Embolic Stroke

What is an embolic stroke?

An embolic stroke is a stroke that happens when an embolism (usually a blood clot) blocks a blood vessel in your brain. It’s a type of ischemic stroke.

Like all strokes, embolic strokes are life-threatening medical emergencies and can be fatal. If you think you or someone you’re with is having a stroke, immediately call 911 or your local emergency services number. The sooner someone is diagnosed and treated, the more likely it is they’ll survive a stroke. Every second counts.

What are embolic stroke symptoms?

Embolic strokes share symptoms with other types of ischemic strokes, including:

• Aphasia (trouble speaking or a complete loss of speech)
• Blurry vision or double vision (diplopia)
• Confusion or agitation
• Coma
• Dizziness or vertigo
• Headaches (usually sudden and severe)
• Memory loss (amnesia)
• Mood swings or sudden personality changes
• Nausea and vomiting
• Neck stiffness
• Passing out or fainting
• Seizures
• Slurred or garbled speaking (dysarthria)
• Sudden worsening or loss of senses (including vision, hearing, smell, taste and touch)
• Weakness or paralysis on one side of your face and body

What are the warning signs of an embolic stroke?

Embolic strokes can cause a lot of different symptoms. To recognize the warning signs of a stroke in yourself or a loved one, remember the acronym BE FAST:

• Balance. Watch for a sudden loss of balance.
• Eyes. Look out for sudden vision loss or changes in one or both eyes.
• Face. Smile. Look for a droop on one or both sides of your or someone’s face.
• Arms. Raise both arms. If you’re having a stroke, one arm will sag or drop in a way that it usually doesn’t.
• Speech. You or someone you’re with might slur your or their speech or have trouble choosing the right words.
• Time. Time is critical — call for help immediately. If possible, look at your watch, phone or a clock to track when symptoms start. Telling a healthcare provider when symptoms began can help them know which treatment options are best.

What causes embolic strokes?

Embolic strokes get their name from their cause — embolisms. An embolism is a blood clot that forms in one part of your body, breaks off, travels through your bloodstream and then gets stuck in a blood vessel somewhere else. Embolic strokes happen when an embolism gets stuck in your brain.

Many health conditions can cause blood clots and embolisms, including:

• Atrial fibrillation
• Atherosclerosis (hardened arteries)
• Clotting disorders
• COVID-19
• Infections that kill tissue in your body

With infections, bacteria or dead pieces of tissue can break free, get into your bloodstream, travel to your brain and then get stuck (this is a major complication of sepsis).

Embolic transient ischemic attacks

A transient ischemic attack (TIA) — sometimes called a “mini-stroke” — is like a stroke, but the effects are temporary. These are often warning signs that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as soon as possible.

Embolic stroke risk factors

Anyone can have an embolic stroke, but some groups have a higher risk, including people who:

• Are Black
• Are older than 65
• Smoke or use other forms of tobacco or nicotine (like vaping)
• Use recreational or nonprescription drugs

Having certain health conditions can increase your risk, including:

• Alcohol use disorder
• Diabetes
• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)

How are embolic strokes diagnosed?

A healthcare provider will diagnose an embolic stroke with a neurological exam, a physical exam and some tests. Providers in the emergency room may diagnose it if emergency services transport you to the ER.

Your provider will use some of the following tests to confirm that you’ve had a stroke:

• Blood tests
• CT scan
• Electrocardiogram (EKG)
• Electroencephalogram (EEG)
• MRI

What are embolic stroke treatments?

The most important part of treating an embolic stroke is restoring blood flow to your brain. Healthcare providers will do this as fast as possible to reduce your risk of permanent brain damage and death.

The two most common treatments include:

• Thrombolytic therapy. These are medications that dissolve clots. Providers will usually only use them if it’s been fewer than four and a half hours since you started having stroke symptoms. Otherwise, they can increase your risk of dangerous internal bleeding.
• Mechanical thrombectomy. This is surgery to remove a blood clot. Your surgeon will insert a small, thin tube (a catheter) into a blood vessel somewhere else in your body. Then, they’ll thread the catheter up to the clot in your brain. They’ll either vacuum the clot up in one piece or break it apart and suck up the pieces. This may only be an option within 24 hours of when you started having stroke symptoms.

