Brain Stem Infarction

WHAT YOU SHOULD KNOW:

A brainstem infarction is a type of stroke that happens when blood cannot flow to your brainstem. Your brainstem allows you to speak, hear, and swallow. It also controls your breathing, heartbeat, blood pressure, balance and eye movements. Blood for your brainstem is supplied through arteries (blood vessels). A blood clot may break loose from an artery wall, and travel to your brainstem. The clot may get stuck in a narrow blood vessel, stopping blood and oxygen from reaching your brainstem. This is called an ischemic stroke. A blood vessel may break if a clot gets stuck in it, or the vessel is weak. Blood will then flow out of the vessel and into brain tissue. This is called a hemorrhagic stroke.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Brainstem stroke is a very bad type of stroke. You may not get better from it or you may die, even with treatment. You may have problems that come with treating your brainstem stroke. Medicines used to thin your blood may lead to new or more bleeding into your brain. You may bleed more than expected during surgery. Your breathing may worsen and you may need a machine to help your breathe. Even with treatment, you could have another stroke.
  
  
• You are at a higher risk of a lung infection if you are not able to move around or you have problems swallowing. Trouble moving can lead to problems such as blood clots, skin breakdown, and contractures. Your balance may be poor after a stroke. This may place you at a higher risk of falling. You may get a blood clot in your leg. This can cause pain and swelling, and can stop blood from flowing where it needs to go in your body. The blood clot may break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause another stroke. These problems can be life-threatening. Talk to your caregiver if you have questions or concerns about these risks.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Intravenous and central lines:

You may get medicines and liquids through a tube placed in a blood vessel in your arm (IV tube) or a central line. A central line is a tube placed into a large vein in your neck or near your collarbone. Samples of blood can be collected through a central line.

Tests:

Ask caregivers for more information about these and other tests you may need:

• CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your skull and brain. You may be given dye, also called contrast, before the test. Tell the caregiver if you are allergic to dye, iodine, or seafood.
  
  
• MRI: This scan uses powerful magnets and a computer to take pictures of your brain. It will also take pictures of the blood vessels and structures in your head. You may be given dye, also called contrast, before the test. Tell caregivers if you are allergic to dye, iodine, or seafood. Remove all jewelry, and tell caregivers if you have any metal in or on your body. Metal can cause serious injury. Tell caregivers if you cannot lie still or are anxious or afraid of closed spaces.
  
  
• Arteriography: X-rays are taken of your arteries (blood vessels) to look for blood flow blockage and bleeding.
  
  
• Blood tests: You may need routine blood tests while you are being treated for your stroke. If you are getting medicine to prevent blood clots, you may need extra tests. These tests can tell caregivers if you are getting the right amount of this medicine. If you are on a ventilator, you may need blood gas tests to check your oxygen level.

Monitoring:

• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Intake and output: Caregivers may need to know the amount of liquid you are getting and how much you are urinating. A Foley catheter is a tube placed in your bladder to drain your urine into a bag. Caregivers will remove the catheter as soon as possible.
  
  
• Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  
  
• ICP monitor: ICP stands for intracranial pressure. An ICP monitor is a small tube that is put through the skull and into the head. The tubing is connected to a TV-type screen. Caregivers use the ICP monitor to keep an ongoing measurement of the pressure inside your skull (the bones of your head).

Medicines:

You may need one or more of the following:

• Fever medicine: This medicine is used to decrease a fever.
  
  
• Blood clot medicines:
  
  
  • Thrombolytics: This medicine is used to break apart clots.
    
    
  • Anticoagulants and antiplatelets: These are medicines to help prevent blood clots.
  
  
• Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
  
  
• Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.
  
  
• Cholesterol medicine: This type of medicine is given to help decrease (lower) the amount of cholesterol (fat) in your blood.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Other medicines: You may need medicine to treat diabetes, high blood cholesterol, or to prevent seizures. Medicine may be given to keep your blood pressure at a certain level if it is too high or too low. .

Sedation:

Sedation medicine can help decrease the pressure in your brain, and can also help decrease pain. If you have a tube in your throat attached to a ventilator to help you breathe, you may be given this medicine. This medicine makes you go into a deep sleep. This is done so you are not aware of any discomfort you may have from the throat tube.

Pressure stockings:

These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).

Pneumatic boots:

Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

Surgery:

Ask caregivers for more information if you need surgery:

• Ventriculostomy: If you have too much fluid and swelling around your brain, a tube may be placed into your skull to drain the fluid. This tube also checks the pressure in your brain.
  
  
• Craniotomy: If your stroke was caused by bleeding onto brain tissue, your caregiver may do surgery on your brain to remove the blood.
  
  
• PEG tubes and J-tubes: A percutaneous endoscopic gastrostomy (PEG) tube, and a jejunostomy tube (J-tube) are small, flexible tubes. The tubes are put through a small cut in your abdomen. The end of a PEG tube goes into your stomach. The end of a J-tube goes into your small intestine. You may have a GJ Tube put in. This tube goes into both your stomach and small intestine. These tubes are used to give you liquids, food, and medicine. The tubes may also be used to let air or fluids out of your stomach.
  
  
• Blood vessel filter: If you are at high risk of getting a clot in your leg (DVT), you may need to have a filter device placed in your blood vessel. This is called an inferior vena cava filter. Ask your caregiver for more information about this procedure.

Therapy:

• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Ventilator: This is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your airway through your mouth or nose. You may need a trach if an ET tube cannot be placed. A trach is an airway tube put into an incision (cut) in the front of your neck. The ET tube or trach is attached to the ventilator.
  
  
• Physical and occupational therapy: Physical and occupational therapists may exercise your arms, legs, and hands. They will help you be active as soon as possible after your stroke. Therapy may help you recover more quickly, and it may prevent contractures and bedsores. You may also learn new ways to do things such as dressing and bathing. This therapy decreases your risk of falling.
  
  
• Bladder and bowel movement training: You may have trouble controlling your urine and bowel movements. A bladder training program can teach you ways to control when you urinate. A bowel program can help you learn how to plan for bowel movements. This training can help your skin stay clean and dry, and help prevent skin breakdown.
  
  
• Swallow therapy: If you cannot swallow well, you may need to be fed through an IV or a tube. A nasogastric (NG) tube is put in your nose and extends into your stomach. A gastrostomy tube goes from the outside of your body into your stomach. A therapist can help you learn safe ways to swallow to prevent coughing and choking. You may also learn which foods and liquids are safe to eat and drink.
  
  
• Help for depression: After a stroke, you may feel depressed or cry easily. Talk to caregivers about your feelings.

Know what to do after you leave:

• Keep all follow-up visits with your caregivers.
  
  
• Learn about your medicines and take them as ordered.
  
  
• Talk to your caregiver about ways to decrease your risk of another stroke:
  
  
  • Stop smoking. Do not use illegal (street) drugs.
    
    
  • Limit alcohol.
    
    
  • Eat foods that are low in fat, cholesterol , salt, and sugar. Eat at least 5 servings of fruits and vegetables each day.
    
    
  • Get 30 minutes of moderate exercise each day, such as brisk walking.
    
    
  • Reach or stay at a healthy weight.
  
  
• Call an ambulance if you have any signs of a stroke:
  
  
  • Weakness or numbness in your arm, leg, or face. This may happen on only 1 side of your body.
    
    
  • Feel too dizzy to stand.
    
    
  • Confusion, or problems speaking or understanding speech.
    
    
  • A very bad headache. This may feel like the worst headache of your life.
    
    
  • Not able to see well out of 1 or both of your eyes.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Brain Stem Infarction (Inpatient Care)