Patient's question:
Headache. Not feeling well, poor appetite, poor sleep, early, blocked blood vesselsDoctor's answer:
Disease Analysis: Cerebral vascular occlusion (brain thrombosis) is treatable if not too severe and managed properly. Brain thrombosis formation occurs when pathological changes occur in the walls of arteries supplying the brain, leading to thrombus formation under conditions such as slow blood flow, altered blood composition, or increased blood viscosity, resulting in vessel occlusion. The most common cause is atherosclerosis. Diabetes, hyperlipidemia, and hypertension can accelerate the development of atherosclerosis in cerebral arteries. The most common sites for brain thrombosis formation include the common carotid artery, internal carotid artery, lower segment of the basilar artery, upper segment of the vertebral artery, the junction of the vertebral and basilar arteries, the main trunk of the middle cerebral artery, the posterior cerebral artery, and the anterior cerebral artery. Other causes include non-specific arteritis, Leptospirosis, aneurysms, collagen diseases, polycythemia vera, and head and neck trauma.Symptoms
(1) General Symptoms: This condition is more common in elderly patients (50–60 years old) with arteriosclerosis, some of whom have a history of diabetes. Symptoms often occur during rest or sleep and gradually peak within 1–3 days. Some patients may experience one or more transient ischemic attacks before the onset. Except in severe cases, symptoms gradually worsen within 1–3 days, with consciousness usually remaining clear and intracranial pressure not significantly elevated.
(2) Focal Neurological Symptoms of the Brain: The variability is large and depends on the degree of vessel occlusion, the size and location of the occluded vessel, and the quality of collateral circulation.
1. Internal Carotid Artery System:
(1) Internal Carotid Artery System: The most common symptoms include hemiplegia, hemisensory loss, hemianopia (triad of hemiplegia, hemisensory loss, and hemianopia), and mental symptoms. In the dominant hemisphere, there may be varying degrees of aphasia, apraxia, and agnosia. Additionally, primary optic atrophy on the affected side may occur, along with characteristic monocular blindness with contralateral hemiplegia (blackout crossed paralysis), Horer’s sign, ophthalmoplegia, and decreased retinal artery pressure.
(2) Middle Cerebral Artery: This is the most common site. Occlusion of the main trunk causes the triad of hemiplegia, hemisensory loss, and hemianopia. In the dominant hemisphere, aphasia may also occur.
(3) Anterior Cerebral Artery: Due to the presence of collateral circulation via the anterior communicating artery, proximal obstruction may be asymptomatic. If the peripheral branches are affected, the frontal lobe inner surface is often involved, with leg paralysis being more severe. This may be accompanied by cortical sensory loss in the legs and urinary dysfunction. Deep penetrating branch obstruction affecting the anterior limb of the internal capsule may cause contralateral central facial and lingual paralysis, as well as mild upper limb paralysis. Bilateral anterior cerebral artery occlusion may lead to mental symptoms and bilateral paralysis.
2. Vertebral-Basilar Artery System:
(1) Posterior Inferior Cerebellar Artery Syndrome: Causes medullary dorsal lateral infarction, leading to vertigo, nystagmus, dysphagia and vagus nerve paralysis on the affected side, cerebellar ataxia, Horer’s sign, and sensory loss or anesthesia on the affected side of the face and contralateral body.
(2) Lateral Spinal Artery: Extremely rare.
(3) Anterior Inferior Cerebellar Artery: Vertigo, nystagmus, conjugate gaze toward the affected side, tinnitus and deafness on the affected side, Horer’s sign, and cerebellar ataxia. Sensory loss or anesthesia may occur on the affected side of the face and contralateral body.
(4) Basilar Artery: High fever, coma, pinpoint pupils, flaccid paralysis of all limbs, and medullary paralysis. Acute complete occlusion can rapidly endanger the patient’s life, and in some cases, it may manifest as locked-in syndrome.
(5) Posterior Cerebral Artery: Presents with occipital lobe syndrome, characterized by hemianopia and transient visual disturbances such as blindness. Additionally, somatopagnosia, agnosia, and apraxia may occur.
Treatment Recommendations
(1) Acute Phase: The principle is to improve blood circulation in the ischemic brain area as soon as possible and promote neurological function recovery.