You may need other treatments, including:

• Blood pressure and sugar management. Your providers will monitor your blood pressure and blood glucose (blood sugar) levels to help your brain recover. They may give you medications to raise or lower your blood pressure to slow down brain damage.
• Blood thinners. Anticoagulant medications thin your blood to prevent it from clotting too easily. Your providers may put you on blood thinners after thrombolytic therapy.
• Endarterectomy. You might need surgery to remove plaque from narrowed or blocked arteries. This can reduce the risk of having another embolism.
• Mild intentional hypothermia. Your providers might safely lower your body temperature. This can slow down brain damage during and after a stroke.
• Oxygen therapy. Your brain doesn’t get enough oxygen during a stroke. Your providers may have you wear a nosepiece that gives you extra oxygen. This will make it easier to breathe and help your body restore oxygen to your brain.

Embolic stroke rehabilitation

Stroke rehab is an important part of treating an embolic stroke. You’ll need stroke rehab to help you adjust to changes in your brain and body after a stroke. You may need to regain abilities you had before the stroke or adjust to new or different disabilities. You might need a combination of:

• Cognitive rehab to help improve your memory, concentration and other mental abilities.
• Occupational therapy to help you safely complete your daily tasks, especially chores or activities that need precise body movements.
• Physical therapy to strengthen your muscles, improve your balance and regain the use of your arms and legs.
• Speech therapy to regain or improve your language and speaking abilities and control the muscles that help you talk, breathe, eat and swallow.

How can you prevent an embolic stroke?

Maintaining your overall health is the best way to prevent embolisms and embolic strokes. Try to:

• Get regular physical activity.
• Eat plenty of healthy foods and maintain a weight that’s healthy for you. Your provider may suggest following an eating plan like the Mediterranean diet.
• Manage your blood pressure, cholesterol and any health conditions you have.
• Quit smoking.

Visit a healthcare provider for a check-up every year (or as often as they suggest). Many of the health conditions and issues that can cause embolic strokes develop and build up over time. They may not cause symptoms you can feel or notice. Your provider will help you catch and manage any warning signs before they increase your risk of a stroke later on.

What is the survival rate for embolic strokes?

Stroke survival rates continue to increase as we develop better, faster ways to treat them. But no one set recovery timeline or outlook is accurate for everyone.

Experts estimate that around 80% of people who have one embolic stroke survive at least a month. Your stroke risk increases after the first time you have a stroke. Survival rates are lower for people who have additional strokes.

Embolic stroke recovery time

Everyone’s body responds differently to an embolic stroke. What you can expect (the prognosis) depends on a few factors, including:

• How quickly it was treated
• Which areas of your brain it affected
• Your overall health

Most people take a few months to recover. Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.

How do I take care of myself after an embolic stroke?

Recovering and rehabbing after a stroke is hard work. Once you and your provider finalize your treatment plan, follow it as closely as possible. In general, you should:

• Go to your rehab and other therapy appointments. Tell your therapists if anything makes you feel unsafe or uncomfortable. Rehab is hard work, but you shouldn’t be in constant pain or discomfort.
• Remember your mental health. Depression and anxiety are extremely common after a stroke. You’re not weak or a quitter for feeling sad or upset. Your emotional health can be just as important as how your physical body is doing. Talk to your provider or a mental health professional if you feel like you need help processing anything during your recovery.
• Take your medications. This is especially true while you’re taking blood thinners. Reducing the risk of future blood clots is important, and taking your medicine as your provider instructs will help your body heal.

When should I go to the ER?

Call 911 or your local emergency services number if you think you’re experiencing stroke symptoms again. Another stroke has an even higher risk of causing severe complications and being fatal. Don’t wait to call for help or go to the emergency room.

People who’ve had an embolic stroke have an increased risk of other potentially serious complications, including:

• Deep vein thrombosis (DVT)
• Heart attack
• Pneumonia
• Pulmonary embolism
• Seizures

Call emergency services or go to the ER if you think you’re experiencing any symptoms of these complications.

Which questions should I ask my doctor?

• Where did the embolism form?
• Which condition or issue caused it?
• Which medications will I need, and how do I take them?
• Which changes to my daily routine will I need to make?