Embolic Stroke

An embolic stroke happens when a blood clot travels through your bloodstream and blocks a blood vessel in your brain, cutting off oxygen and causing brain cells to die. This is a life-threatening emergency that requires immediate medical attention—every second counts in saving lives and preventing permanent brain damage.

Table of contents

• What is an embolic stroke?
• What causes embolic strokes?
• Who is at higher risk?
• Recognizing the warning signs
• How embolic strokes are diagnosed
• Emergency treatment and care
• Preventing embolic strokes

What is an embolic stroke?

An embolic stroke is a type of ischemic stroke (a stroke caused by a blockage rather than bleeding). The word “embolic” comes from embolism, which is a blood clot that forms in one part of your body, breaks free, and travels through your bloodstream until it gets stuck somewhere else^[1].

In an embolic stroke, the blood clot travels to your brain and blocks a blood vessel there. When this happens, blood cannot reach that part of your brain, so brain cells stop getting oxygen and nutrients. Without quick treatment, these brain cells begin to die within minutes^[2].

Embolic strokes are one of the most common causes of illness and death worldwide. They require emergency medical care—the sooner treatment begins, the better the chances of survival and recovery^[1].

What causes embolic strokes?

Embolic strokes happen when blood clots or other material break free from where they formed and travel to the brain. The clot can come from several different places in your body^[2].

The most common source of these traveling clots is the heart. Several heart conditions can create blood clots that may lead to an embolic stroke^[1]:

• Atrial fibrillation (an irregular heartbeat where the upper chambers of the heart quiver instead of beating properly, causing blood to pool and form clots)
• Heart valve problems, especially damaged or artificial valves
• Atherosclerosis (hardened arteries where fatty deposits called plaque build up on artery walls and can break free)
• Heart infections that kill tissue and create debris
• An enlarged heart chamber where blood moves slowly and clots can form

Blood clots can also form in arteries outside the brain and travel there. This is called artery-to-artery embolism^[2].

In some cases, a clot forms in the veins of the legs or pelvis and travels to the brain through an abnormal opening in the heart called a patent foramen ovale. This is known as paradoxical embolism^[2].

Less commonly, other health problems can cause embolic strokes. These include blood clotting disorders, COVID-19, and serious infections where bacteria or dead tissue pieces enter the bloodstream^[1].

Who is at higher risk?

Anyone can have an embolic stroke at any age, but certain groups of people face higher risks^[1].

You are more likely to have an embolic stroke if you:

• Are Black
• Are older than 65
• Smoke or use tobacco products, including vaping
• Use recreational drugs

Having certain medical conditions also increases your risk^[1]:

• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)
• Diabetes
• Alcohol use disorder
• Heart rhythm problems like atrial fibrillation

Recognizing the warning signs

Embolic stroke symptoms appear suddenly and without warning. Recognizing these signs quickly can save lives and reduce permanent damage^[1].

Common symptoms include:

• Weakness or numbness on one side of your face or body
• Aphasia (trouble speaking or complete loss of speech)
• Slurred or confused speech (dysarthria)
• Blurry vision or double vision in one or both eyes
• Sudden, severe headache
• Dizziness or loss of balance
• Confusion or trouble understanding others
• Memory loss
• Sudden personality changes or mood swings
• Nausea and vomiting
• Fainting or passing out

To quickly recognize stroke symptoms, remember the acronym BE FAST^[1]:

• Balance: Watch for sudden loss of balance
• Eyes: Look for sudden vision loss or changes
• Face: Ask the person to smile—look for drooping on one side
• Arms: Ask the person to raise both arms—one arm may sag or drop
• Speech: Listen for slurred speech or trouble choosing words
• Time: Time is critical—call emergency services immediately

If possible, note what time the symptoms began. This information helps doctors determine the best treatment options^[1].

Some people experience a transient ischemic attack (TIA), sometimes called a “mini-stroke.” The symptoms are similar to a stroke but temporary, lasting only minutes or hours. Even if symptoms go away, you must seek emergency care immediately. A TIA is a serious warning sign that a full stroke may happen soon^[1].

How embolic strokes are diagnosed

When you arrive at the hospital with stroke symptoms, doctors work quickly to determine what type of stroke you are having and where the blockage is located. This information guides treatment decisions^[2].

Doctors use several types of tests to diagnose an embolic stroke. Brain imaging tests like CT scans (computed tomography) or MRI scans (magnetic resonance imaging) create pictures of your brain to show whether you are having a stroke and what kind^[2].

To find the source of the blood clot, doctors may order heart tests. An echocardiogram uses sound waves to create images of your heart and can show blood clots, valve problems, or abnormal heart chambers. Doctors may perform a standard echocardiogram or a special type called a transesophageal echocardiogram, where a small probe is placed down your throat to get clearer pictures^[2].

A Holter monitor is a portable device you wear that records your heart rhythm over several hours or days. This helps detect irregular heartbeats like atrial fibrillation^[2].

Doctors also examine your blood vessels using imaging tests. These tests help find blockages, narrowed arteries, or areas where plaque has built up^[2].

Emergency treatment and care

Embolic stroke treatment must begin as quickly as possible. The main goal is to restore blood flow to your brain and prevent further damage^[1].

The most important treatment is a medicine called tissue plasminogen activator (tPA). This drug breaks up blood clots and must be given within a few hours after stroke symptoms begin. The sooner you receive tPA, the better your chances of recovery^[11].

If you cannot receive tPA or if it does not work well enough, doctors may use other medications to thin your blood and prevent new clots from forming. These include aspirin or other blood-thinning drugs^[11].

In some cases, doctors perform a procedure called thrombectomy. A surgeon threads a thin, flexible tube called a catheter through your blood vessels to reach the clot in your brain and remove it. This procedure can be done several hours after symptoms begin and may help people who cannot receive tPA^[11].

After emergency treatment, you will need ongoing care to prevent another stroke. This may include medications to control blood pressure, cholesterol, or heart rhythm problems. Some people need surgery to repair damaged blood vessels or heart valves^[2].

Preventing embolic strokes

Many embolic strokes can be prevented by managing your health and making lifestyle changes. Taking these steps can significantly reduce your risk^[1].

Control your heart health. If you have atrial fibrillation or other heart problems, work with your doctor to manage these conditions. Take all medications as prescribed, including blood thinners if recommended^[2].

Manage your blood pressure. High blood pressure is one of the leading causes of stroke. Check your blood pressure regularly and follow your doctor’s treatment plan to keep it under control^[1].

Keep your cholesterol in a healthy range. High cholesterol contributes to plaque buildup in your arteries. Eat foods low in saturated fat and sodium, and take cholesterol-lowering medications if your doctor prescribes them^[1].

If you have diabetes, manage your blood sugar levels carefully. Diabetes increases stroke risk, so follow your treatment plan closely^[1].

Make healthy lifestyle choices. Stop smoking and avoid all tobacco products, including vaping. Limit alcohol to no more than one drink per day for women and two drinks per day for men. Stay physically active and maintain a healthy weight^[1].

See your doctor regularly for checkups, especially if you have risk factors for stroke. Early detection and treatment of health problems can prevent strokes from happening^[2].