Brainstem Stroke

(Stroke, Brainstem)

Definition

The brainstem is located directly above the spinal cord. It helps controls involuntary functions like heartbeat, breathing, and blood pressure. Nerves that are used for eye movement, hearing, talking, chewing, and swallowing are also controlled by the brainstem. Normal brainstem function is vital to survival.

A brainstem stroke happens when the brain’s blood supply is interrupted in this area. This type of stroke can result in death, since the damaged brainstem can no longer control the body’s vital functions.

Brain Stem

Causes

There are two main types of stroke:

Ischemic
Hemorrhagic

An ischemic stroke (the more common form) is caused by a sudden decrease in blood flow to a region of the brain, which may be due to:

A clot that forms in another part of the body (eg, heart or neck) breaking off and blocking flow in a blood vessel supplying the brain (embolus)
A clot that forms in an artery that supplies blood to the brain (thrombus)
A tear in a blood vessel supplying a part of the brain (arterial dissection)

A hemorrhagic stroke is caused by a burst blood vessel that results in bleeding in the brain.

Risk Factors

Examples of risk factors you can control or treat include:

Certain conditions, like:
- High blood pressure
- High cholesterol
- High levels of the amino acid homocysteine (may lead to blood clots)
- Atherosclerosis (narrowing of the arteries due to build-up of plaque)
- Atrial fibrillation (abnormal heart rhythm)
- Obesity
- Metabolic syndrome
- Type 2 diabetes
- Alcohol or drug abuse

Medicines (eg, long-term use of birth control pills )
Lifestyle factors
- Smoking
- Physical inactivity
- Diet high in sodium and processed foods

Risk factors that you cannot control include:

History of stroke , heart attack , or other type of cardiovascular disease
History of transient ischemic attack (TIA)—With a TIA, stroke symptoms often resolve within minutes (and always within 24 hours). They may signal a very high risk of having a stroke in the future.
Age: 60 or older
Family members who have had a stroke
Gender: males
Race: Black, Asian, Hispanic
Blood disorder that increases clotting
Heart valve disease (eg, mitral stenosis )

Symptoms

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

Problems with vital functions (eg, breathing)
Difficulty with chewing, swallowing, and speaking
Weakness or paralysis in the arms, legs, and/or face
Problems with sensation
Hearing loss
Vision problems
Vertigo (feeling of spinning or whirling when you are not moving)
“Locked-in syndrome” (only the eyes are able to move)
Coma

If you or someone you are with has stroke symptoms, get emergency medical care right away.

Diagnosis

Since this is an emergency, the doctor will make a diagnosis as quickly as possible. Tests may include:

Exam of nervous system
Computed tomography (CT) scan —a type of x-ray that uses a computer to make pictures of the brain
CT angiogram—a type of CT scan that evaluates the blood vessels in the brain and/or neck
Magnetic resonance imaging (MRI) —a test that uses magnetic waves to make pictures of the brain
Magnetic resonance angiography (MRA) —a type of MRI scan that evaluates the blood vessels in the brain and/or neck
Angiogram —a test that uses a catheter (tube) and x-ray machine to assess the heart and its blood supply
Heart function tests (eg, electrocardiogram , echocardiogram )
Doppler ultrasound —a test that uses sound waves to examine blood vessels
Blood tests
Tests to check the level of oxygen in the blood
Kidney and liver function tests

Treatment

Immediate treatment is needed to potentially:

Dissolve a clot causing an ischemic stroke to allow blood flow to the brain
Stop the bleeding during a hemorrhagic stroke

The doctor and nurses will take steps to stabilize the functions of the heart and lungs. A tube may be placed into the windpipe to provide oxygen.

Medications

For an ischemic stroke, medicines 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 medicines to:

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

Surgery

These procedures may be done to treat an ischemic stroke:

Embolectomy—a catheter is used to remove the clot or deliver clot-dissolving drugs
Carotid angioplasty and stenting —carotid artery is widened and a mesh tube is placed to keep it open

For a hemorrhagic stroke, a clip or tiny coil may be placed on the aneurysm to stop it from bleeding.

