Brainstem Stroke

Brainstem strokes happen when there is damage to the area. Brainstem damage can occur when there is bleeding in the area or an interruption of blood supply. This is a small but powerful area of the brain that controls basic bodily functions. These strokes can be particularly damaging and debilitating.

The brainstem connects the brain and the spinal cord. It has three main parts: the midbrain, pons, and medulla. The brainstem contains collections of neurons called nuclei and serves as a highway for nerves connecting the brain to the rest of the body.

Nerve pathways that control sensation and movement travel through the brainstem. Damage to the brainstem can affect our ability to feel and move.

The brainstem controls our body’s most basic functions.

The most common cause of brainstem stroke is high blood pressure and smoking. The tiny blood vessels that supply the brainstem can be damaged over time, leading to stroke.

Trauma can also damage the vessels in the back of the neck that supply the brainstem. 

What Causes a Brainstem Stroke?

Brainstem strokes happen when a blood vessel is blocked or when a blood vessel bursts and bleeds.

Common Risk Factors for Brainstem Strokes

People with high blood pressure, smoking cigarettes, high cholesterol, and diabetes are more likely to have a brainstem stroke. If someone in your family has had a stroke, you might be more likely to have one, too.

Drug abuse causes a surge in blood pressure and weakens blood vessels, causing an increased risk for ischemic stroke, intracerebral hemorrhage, or aneurysm rupture. 

Recognizing the symptoms and early warning signs of a brainstem stroke is vital because TIME IS BRAIN. Going to the hospital early is key! There are more treatment options right after stroke symptoms start and a better chance of recovery.

Common Symptoms of Brainstem Stroke

Symptoms can vary depending on where the stroke occurs, but they might include problems with balance, dizziness, trouble swallowing or speaking, and weakness on one side of the body. Other signs to watch out for are a terrible headache, confusion, changes in how awake someone is, and trouble breathing.

• Dizziness
• Nausea and vomiting
• Balance problems
• Lack of coordination
• Sudden severe headache
• Changes in vision or eye movement 
• Facial droop
• Arm or leg weakness
• Numbness
• Trouble speaking
• Trouble swallowing
• Change in alertness

Differences Between Brainstem Stroke and Other Types of Strokes

Brainstem strokes have different symptoms than strokes in other parts of the brain. They are more likely to cause dizziness, nausea and vomiting, and balance problems. They can be more severe because they affect important basic body functions.

A neurologic exam and brain imaging are necessary to determine if someone is having a stroke. Doctors use different tests like CT scans and MRIs to find out the type of stroke. They also examine how blood flows in the brain and check the heart.

Different Types of Brainstem Strokes

Brainstem strokes can be broadly classified into two types:

• Ischemic Brainstem Stroke occurs when a blood clot BLOCKS blood flow to the brainstem. It is the most common type of brainstem stroke.
• Hemorrhagic Brainstem Stroke involves BLEEDING in or around the brainstem, often due to a ruptured blood vessel.

There are time-sensitive treatments available for stroke that can improve recovery. Most patients will need long-term treatment to prevent another stroke. 

Emergency Treatment for Brainstem Stroke

In the first few hours to days after a stroke, there are special treatments available for ischemic and hemorrhagic brainstem strokes. TIME IS BRAIN!

Immediate treatment options:

• Thrombolytic medications are clot-busting drugs used early when a blood vessel is blocked.
• Thrombectomy is a procedure to remove a blood clot from a blocked vessel.
• Medications to minimize bleeding are used if there is a bleed in the brainstem.
• Surgeries to repair a ruptured or abnormal blood vessel.
• There are surgeries for severe brain swelling.

Ongoing Treatment and Medications

Most patients will need a long-term antiplatelet medication like Aspirin or Clopidogrel (Plavix) to help prevent more strokes. Statin medications are used to lower cholesterol and reduce inflammation in the blood vessels.

The goal of long-term medication treatment is to lower the risk of another stroke. The risk of another stroke is highest in the first few weeks after the first stroke. Rehabilitation therapies are also a critical part of ongoing treatment.

