Brain Stem Infarction

WHAT YOU SHOULD KNOW:

Brain Stem Infarction (Inpatient Care) Care Guide

A brainstem infarction (BSI) is a stroke that happens when blood cannot flow to your brainstem. When oxygen cannot get to an area of the brain, tissue in that area may get damaged. Your brainstem allows you to speak, hear, and swallow. It also controls your breathing, heartbeat, blood pressure, balance, and eye movements.

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:

  • A BSI is life-threatening, and you may not recover from it. This may happen even if you get treatment soon after your stroke starts. You may bleed more than expected during surgery. You may get blood clots that break loose and travel to your lungs or brain. Your breathing may worsen and you may need a machine to help you breathe. You may go into a coma. After your stroke, you may be paralyzed. You are at greater risk of falling after a stroke. You may develop medical problems such as muscle shortening or bedsores. Your brain may be damaged by the stroke, and you may have seizures. Without treatment, the damage caused by a stroke can get worse, and your risk for another stroke increases.

  • Even with treatment, you may have lasting problems talking, thinking, or moving your body. You may not be able to care for yourself or live alone. You may die from having a stroke. You could have another stroke, even after treatment.

WHILE YOU ARE HERE:

Informed consent

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.

IV:

You may need an IV to give you medicine or liquids if you cannot swallow. Some IV lines can also be used to collect blood samples.

Tests:

  • CT or MRI scan: Caregivers use these pictures to see blood flow blockage in your brain that may cause a stroke. The pictures can also show bleeding or damage if you already had a stroke. You may be given dye to help the pictures show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with metal. Metal can cause serious injury. Tell the caregiver if you have a metal implant.

  • 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 show whether you are getting the right amount of medicine. If you are on a ventilator, you may need blood gas tests to check your oxygen level. A ventilator is a machine that gives you oxygen through a tube placed down your throat or through an incision in your neck.

Monitoring:

  • Oxygen: Caregivers will monitor your oxygen levels. They will give you extra oxygen if your level drops too low. You may need a ventilator to give you oxygen if you cannot breathe on your own.

  • 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. You may need a Foley catheter. 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, to prevent infection.

  • 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: A small tube is put through your skull and connected to a screen. Caregivers use the ICP monitor to keep an ongoing measurement of the pressure inside your skull.

Medicines:

  • Antipyretics: These decrease a fever.

  • Thrombolytics: These break apart blood clots.

  • Anticoagulants and antiplatelets: These prevent blood clots.

  • Pain medicine: You may be given medicine to decrease or stop your pain. Do not wait until the pain is severe before you ask for more pain medicine.

  • Sedatives: These help decrease the pressure in your brain, and can also help decrease pain.

  • Other medicines: You may need medicine to treat diabetes or 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.

Treatment:

  • 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. You will learn to move carefully to lower your risk of falling. Therapy may help you recover more quickly, and it may prevent muscle shortening and bedsores. You may also learn new ways to do things such as dressing and bathing.

  • Bladder and bowel 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: You may be at risk of breathing food or liquid into your lungs after a stroke. A therapist can help you learn safe ways to swallow.

  • 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.

Feeding tube:

You may need a feeding tube if you cannot swallow food or liquids. The tube may also be used to let air or fluids out of your stomach.

  • NG tube: An NG tube goes from your nose to your stomach.

  • G tube: A G tube goes from the outside of your body into your stomach. A PEG tube is a type of G tube.

  • J tube: A J-tube is put through a small incision in your abdomen. The end of a J-tube goes into your small intestine.

  • GJ tube: A GJ tube goes into both your stomach and small intestine.

Surgery:

  • Ventriculostomy: A tube is placed into your skull to drain extra fluid and to check the pressure in your brain.

  • Craniotomy: A caregiver removes blood from around your brain.

  • Blood vessel filter: You may need a filter placed in your blood vessel to prevent complications from a blood clot in your leg (DVT).

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

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