrombosis occurs, it endangers both the mother and the fetus, so careful nursing is essential during pregnancy.

Additionally, young pregnant women rarely develop cerebral thrombosis, but due to hormonal changes during pregnancy, they are prone to deep vein thrombosis in the lower limbs. Therefore, regardless of age, pregnant women require extra care.

What should be noted in daily life and diet for cerebral thrombosis?

Atherosclerosis is the main cause of cerebral thrombosis, and preventing or managing it is a long-term issue that cannot be resolved simply by short-term treatments. Attention must be paid to lifestyle habits, medication, and more.

• First, take anti-atherosclerotic medications regularly and long-term to prevent thrombosis.

• Second, obesity, high cholesterol, high blood sugar, and high blood pressure are risk factors for atherosclerosis. In addition to medication, dietary adjustments play a crucial role.

• Obese patients should limit staple food intake to achieve or approach a normal weight. Generally, control daily staple food intake to around 300 grams. If still hungry, supplement with vegetables and soy products, and try to adopt the habit of eating until 80% full.

• Avoid or minimize animal fats and organ meats such as fatty pork, intestines, and stomach, as these foods are high in cholesterol and saturated fats, which can worsen atherosclerosis.

• Consume more high-quality proteins like milk, fish, eggs (limit egg yolks), and soy products, while reducing intake of pork, beef, and lamb—opt for lean cuts.

• Eat more vitamin-rich foods. Keep the diet light and avoid excessive salt; it's best to avoid pickled foods. Excessive salt intake can raise blood pressure.

• Increase fiber intake with foods like celery and whole grains to improve digestion and prevent constipation.

PREVENTION

How to Prevent Cerebral Thrombosis?

To prevent cerebral thrombosis, the following points must be noted:

• Control blood pressure: Maintain blood pressure at a stable level, but avoid lowering it excessively. Low blood pressure can lead to insufficient cerebral blood supply, increasing the risk of cerebral vascular embolism.

• Actively manage diabetes, hyperlipidemia, etc.: These conditions may contribute to cerebral thrombosis. Individuals with a history of transient ischemic attacks or coronary heart disease should undergo long-term preventive treatment.

• Avoid smoking and excessive alcohol consumption.

• Regular check-ups: It is advisable to check cholesterol and lipid levels at least once a year.

• Use aspirin: Under a doctor's guidance, take aspirin continuously and long-term—once daily at 50 mg or twice daily (morning and evening). Aspirin is contraindicated for patients with bleeding tendencies (e.g., nosebleeds, gum bleeding).

• Take medication regularly: Patients with a history of cerebral thrombosis must strictly follow their doctor's instructions for regular medication to prevent recurrence. After discharge, they should continue prescribed treatments, manage underlying conditions like diabetes and hypertension, and attend regular follow-up examinations.