Brainstem Stroke

Overview

Definition

The brainstem is just above the spinal cord. It helps to control automatic roles like heartbeat, breathing, and blood pressure. This makes brainstem’s job vital. The brainstem also controls movement for the eyes and muscle movement. It also controls how you hear, talk, chew, and swallow.

A brainstem stroke happens when the blood supply to the area is stopped. Blood brings oxygen and nutrients to brain tissue. When blood flow is stopped, the brain tissue quickly dies. Since the brainstem has a vital role, this damage can lead to death.

Brainstem
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There are 2 main types of stroke: ischemic and hemorrhagic . An ischemic stroke is the most common type of stroke.

Causes

An ischemic stroke is caused by a block of the blood flow, which may be due to:

  • A clot from another part of the body like the heart or neck. The clot breaks off and flows through the blood until it becomes trapped in a blood vessel supplying the brain.
  • A clot that forms in an artery that supplies blood to the brain.
  • A tear in an artery supplying blood to the brain. This is called an arterial dissection.

A hemorrhagic stroke is caused by a burst blood vessel. Blood spills out of the broken blood vessel and pools in the brain. This slows or stops the flow of blood and causes a build up of pressure on the brain.

Risk Factors

Certain factors increase your risk of stroke, but can not be changed, such as:

  • Race—People of African American, Hispanic, or Asian/Pacific Islander descent are at increased risk.
  • Age: Older than 55 years of age
  • Family history of stroke

Other factors that may increase your risk can be changed such as:

  • Drug abuse from cocaine , amphetamines, or heroin use
  • Smoking
  • Lack of activity

Certain medical issues can increase your risk of stroke. Proper care or preventing these issues can greatly lower your risk of stroke. Medical conditions include:

  • High blood pressure
  • High cholesterol levels —specifically high-LDL bad cholesterol
  • Low bone mineral density, especially in women
  • Obesity and metabolic syndrome
  • High blood homocysteine level
  • Atherosclerosis
  • Type 2 diabetes or impaired glucose tolerance
  • Atrial fibrillation
  • Blood disorders such as sickle cell disease and polycythemia
  • Vascular dementia
  • Disease of heart valves, such as mitral stenosis
  • Prior stroke or cardiovascular disease, such as heart attack
  • Peripheral artery disease
  • Transient ischemic attack (TIA) —a warning stroke with stroke-like symptoms that go away shortly after they appear
  • Conditions that increase your risk of blood clots such as:
    • Cancer
    • Certain autoimmune diseases
  • Migraine with aura
  • Having a blood vessel abnormality
  • Psychological disorders, such as depression or anxiety

Risk factors specific to women include:

  • Previous pre-eclampsia
  • Use of birth control pills , especially if you are over 35 years old and smoke
  • Long-term use of hormone replacement therapy
  • Menopause
  • Pregnancy—due to increased risk of blood clots

SymptomsandDiagnosis

Symptoms

The symptoms of a brainstem stroke can be severe and may include:

  • Problems with vital functions, such as breathing
  • Difficulty with chewing, swallowing, and speaking
  • Weakness or paralysis in the arms, legs, and/or face
  • Problems with balance or sensation
  • Hearing loss
  • Vision problems
  • Vertigo —a feeling of spinning or whirling when you are not moving
  • Locked-in syndrome, which occurs when only the eyes are able to move
  • Coma

If you or someone you know has any of these symptoms, call for emergency medical services right away. Brain tissue without blood flow dies quickly. Early care can decrease damage.

Diagnosis

The doctor will make a diagnosis as quickly as possible. An exam of your nervous system will be done.

Blood tests may be done. It will show blood clotting issues.

Images may be taken of the brain. This can be done with:

  • CT scan
  • Angiogram —to assess the heart and its blood supply
  • CT angiogram
  • MRI scan
  • Magnetic resonance angiography (MRA)
  • Doppler ultrasound

Your heart will also be closely checked. Tests may include:

  • Electrocardiogram —show electrical activity of the heart
  • Echocardiogram —show movement of muscle

Your kidney and liver function will also be tested to look for changes.

Treatments

Treatment

Immediate treatment is needed to:

  • Dissolve or remove a clot for ischemic stroke
  • Stop bleeding for hemorrhagic stroke

The heart and lungs may need support. A tube may be placed in the to help with breathing.

Medications

For an ischemic stroke, medicine may be given to:

  • Dissolve clots and prevent new ones from forming
  • Thin blood
  • Control blood pressure
  • Treat an irregular heart rate
  • Treat high cholesterol

For a hemorrhagic stroke, the doctor may give medicine to:

  • Work against any blood-thinning drugs you may regularly take
  • Reduce how your brain reacts to bleeding
  • Control blood pressure

Surgery

Options to treat an ischemic stroke include:

  • Embolectomy—a tube is passed through blood vessels to the blocked vessel. It can remove the clot or deliver drug to break up the clot.
  • Vertebrobasilar angioplasty and stenting —the carotid, a major artery to the brain, is widened. A mesh tube is left in place to help keep it open

A feeding tube may need to be placed later. It will help to deliver nutrients.

Rehabilitation

Brainstem strokes can lead to serious problems. Therapy will focus on recovering as much ability as possible:

  • Physical therapy—to improve movement
  • Occupational therapy—to help with everyday tasks and self-care
  • Speech therapy—to improve swallowing and speech
  • Psychological therapy—to provide support after the stroke

Prevention

Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:

  • Exercise regularly.
  • Eat more fruits, vegetables , and whole grains . Limit dietary salt and fat .
  • If you smoke , talk to your doctor about ways to quit.
  • Increase your consumption of fish.
  • Drink alcohol only in moderation. This means 1-2 drinks per day.
  • Maintain a healthy weight.
  • Check your blood pressure frequently . Follow your doctor's recommendations for keeping it in a safe range.
  • Take aspirin if your doctor says it is safe.
  • Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
  • Talk to your doctor about the use of statins. These types of drugs may help prevent certain kinds of strokes in some people.
  • Seek medical care if you have symptoms of a stroke, even if symptoms stop.
  • If you use drugs, talk to your doctor about rehabilitation programs.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Stroke, Brainstem)

RESOURCES

American Heart Association http://www.heart.org 

National Stroke Association http://www.stroke.org 

CANADIAN RESOURCES

Health Canada https://www.canada.ca 

Heart and Stroke Foundation of Canada http://www.heartandstroke.com 

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