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

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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.