The brainstem is located directly above the spinal cord. It helps control involuntary functions like heartbeat, breathing, and blood pressure. Normal brainstem function is vital to survival. Nerves that are used for eye movement, hearing, talking, chewing, swallowing, and muscle movement are also controlled by the brainstem.
A brainstem stroke happens when the blood supply to the brainstem is interrupted. This type of stroke can result in death, since the damaged brainstem can no longer control the body’s vital functions.
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There are 2 main types of stroke: ischemic and hemorrhagic. An ischemic stroke is the most common type of stroke.
An ischemic stroke is caused by a blockage 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 brainA 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 interrupts the flow of blood and causes a build up of pressure on the brain.
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 ageFamily history of stroke
Other factors that may increase your risk can be changed such as: Drug abuse
, amphetamines, or heroin use
Certain medical condition that can increase your risk of stroke. Management or prevention of these conditions can significantly decrease your risk. Medical conditions include: High blood pressureHigh cholesterol levels
—specifically high-LDL bad cholesterol
Low bone mineral density, especially in womenObesity
metabolic syndromeHigh blood homocysteine levelAtherosclerosisType 2 diabetes
or impaired glucose tolerance
Blood disorders such as
sickle cell disease
Disease of heart valves, such as
Prior stroke or cardiovascular disease, such as
heart attackPeripheral artery diseaseTransient 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:
CancerCertain autoimmune diseasesMigraine with auraHaving a blood vessel abnormality
Risk factors specific to women include: Previous pre-eclampsiaUse of birth control pills
especially if you are over 35 years old and smoke
Long-term use of
hormone replacement therapyMenopausePregnancy—due to increased risk of blood clots
The symptoms of a brainstem stroke can be severe and may include: Problems with vital functions, such as breathingDifficulty with chewing, swallowing, and speakingWeakness or paralysis in the arms, legs, and/or faceProblems with balance or sensationHearing lossVision problemsVertigo—a feeling of spinning or whirling when you are not moving
Locked-in syndrome, which occurs when only the eyes are able to moveComa
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.
Since this is an emergency, the doctor will make a diagnosis as quickly as possible. An exam of your nervous system will be done.
Your bodily fluids may be tested. This can be done with blood tests.
Images may be taken of your bodily structures. This can be done with: CT scanAngiogram
—to assess the heart and its blood supply
CT angiogramMRI scanMagnetic resonance angiography (MRA)Doppler ultrasound
Your heart function will be examined. This can be done with tests such as
Your kidney and liver function will also be tested.
Immediate treatment is needed to: Dissolve or remove a clot for ischemic strokeStop bleeding for hemorrhagic stroke
If needed, steps may be taken to help support your heart and lungs. A tube may be placed into the windpipe to provide oxygen.
For an ischemic stroke, medication may be given to: Dissolve clots and prevent new ones from formingThin bloodControl blood pressureTreat an irregular heart rateTreat high cholesterol
For a hemorrhagic stroke, the doctor may give medication to: Work against any blood-thinning drugs you may regularly takeReduce how your brain reacts to bleedingControl blood pressure
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 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.
When your condition is stabilized, a feeding tube may be placed to deliver nutrients.
Brainstem strokes can lead to serious deficits. Therapy programs focus on regaining as much ability as possible: Physical therapy—to work on improving movementOccupational therapy—to assist in everyday tasks and self-careSpeech therapy—to improve swallowing and speech challengesPsychological therapy—to provide support in adjusting to life after the stroke
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.
. Limit dietary
, 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.
Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
Hemorrhagic stroke. National Stroke Association website. Available at:
Accessed November 18, 2014.
Hemorrhagic strokes (bleeds). American Stroke Association website. Available at:
http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds_UCM_310940_Article.jsp. Updated September 16, 2014. Accessed November 18, 2014.
Ischemic strokes (clots). American Stroke Association website. Available at:American Stroke Association website. Available at:
http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp#.Vk3ipE2FPIU. Updated August 29, 2014. Accessed November 18, 2014.
Jensen M, St. Louis E. Management of acute cerebellar stroke. Arch Neurol. 2005;62(4):537-544.
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 November 18, 2014.
Recognizing stroke. National Stroke Association website. Available at:
Accessed November 18, 2014.
2/7/2014 DynaMed's Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T566761/Prevention-of-stroke: Bushnell C, McCollough LD, Awad IA, et al.
Guideline for the prevention of stroke in women.
Available at: http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48. Accessed November 18, 2015.
6/2/2014 DynaMed's Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T580145/Stroke-rehabilitation: Myint PK, Cleark AB, Kwok CS, et al. Bone mineral density and incidence of stroke: European prospective investigation into cancer-Norfolk population-based study, systemic review, and meta-analysis. Stroke. 2014;45(2):373-382.
Last reviewed November 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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