Brain Stem Infarction

What is a brainstem infarction?

A brainstem infarction is a type of stroke. A brainstem stroke 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.

What causes a brainstem stroke?

• Ischemic stroke: This happens when an artery to your brainstem gets blocked. This can be caused by having plaque in your artery. Plaque happens when fatty deposits and other things build up in an artery. You can also get a blocked artery from a blood clot. The clot can break loose from an artery somewhere else 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. Most brainstem strokes are ischemic strokes.
  
  
• Hemorrhagic stroke: A blood vessel may break and leak if a clot gets stuck in it, or the vessel wall is weak. Blood then flows out of the vessel and into brain tissue. This is called a hemorrhagic stroke.

What are the signs and symptoms of a brainstem stroke?

The following signs and symptoms show that you may be having, or you are about to have a stroke in your brainstem:

• You have dizziness and loss of balance. You may have nausea (feeling sick to your stomach) and vomiting (throwing up).
  
  
• You have slurred speech, or you have trouble speaking or swallowing.
  
  
• You have blurred or double vision. One or both of your eyes may be painful.
  
  
• You have numbness and weakness on 1 side of your body or face. You may drop things easily and feel clumsy.
  
  
• You are less awake than you should be, or you become unconscious (not able to wake up).
  
  
• You have jerky eye movements. Your pupils (the black circle in the center of each of your eyes) may not be the same size.
  
  
• You have a headache, or a loss of hearing that is new.

How is a brainstem stroke diagnosed?

Your caregiver will ask about your and your family's medical history. He will ask about the medicines you take and if you use street drugs. He will also do a physical exam and look for signs that show what part of your brain was injured. You may need blood tests and other tests to help your caregiver learn if you have had a stroke, or if you will soon have one. Tests also help your caregiver know where in your brain a stroke happened, and how much tissue damage you may have from it . You may need 1 or more of the following tests:

• 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 to look for blood flow blockage and bleeding.

How is a brainstem stroke treated?

Treatment depends on what caused your stroke, and your signs and symptoms. Caregivers will check your breathing, blood pressure, temperature, and ability to swallow. You may need any of the following medicines:

• Fever medicine: This medicine is used to decrease a fever.
  
  
• Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.
  
  
• Blood clot medicines: If your stroke was caused by a blood clot, you may also need the following 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.
  
  
• 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.
  
  
• 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.

What other treatments may be needed with a brainstem stroke?

• 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.
  
  
• 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 into 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.

What are the risks of a brainstem stroke?

• Brainstem stroke is a very bad type of stroke. You may not get better from it, or you may die. This may happen even if you get treatment for it soon after your stroke starts. 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 you breathe. Even with treatment, you could have another stroke.
  
  
• You may have other problems that come from having a brainstem stroke. Your balance may be poor after the stroke. This may increase your risk of falling. 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 skin breakdown, contractures, and blood clots. 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.
  
  
• You may not be able to see or hear as well as you did before your stroke. You may not be able to speak or swallow as you did before your stroke. You may start to have seizures (convulsions). You may be paralyzed (not able to move) on 1 or both sides of your body. You may go into a coma (very deep sleep) and not wake up. You may get a rare problem called locked-in syndrome. This is when you cannot move any part of your body, but you remain able to think clearly. Talk to your caregiver if you have questions or concerns about these risks.

What can I do to help recover from a brainstem stroke?

• Go to your rehabilitation sessions:
  
  
  • Rehabilitation (rehab) is a program of exercises and activities. Rehab can help you return to your usual activities, and prevent problems such as muscle shortening (contractures) and skin breakdown (bedsores). Physical therapists may work with you to strengthen your arms, legs, and hands. They may help you relearn or improve how you walk (gait training). Occupational therapist may teach you new ways to do daily activities, such as getting dressed. A speech therapist may help you relearn or improve your ability to talk and swallow. Ask caregivers how to prevent skin breakdown after a stroke.
    
