Will blood clots from a stroke dissolve over time?

A fellow caregiver asked...

My 63 year old mom had a major stroke in July. She can now get up using a quad cane and get around very slowly. Nothing has come back in her Left arm. She has spasms at night that are very painful. The main artery in her neck is 100% occluded and the veins around that artery have plaque build up. I think she had a TIA last week.I am caring for her at home and she has no insurance. This morning she thought she was having a stroke because of a severe headache but she mentally was okay. The doctor told me he disease was quite extensive. It has been 3 months, do you think she will get better physically and will I know when it's time to call 911? Lastly, what happens to the blood clots in the brain? Do they dissolve over time? Do they stay in the brain? My mom thinks when the blood clots dissolve, her arm and leg will start working. I told her she misunderstood the doctor.

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Sorry to hear of your predicaments.

To answer your questions:

1) Stroke symptoms usually improve over the first 6 months after the stroke, then plateau. In general, the most improvement is seen early on after the stroke, then slows down with time. Therefore, by 3 months, she should have the majority of improvement that one would expect. Most important is for her to keep active with her therapy exercises to try and regain strength in the involved and uninvolved muscles.

2) With regards to calling 911, I think this is a discussion you should have with your doctor who might know more of the details of her entire situation. In general, however, if someone is having a very severe headache, I would call 911 unless you were specifically told not to do so by your regular doctor.

3) An occluded artery virtually always stays occluded. New arteries grow or enlarge to help bring blood flow to areas that need additional blood. However, I would not expect her to suddenly regain function of her arm or leg because of new blood vessel growth. That is not how the brain works. Loss of strength in the arm and leg is due to cell death of neurons - this will not reverse this far out from the stroke even if new blood vessel growth improves the flow of blood to that part of the brain.

Good luck, and I hope that helps.