How is it Diagnosed?
Diagnosing a brain clot, typically referring to an ischemic stroke or cerebral thrombosis,
is an emergency and relies on rapid clinical and radiological assessment. The process
starts with history-taking focused on sudden neurological symptoms such as slurred
speech, facial droop, limb weakness, confusion, or vision loss. A physical examination
includes a detailed neurological evaluation using tools like the NIH Stroke Scale to
quantify deficits.
Immediate brain imaging is crucial. A non-contrast CT scan is typically the first test done
to rule out hemorrhagic stroke. However, it may appear normal in early ischemia. For
better visualization of a clot or area of infarction, MRI with diffusion-weighted imaging
(DWI) is preferred and highly sensitive.
CT angiography (CTA) or MR angiography (MRA) can be performed to detect large
vessel occlusions and assess cerebral vasculature. Carotid Doppler ultrasound may also
be conducted to evaluate blood flow in major neck arteries. In certain cases,
transcranial Doppler may be used.
Blood tests, including clotting profile, lipid panel, glucose levels, and inflammatory
markers, help identify underlying causes. Echocardiography, particularly
transesophageal, can detect cardiac sources of emboli. Continuous cardiac monitoring
may reveal arrhythmias like atrial fibrillation.
Accurate and timely diagnosis of a brain clot is critical to initiate thrombolytic therapy
(within the first few hours) or mechanical thrombectomy for eligible patients, greatly
influencing the outcome.