    
  • Your rehab program may include functional electrical stimulation to help your muscles work better. You may do weight lifting to increase your strength and exercises to improve your balance and movement. These activities can also decrease your risk of falling. Stretching exercises, riding a bike, or walking can also help you recover. Ask your caregivers what activities you should do to help you recover from your stroke.
  
  
• Get help for depression: The way you think and feel about things may change after a stroke. You may be forgetful, or have trouble thinking clearly. You may get angry or start crying easily, or you may feel depressed. Talk to caregivers about your feelings. Counseling, medicines, and support groups can help you cope with the changes that happen after a stroke.

What increases my risk of a brainstem stroke?

• You are at least 55 years old.
  
  
• You are African American or Native American.
  
  
• You are a man.
  
  
• You are woman and use birth control pills, or you take hormone replacement medicine after menopause. Menopause occurs when an adult woman stops having monthly periods.
  
  
• Your father or mother had a stroke, or you had a low weight when you were born.
  
  
• You have high blood pressure, or blood vessel or sickle cell disease that is not being treated.
  
  
• You have atrial fibrillation, diabetes, or other heart or blood vessel conditions.

What lifestyle changes can decrease my risk of a brainstem stroke?

• Lower your blood pressure. Take your blood pressure medicine as ordered by your caregiver. Do not stop taking these medicines without asking your caregiver. Follow your caregiver's instructions to check your blood pressure, and write the numbers down to show him.
  
  
• Manage your diabetes. Diabetes (high blood sugar) increases your risk of a stroke. Manage your diabetes by keeping your blood sugar level within the range of numbers your caregiver tells you it should be. Follow your caregiver's instructions to check your blood sugar, and write the numbers down to show him.
  
  
• Eat healthy foods. What you eat can help prevent or manage your high blood pressure, high cholesterol, and diabetes. Any of these medical conditions increases your risk of stroke. Eat foods low in fat, cholesterol, salt, and sugar. Eat at least 5 servings of fruits and vegetables each day. Eat foods that are high in potassium, such as potatoes and bananas.
  
  
• Reach or stay at a healthy weight. If you are overweight or obese (weigh more than your caregiver suggests), you may need to lose weight. Weight loss can decrease your blood pressure and your risk of stroke. Ask your caregiver how much you should weigh and about how you can lose weight.
  
  
• Exercise. Get 30 minutes of moderate exercise each day to help prevent a stroke. Good exercises are cycling, fast walking, and jogging. Ask your caregiver what exercises you should do.
  
  
• Limit alcohol. Your risk of brainstem stroke increases if you have 5 or more drinks of alcohol a day. Alcohol can damage your brain, heart, and liver. Men should not have more than 2 drinks per day. Women should not have more than 1 drink per day. Tell your caregiver if you drink alcohol.
  
  
• Quit smoking. If you smoke, you should quit. Cigarette smoke increases your risk of a stroke. It is never too late to quit smoking. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quit smoking to improve your health and the health of those around you. Ask for help if you are having trouble quitting.
  
  
• Do not use street (illegal) drugs. Cocaine, methamphetamines (meth), and heroin increase your risk of a stroke.

How can I tell if someone is having a stroke?

Know the F.A.S.T. test to recognize the signs of a stroke:

• F = Face: Ask the person to smile. Drooping on 1 side of the mouth or face is a sign of a stroke.
  
  
• A = Arms: Ask the person to raise both arms. One arm that slowly comes back down or cannot be raised is a sign of a stroke.
  
  
• S = Speech: Ask the person to repeat a simple sentence that you say first. Speech that is slurred or strange sounding is a sign of a stroke.
  
  
• T = Time: Call an ambulance to take the person to the hospital if you see any of these signs.

When should I call my caregiver?

Call your caregiver if:

• Your blood pressure is higher or lower than your caregiver has told you it should be.
  
  
• You have skin tears, or sores on your heels, head, or buttocks from lying in bed.
  
  
• You have bowel movement problems.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You cannot make it to your next appointment.
  
  
• You have questions about your therapy, medicine, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have a seizure.
  
  
• You are bleeding from your rectum, nose, or other body area.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

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.

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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.

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