Brainstem Stroke



Copyright © Nucleus Medical Media, Inc.

There are two 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 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 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 interrupts 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, 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
    Physical inactivity

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 pressure
    High cholesterol levels—specifically high-LDL bad cholesterol
    Obesity and metabolic syndrome
    High blood homocysteine level
    Atherosclerosis
    Diabetes mellitus or impaired glucose tolerance
    Atrial fibrillation
    Blood disorders such as sickle cell disease and polycythemia
    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

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

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  

Since this is an emergency, the doctor will make a diagnosis as quickly as possible. An exam of your nervous system will be done.

Images may be taken of your bodily structures. This can be done with:

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

Your bodily fluids may be tested. This can be done with:

    Blood tests
    Tests to check the level of oxygen in the blood

Your heart function will be examined. This can be done with tests such as electrocardiogram and echocardiogram .

Your kidney and liver function will also be tested.

Treatment  

Immediate treatment is needed to:

    Dissolve or remove a clot for ischemic stroke
    Stop 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.

Medications  

For an ischemic stroke, medication 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 medication 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
    Vertebrobasilar 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.

When 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  

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.
    Stop abusing drugs such as cocaine. Your doctor can refer you to rehabilitatin programs.

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