Cerebral clot

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As some of you know, my dad had a stroke this past Sunday morning. They did a CT and confirmed it was a clot-no hemmorrage. Origination remains unknown. He did not recieve the TpA (reasoning unclear...still investigating ), but has been on Heparin in the ICU. He has multiple deficits related to the ischemia including expressive aphasia, no gag reflex (at all), and rt. sided weakness- so rehab. has of course been initiated.

Here's my question: what about the clot? Aside from surgery to remove it- is there anything else they can do? I'm familiar with Heparin-but realize this was given to prevent more clots, not as a treatment for the existing one.Can anyone with experience in this type of situation shed some light on possible treatments?

At this point, their doing test after test to find the cause, unable to isolate so far. They are possibly looking into DM as a related facter-due to his BS being 195 when admitted to ER. They have since been 100 and 95. (Asked about a HgA1C-don't know the answer yet.)

Any input would be greatly appreciated. Thanks.

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Specializes in OB, M/S, ICU, Neurosciences.

(((((Jenac)))))

I'm so sorry to hear about your dad.

Not knowing anything about your dad's medical history, age, etc., it is difficult to know why TpA wasn't used, however, if he was over 4 hours into the stroke (4 hrs. from onset of symptoms), there is already permanent damage done. TpA then becomes dangerous to use, because of the tissue necrosis in the region of the stroke, and greater chance of bleeding into the area. You then have a much sicker patient--hemorrhagic on top of embolic stroke, and the prognosis isn't nearly as good.

I don't know where you are located in Ohio, but if he is in one of the tertiary care centers like University Hospitals or Cleveland Clinic, they have protocols in place to ensure that a workup is done to try to determine source of the embolus. Diabetes is right up there on the list of contributing factors for stroke, as is carotid stenosis, atrial fib., as well as a number of other diseases. No doubt he will have carotid duplex scanning and a 2D Echo, in addition to lots of labwork to help identify other potential risk factors.

It sounds like they are already doing all the appropriate stuff with initiation of rehab. Since he has no gag and is aphasic, I assume they are feeding him enterally. He has a long and challenging road ahead, and so will you and your family. I wish you lots of patience--it's not easy being the nurse and the daughter!

Good luck, and feel free to pm me anytime.

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Specializes in HIV/AIDS, Dementia, Psych.

I do not have any experience in this type of problem, but I do want to say that I'm sorry your family is going through such an ordeal. (((((((hugs)))))))

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Specializes in ICU.

((((((((((((((hugs)))))))))))))) Sorry about your Dad - but the Best Blonde rn is correct - if there is any suspicion that there is already necrosis they will not use throbolysis as it markedly increases the risk of intracerebral haemorrhage.

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I am not sure if the same goes for a pulmonary embolism but I had 2 of those I was not given clot busters because it had been too long. I was started on heparin a full workup to see if I had a clotting disorders. The doctor told me with blood clots the heparin is used to prevent more clots but also so that the clot does not grow and then the body has time to break the clots down again I am not sure if it is the same when they go to the brain. I really hope your dad gets better I will be praying.

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Specializes in ICU, CM, Geriatrics, Management.

All the best with your situation, Jen.

Hope the rehab works well and Dad achieves an optimal recovery.

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Thank you all for the info. and the support. Time will tell how bad it really is going to be. But he's a fighter-and he's trying so hard to work through it...

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Specializes in CCU (Coronary Care); Clinical Research.

Sorry to hear about your dad. After he goes to rehab, he will be taken off the heparin and probably placed on aggrenox or plavix. The neurologist that I work with seems to use aggrenox for almost all of his post stroke patients. Strokes are tough because at this point there is so little that can be done, it turns to preventing another stroke, managing symptoms, and lots of hard work to try to regain some of ADLs. I hope that you dad is recovering well.

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