1. Reduce Cerebral Edema: In patients with severe infarction, diuretics or dehydration agents may be used.
2. Improve Microcirculation: Low-molecular-weight dextran can be used to reduce blood viscosity and improve microcirculation.
3. Dilute Blood:
(1) Isovolemic Blood Dilution Therapy: Blood is removed via venous bleeding, with equal volume of fluid replaced.
(2) Hypervolemic Blood Dilution Therapy: Intravenous administration of non-blood fluids to achieve volume expansion.
4. Thrombolysis:
(1) Streptokinase.
(2) Urokinase.
5. Anticoagulation: To prevent thrombus extension and the formation of new thrombi.
(1) Heparin.
(2) Dicoumarin.
6. Vasodilation: Vasodilators are generally considered ineffective and may worsen the condition in severe cases with intracranial hypertension, so they are not typically used in the early stage.
7. Others: Hyperbaric oxygen therapy, external counterpulsation therapy, and photopheresis can also be used.
(2) Recovery Phase: Continue strengthening motor and speech therapy for paralyzed limbs. In addition to medication, physical therapy, occupational therapy, and acupuncture can be combined. Long-term use of antiplatelet agents such as (Panshin) or aspirin may help prevent recurrence. Pay special attention to a low-salt, light diet, eating more vegetables, and less animal meat. Increase fish consumption and take lipid-lowering drugs. Traditional Chinese medicine (TCM) is also effective. For example:
- Angelica sinensis 12g, radix et rhizoma gentianae 15g, peach kernel 10g, safflower 10g, peony root 12g, achyranthes root 20g, pueraria lobata 20g, oyster shell 20g, Uncaria sinensis 15g, Eucommia ulmoides 10g, poria 15g, cinnamon 15g, licorice 10g, ligusticum 10g. Decoction, taken three times daily.
Medications for Recovery Phase:
The best treatment for acute cerebral vascular occlusion should primarily involve Western medicine due to its rapid onset and targeted effects, which can quickly suppress symptom progression. However, most Western medications have significant side effects and may cause liver and kidney damage, as well as drug resistance (47% of patients develop resistance to aspirin). Therefore, they are not suitable for long-term use in brain thrombosis patients.
For the recovery phase, Western medications are generally used to effectively improve symptoms and reduce the high recurrence rate of brain thrombosis. The most effective approach is to adhere to reliable long-term medication, as only scientific use can effectively address the underlying causes of brain thrombosis, such as atherosclerosis plaque formation and high blood viscosity, thereby preventing further atherosclerosis and thrombus formation. This helps create a favorable internal environment for brain tissue, restores the nervous system, and improves motor and speech functions.
Modern TCM has advantages in long-term efficacy, high safety, and no drug resistance for chronic diseases like cerebral vascular occlusion. However, its drawbacks include unstable active ingredient content and high dosage. To address this, China has proposed a secondary development plan for TCM, selecting traditional herbs with proven efficacy and promising prospects. Using modern production techniques, these herbs are refined to enhance efficacy while ensuring more stable and rational dosage forms.
Currently, market products like Compound Salvia Miltiorrhiza Droplets and Qingkailing Injection are examples of such secondary development. New drugs for treating cerebral vascular occlusion have also been developed. Tianxintai’s Thrombo Heart Pulse (Thrombo Heart Pulse), funded by the government for secondary development, targets the root causes of brain thrombosis by acting on both blood vessel lesions (atherosclerosis plaque formation, lumen stenosis) and blood lesions (high blood viscosity, high blood lipids, high blood pressure, platelet aggregation).
Tianxintai’s Thrombo Heart Pulse combines multiple therapeutic effects, including blood circulation promotion, stasis resolution, aromatic opening, lipid reduction, and anticoagulation, with multi-target action unmatched by Western medicine or small compound TCM formulas. The formula includes ten precious herbs from animal, plant, and aromatic sources, working synergistically with over 100 active ingredients like hirudin, ligusticum, and salvia miltiorrhiza to combat atherosclerosis and thrombus formation. This helps restore a favorable internal environment for brain tissue, recover neurological function, and improve motor and speech functions.
We wish you a speedy recovery!