Once your condition is stabilized, a feeding tube may be placed to deliver nutrients.

Rehabilitation

Brainstem strokes can lead to serious deficits. Therapy programs focus on regaining as much ability as possible:

Physical therapy—to work on improving movement
Occupational therapy—to assist in everyday tasks and self-care
Speech therapy—to improve swallowing and speech challenges
Psychological therapy—to provide support in adjusting to life after the stroke

Prevention

To help reduce your chance of having a stroke, take the following steps:

Exercise regularly .
Eat a healthy diet that includes fruits, vegetables, whole grains, and fish.
Maintain a healthy weight.
Drink alcohol only in moderation (1-2 drinks per day).
If you smoke, quit .
If you have a chronic condition, like high blood pressure or diabetes, get proper treatment.
If recommended by your doctor, take a low-dose aspirin every day.
If you are at risk for having a stroke, talk to your doctor about statin medicines.

RESOURCES

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

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

CANADIAN RESOURCES

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

Stroke Survivors Association of Ottawa http://www.strokesurvivors.ca/

References

Adams H, Adams R, Brott T, et al. Guidelines for the early management of patients with ischemic stroke. American Heart Association website. Available at: http://stroke.ahajournals.org/cgi/content/full/34/4/1056 . Published 2003. Accessed April 22, 2011.

Am I at risk for a stroke? National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=risk . Accessed April 15, 2011.

Brain stem stroke. American Heart Association website. Available at: http://cms.strokeassociation.org/STROKEORG/AboutStroke/EffectsofStroke/Brain-Stem-Stroke%5FUCM%5F310771%5FArticle.jsp . Updated December 23, 2010. Accessed April 22, 2011.

Brainstem stroke. Ohio State University website. Available at: http://medicalcenter.osu.edu/patiented/materials/pdfdocs/dis-cond/stroke/brainstem-stroke.pdf . Accessed April 22, 2011.

Cerebral angiography. Internet Stroke Center website. Available at: http://www.strokecenter.org/patients/diagnosis/angio.htm . Accessed April 22, 2011.

Effects of stroke. Magee Rehabilitation website. Available at: http://www.mageerehab.org/effects-of-stroke.php . Accessed April 15, 2011.

Effects of stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=EFFECT . Accessed April 15, 2011.

Effects of stroke. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcare%5Fservices/stroke/effects/Pages/index.aspx . Accessed April 15, 2011.

Effects of stroke. Rush University Medical Center website. Available at: http://www.rush.edu/rumc/page-1098987413801.html . Accessed April 15, 2011.

Mena F, Fruns M, Contreras A, Soto F, Mena I. Acute brainstem infarct: multidisciplinary management. Alasbimn Journal website. Available at: http://www.alasbimnjournal.cl/revistas/5/mena5.htm . Published October 1999. Accessed April 22, 2011.

Prevention of stroke: recommendations. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated April 7, 2011. Accessed April 15, 2011.

Stroke (acute management): treatment overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated April 11, 2011. Accessed April 15, 2011.

Stroke: causes. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=causes . Updated July 1, 2010. Accessed April 15, 2011.

Stroke: frequently asked questions. Women’s Health.gov website. Available at: http://www.womenshealth.gov/faq/stroke.cfm . Updated January 28, 2009. Accessed April 22, 2011.

Stroke: treatments and drugs. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=treatments-and-drugs . Accessed July 1, 2010. Accessed April 15, 2011.

Tests for the emergent evaluation of the patient with acute ischemic stroke. Internet Stroke Center website. Available at: http://www.strokecenter.org/education/ais%5Fevaluation/tests.htm . Accessed April 22, 2011.

Wood D. Stroke. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 28, 2011. Accessed April 15, 2011.

Revision Information

Reviewer: Rimas Lukas, MD
Review Date: 06/2012 -
Update Date: 00/61/2012 -

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.

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