Brainstem Stroke

Causes

An ischemic stroke happens when blood flow is blocked. This may be caused by:

• A clot from another part of the body that breaks off and gets 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 that supplies blood to the brain

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

Risk Factors

This problem is more common in older adults and people with a family history of stroke.

Problems that affect blood vessel health and blood flow can raise the risk of stroke. Some examples are:

• History of transient ischemic attacks (TIA)
• Lack of physical activity
• Smoking
• Alcohol use disorder
• Obesity or metabolic syndrome
• Type 2 diabetes or prediabetes
• High blood pressure
• High cholesterol
• Heart problems such as past heart attack, atrial fibrillation or enlarged heart
• Diseases of blood vessels such as carotid artery stenosis or atherosclerosis
• Substance misuse of cocaine, amphetamines, or heroin

Daily habits can also play a role. Some examples are:

• Smoking and vaping
• A diet that is high in saturated fat, trans fat, cholesterol, and sodium
• Not being physically active
• Cocaine, amphetamines, or heroin use

Symptoms

A person having a brainstem stroke may have:

• Muscle weakness
• Hearing and vision problems
• Sensory changes
• Problems with balance
• A feeling of spinning when they are still
• Problems breathing
• Problems chewing, swallowing, and speaking

Diagnosis

A stroke needs to be diagnosed fast. The doctor will ask about symptoms and health history. A physical exam will be done. The doctor will look for signs of nerve or brain problems.

Blood tests may be done to look for clotting problems.

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

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

Heart function will be checked. This can be done with:

• Electrocardiogram (ECG) to look at the heart's electrical activity
• Echocardiogram to look at the heart's muscle movements

Treatment

Emergency care will be needed. The heart and lungs may need support. A tube may also be placed to help with breathing. Other options are:

Medications

For an ischemic stroke, medicine may be given to:

• Dissolve clots and prevent new ones from forming
• Thin blood

For a hemorrhagic stroke, medicine may be given to:

• Work against any blood-thinning drugs a person has been taking
• Reduce how the brain reacts to bleeding

Surgery

Options to treat an ischemic stroke are:

• Embolectomy—a tube is passed through blood to remove a clot or deliver medicine to break it up
• Vertebrobasilar angioplasty and stenting—a major artery to the brain is widened and a mesh tube is left in place to help keep it open

Rehabilitation

Therapy may be needed to regain lost skills. Options are:

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

Prevention

The risk of stroke can be lowered by:

• Managing long term health problems, such as high blood pressure and diabetes
• Keeping a healthy weight through diet and exercise
• Eating a diet that is low in fat and cholesterol and rich in whole grains, fruits, and vegetables
• Not smoking or vaping
• Limiting alcohol