Surgical Interventions

Surgical interventions for brainstem strokes are more common in hemorrhagic cases. Procedures may include surgical clipping or coiling of aneurysms and, in some cases, surgery to relieve pressure on the brain if there is significant swelling.

Treatment options for brainstem stroke are tailored to the type and severity of the stroke, as well as the patient's overall health. It is essential to begin treatment as soon as possible to improve the chances of recovery.

Rehabilitation and recovery start immediately, look different for every patient, and can take time. Some people can go straight home from the hospital, but others need intense rehabilitation. The goal of recovery will vary for each patient. Life may look different than it did before the stroke.

Physical and Occupational Therapy

Physical therapy focuses on improving motor skills, strength, and balance. Occupational therapy aims to help patients navigate everyday activities such as eating, dressing, and bathing. Both physical and occupational therapy should be involved after a stroke.

Speech and Swallowing Therapy

Many brainstem stroke survivors experience difficulties with speech and swallowing. Speech therapists work to improve communication and address swallowing difficulties. They teach methods for safe eating, drinking, and swallowing and help decide if someone needs a feeding tube.

Speech therapists can help with cognitive recovery through exercises and activities.

Recovery and rehabilitation require a multidisciplinary approach and are often the most challenging parts of the post-stroke journey. Success in this phase significantly depends on the intensity of therapy and the support from healthcare professionals, family, and caregivers. Patients often find they receive back what they put into their therapy plans.

Prognosis and Complications

Understanding the prognosis and potential complications is essential for patients and caregivers dealing with a brainstem stroke. Patience and flexibility are key in this process. The prognosis for a brainstem stroke varies widely from no disability to fully reliant on others. Some patients may experience significant recovery, especially with prompt and effective treatment, while others might face lifetime disabilities. The first three months after a stroke are the most critical for recovery, but recovery is a process that continues for years after a stroke.

Potential Complications and How to Manage Them

Complications from brainstem strokes can include problems with movement, speech, swallowing, and vision. Some patients may experience emotional changes or cognitive difficulties. Managing these complications often involves a combination of medication, rehabilitation therapies, and support from healthcare professionals specialized in stroke recovery.

Brainstem Stroke Life Expectancy and Survival Rates

Life expectancy and survival rates after a brainstem stroke depend on several factors, including the severity of the stroke, age, and overall health. Advances in stroke treatment and rehabilitation have improved outcomes, but severe strokes can still be life-threatening or lead to significant long-term disability.

The prognosis and potential complications of a brainstem stroke highlight the importance of immediate medical intervention and a robust rehabilitation program. Understanding these aspects is crucial for setting realistic expectations and planning post-stroke care and support.

Life after a brainstem stroke may be different than it was before. Some patients will need assistive devices for mobility, equipment to accommodate physical limitations, and new routines to manage daily activities. Survivors may need ongoing therapy to maintain and improve their functional abilities.

Support Systems and Communities for Survivors and Families

Support from family, friends, and healthcare professionals is crucial for recovery and adaptation. Connecting with support groups and communities of stroke survivors can provide valuable emotional support and practical advice. Survivor networks offer a platform for sharing experiences and coping strategies for navigating the challenges post-stroke.

The landscape of brainstem stroke care is continuously evolving, with ongoing research and advances offering new hope for treatment and recovery.

Current Research on Brainstem Strokes

Current research in brainstem strokes focuses on several areas, including improved diagnostic techniques, novel therapeutic interventions, and a better understanding of the recovery process. Studies are exploring the impact of biomarkers on quicker diagnosis, new treatment drugs, and innovative rehabilitation techniques on recovery outcomes.

Advances in Treatment and Rehabilitation

Advancements in treatment have led to more effective emergency interventions, such as mechanical thrombectomy for ischemic strokes, which have significantly improved outcomes.

Brainstem stroke rehabilitation research is dynamic and promising, especially with UC Health's Comprehensive Stroke Center leading the charge. We have multiple ongoing studies and technological innovations paving the way for better outcomes and more effective treatments in the future.