Neurosurgeon Questions Blood Clots

Can a blood clot in the brain be removed by medicines alone?

My son who is 13 years old has been diagnosed with a blood clot in the brain. Is there any way that this clot can be removed with the help of medications or will it have to be removed surgically?

8 Answers

If it is small and acute, then the clot will probably dissolve and be absorbed naturally. If it is acute and expanding, then surgery would be indicated based on suitable imaging studies. If it is chronic and expanding, then surgery may be indicated to evacuate or drain it.
A “blood clot“ could be a number of different things. A blood clot outside the brain will generally not benefit from medication and may require surgery. The same could be said of a blood clot within the tissue of the brain. A blood clot inside of a blood vessel is a common source of stroke by limiting blood supply to the brain. Most often that is treated with medication, and sometimes by advanced therapies that are directed through a catheter that goes up into the arteries to put medication directly in the area of the blood clot in the blood vessel, or even to grasp the clot and remove it.
A 13-year-old that has developed an intracranial hemorrhage, or blood clot, needs to be evaluated for causation. The concern I have for a 13-year-old with an intracranial hemorrhage, or blood clot, would be arteriovenous malformation, or possibly a neoplasm. Other considerations may be moyamoya disease. Other vasculitis disorders may also cause intracranial hemorrhage.

The child needs to be worked up with MRI imaging with and without gadolinium, as well as four vessel angiography, or CT/angiography.

With respect to an idiopathic, or Unknown cause of intracranial hemorrhage, the clot usually resolves over time without surgical intervention if there is no greater than 4 mm of midline shift and if the patient is without frank neurologic deficit.

If there is alteration of mental status, or a neurologic deficit is present, then a neurosurgeon may consider evacuating the clot, after it has been worked up to determine the origin or ideology.

Thank you very much for your time


Jason Garber, M.D., FACS.
Depends where it is, how long it’s been there, what damage has or is it doing. Most trials involving placing a catheter surgically into the clot and putting in “a medicine” to breakdown the clot is in older folks. Blood clots in 13 y/o patients are usually caused by different problems and dissolving the clot with a medicine may have a high risk of causing more bleeding and even death. Google Mistie Trials for ICH (intracerebral hemorrhage).

This can sometimes be removed by an endovascular procedure done by an interventional radiologist, but it has to be in a favourable location and within a certain time frame. If not, then usually, blood thinners can only prevent the formation of new clots and the body's own scavenger cells remove this clot.
It would need to be evaluated to see if it is causing significant mass effect upon the brain. It might be small enough that it could just be resorbed.
Since you have time to type this question, this is not an emergency or they would have already removed the blood clot surgically. Blood clots in the brain absorb by themselves. If it is not an emergency, the clot is not getting bigger or there are no incapacitating symptoms, the blood clot will absorb by itself usually over weeks. There is no medication to make this go faster. Also, it depends exactly where the clot is... inside the brain? Outside and pushing on brain etc. more importantly what caused the clot... trauma or did it happen by itself. In a 13 year old, there must be an underlying cause such as a vascular malformation which requires further investigation.
Sometimes it can be dissolved with anticoagulants (medication that makes the blood very thin by preventing it from clotting). However, these medications come with their own risks and cannot be used in all situations or for all blood clots. I do not know what kind of blood clot he has so I cannot tell you specifically. Risks vs. benefit must always be evaluated and this depends on case by case basis.