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Brain Stem Infarction

What is a brainstem infarction?

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 be damaged. Your brainstem allows you to speak, hear, and swallow. It also controls your breathing, heartbeat, blood pressure, balance, and eye movements.

What causes a BSI?

  • Ischemic stroke: Most brainstem strokes are ischemic strokes. An ischemic stroke occurs when blood is suddenly blocked and cannot flow to your brain. The block is usually caused by a blood clot that gets stuck in a narrow blood vessel.

  • Hemorrhagic stroke: A hemorrhagic stroke happens when a blood vessel in your brain bursts. This may happen if the blood vessel wall is weak, or if a blood clot gets stuck. Blood then flows out of the vessel and damages brain tissue.

What are the signs and symptoms of a BSI?

The following signs and symptoms may be a warning that you are about to have a stroke in your brainstem:

  • Dizziness, loss of balance, nausea, or vomiting

  • Slurred speech, or trouble speaking or swallowing

  • Blurred or double vision, or eye pain

  • Numbness and weakness on 1 side of your body or face

  • Drowsiness or unconsciousness

  • Jerky eye movements, or pupils that are not the same size

  • Sudden headache or hearing loss

How is a BSI diagnosed?

Your caregiver will ask about your signs and symptoms and when they began. He will ask about your medicines and if you drink alcohol or use street drugs. He will also look for signs that your brainstem was injured. You may need any of the following tests to help your caregiver learn if you have had a stroke, or if you will soon have one:

  • CT or MRI: 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 to look for blood flow blockage and bleeding.

How is a BSI 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.

  • Medicines: The type of medicine you need depends on the type of stroke you had. You may need medicine to improve your blood's ability to clot and stop the bleeding. You may instead need medicine to break up blood clots, or to prevent them from forming. You may also need this type of medicine after bleeding is controlled, to prevent a clot from forming. You may also need medicine to lower a fever, treat diabetes or high cholesterol, or prevent seizures. Medicine may be given to keep your blood pressure at a certain level if it is too high or too low.

  • Rehabilitation: Rehabilitation (rehab) is an important part of treatment. Physical therapists help strengthen your arms, legs, and hands. You may learn exercises to improve your balance and movement to decrease your risk of falling. Occupational therapists teach you new ways to do daily activities, such as getting dressed. A speech therapist helps you relearn or improve your ability to talk and swallow.

  • Ventilator: A tube is put into your airway through your nose, mouth, or an incision in your neck. The ventilator gives you oxygen through the tube.

  • Surgery: You may need to have a tube placed in your skull. The tube drains fluid and checks the pressure in your brain. Your caregiver may do surgery on your brain to stop the bleeding and remove the leaked blood. You may need a filter placed in your blood vessel to prevent complications from a blood clot in your leg (DVT).

What increases my risk of a BSI?

  • You are at least 55 years old.

  • You are a man.

  • You are African American.

  • You are a woman and use birth control pills, or you take hormone replacement medicine.

  • Your father or mother had a stroke, or you had a low birthweight.

  • You have high blood pressure, blood vessel disease, or sickle cell anemia that is not being treated.

  • You have atrial fibrillation, diabetes, or another heart condition.

What lifestyle changes can decrease my risk of a BSI?

  • Manage health conditions: High blood pressure, diabetes, and high cholesterol all increase your risk of stroke. Take your medicines as directed. Follow your caregiver's instructions to check your blood pressure and blood sugar levels. Write the numbers down to show him.



  • Eat healthy foods: What you eat can help prevent or manage high blood pressure, high cholesterol, and diabetes. Eat foods that are low in fat, cholesterol, salt, and sugar. Eat at least 5 servings of fruits and vegetables each day. Include foods that are high in potassium, such as potatoes and bananas. If you take warfarin, it works best when you eat about the same amount of vitamin K each day. Vitamin K is found mainly in leafy green vegetables. Ask your caregiver for a list of other foods that contain vitamin K.

  • Reach or stay at a healthy weight: Weight loss can decrease your blood pressure and your risk of stroke. Ask your caregiver how much you should weigh and how to lose weight safely. Ask which exercises you should do. You will need to exercise carefully after a stroke so you do not fall.

  • Limit alcohol: Men should limit alcohol to 2 drinks per day. Women should limit alcohol to 1 drink per day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.

  • Do not use street drugs or smoke cigarettes: Your risk of stroke increases if you use drugs such as cocaine, or you smoke cigarettes. Ask your caregiver for help if you are having trouble quitting.

What are the risks of a BSI?

  • 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 skin breakdown (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 a stroke. You could have another stroke, even after treatment.

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 911 if you see any of these signs. This is an emergency.

When should I contact my caregiver?

Contact your caregiver if:

  • Your blood pressure is higher or lower than you were told it should be.

  • You have skin tears, or sores on your heels, head, or buttocks from lying in bed.

  • You have bowel movement problems.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You have a seizure.

  • You are bleeding from your rectum or nose.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

  • You suddenly feel dizzy, lightheaded, and have shortness of breath.

  • You have chest pain. You may have more pain when you take a deep breath or cough. You may cough up blood.

  • You have weakness or numbness in your arm, leg, or face.

  • You are confused and have problems speaking or understanding speech.

  • You have vision loss or a severe headache.

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. 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.

© 2014 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.

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