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The brainstem is located directly above the spinal cord. It helps control involuntary functions like heartbeat, breathing, and blood pressure. Normal brainstem function is vital to survival. Nerves that are used for eye movement, hearing, talking, chewing, swallowing, and muscle movement are also controlled by the brainstem.
A brainstem stroke happens when the blood supply to the brainstem is interrupted. This type of stroke can result in death, since the damaged brainstem can no longer control the body’s vital functions.
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An ischemic stroke is caused by a blockage of the blood flow, which may be due to:
- A clot from another part of the body like the heart or neck. The clot breaks off and flows through the blood until it becomes trapped in a blood vessel supplying the brain.
- A clot that forms in an artery that supplies blood to the brain
- A tear in an artery supplying blood to the brain. This is called an arterial dissection.
A hemorrhagic stroke is caused by a burst blood vessel. Blood spills out of the broken blood vessel and pools in the brain. This interrupts the flow of blood and causes a build up of pressure on the brain.
Certain factors increase your risk of stroke, but can not be changed, such as:
- Race—People of African American, Hispanic, or Asian/Pacific Islander descent are at increased risk.
- Age: Older than 55 years of age
- Family history of stroke
Other factors that may increase your risk can be changed such as:
Certain medical condition that can increase your risk of stroke. Management or prevention of these conditions can significantly decrease your risk. Medical conditions include:
- High blood pressure
- High cholesterol levels —specifically high-LDL bad cholesterol
- Low bone mineral density, especially in women
- Obesity and metabolic syndrome
- High blood homocysteine level
- Type 2 diabetes or impaired glucose tolerance
- Atrial fibrillation
- Blood disorders such as sickle cell disease and polycythemia
- Vascular dementia
- Disease of heart valves, such as mitral stenosis
- Prior stroke or cardiovascular disease, such as heart attack
- Peripheral artery disease
- Transient ischemic attack (TIA) —a warning stroke with stroke-like symptoms that go away shortly after they appear
Conditions that increase your risk of blood clots such as:
- Certain autoimmune diseases
- Migraine with aura
- Having a blood vessel abnormality
Risk factors specific to women include:
The symptoms of a brainstem stroke can be severe and may include:
- Problems with vital functions, such as breathing
- Difficulty with chewing, swallowing, and speaking
- Weakness or paralysis in the arms, legs, and/or face
- Problems with balance or sensation
- Hearing loss
- Vision problems
- Vertigo—a feeling of spinning or whirling when you are not moving
- Locked-in syndrome, which occurs when only the eyes are able to move
If you or someone you know has any of these symptoms, call for emergency medical services right away. Brain tissue without blood flow dies quickly. Early care can decrease damage.
Since this is an emergency, the doctor will make a diagnosis as quickly as possible. An exam of your nervous system will be done.
Your bodily fluids may be tested. This can be done with blood tests.
Images may be taken of your bodily structures. This can be done with:
- CT scan
- Angiogram —to assess the heart and its blood supply
- CT angiogram
- MRI scan
- Magnetic resonance angiography (MRA)
- Doppler ultrasound
Your heart function will be examined. This can be done with tests such as electrocardiogram and echocardiogram .
Your kidney and liver function will also be tested.
Immediate treatment is needed to:
- Dissolve or remove a clot for ischemic stroke
- Stop bleeding for hemorrhagic stroke
If needed, steps may be taken to help support your heart and lungs. A tube may be placed into the windpipe to provide oxygen.
For an ischemic stroke, medication may be given to:
- Dissolve clots and prevent new ones from forming
- Thin blood
- Control blood pressure
- Treat an irregular heart rate
- Treat high cholesterol
For a hemorrhagic stroke, the doctor may give medication to:
- Work against any blood-thinning drugs you may regularly take
- Reduce how your brain reacts to bleeding
- Control blood pressure
These procedures may be done to treat an ischemic stroke:
- Embolectomy—a catheter is used to remove the clot or deliver clot-dissolving drugs
- Vertebrobasilar angioplasty and stenting —carotid artery is widened and a mesh tube is placed to keep it open
For a hemorrhagic stroke, a clip or tiny coil may be placed on the aneurysm to stop it from bleeding.
When your condition is stabilized, a feeding tube may be placed to deliver nutrients.
Brainstem strokes can lead to serious deficits. Therapy programs focus on regaining as much ability as possible:
- Physical therapy—to work on improving movement
- Occupational therapy—to assist in everyday tasks and self-care
- Speech therapy—to improve swallowing and speech challenges
- Psychological therapy—to provide support in adjusting to life after the stroke
Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:
- Exercise regularly.
- Eat more fruits, vegetables , and whole grains . Limit dietary salt and fat .
- If you smoke , talk to your doctor about ways to quit.
- Increase your consumption of fish.
- Drink alcohol only in moderation. This means 1-2 drinks per day.
- Maintain a healthy weight.
- Check your blood pressure frequently . Follow your doctor's recommendations for keeping it in a safe range.
- Take aspirin if your doctor says it is safe.
- Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
- Talk to your doctor about the use of statins. These types of drugs may help prevent certain kinds of strokes in some people.
- Seek medical care if you have symptoms of a stroke, even if symptoms stop.
- If you use drugs, talk to your doctor about rehabilitation programs.
American Heart Association
National Stroke Association
Heart and Stroke Foundation of Canada
Association of Ottawa
Association of Ottawa
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2/7/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T566761/Prevention-of-stroke: Bushnell C, McCollough LD, Awad IA, et al. Guideline for the prevention of stroke in women. Available at: http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48. Accessed November 18, 2015.
6/2/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T580145/Stroke-rehabilitation: Myint PK, Cleark AB, Kwok CS, et al. Bone mineral density and incidence of stroke: European prospective investigation into cancer-Norfolk population-based study, systemic review, and meta-analysis. Stroke. 2014;45(2):373-382.
6/2/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T361037/Risk-factors-for-stroke-or-transient-ischemic-attack: Imfeld P, Bodmer M,Schuerch M, Jick SS, Meier CR. Risk of incident stroke in patients with Alzheimer disease or vascular dementia. Neurology. 2013;81(10):910-919.
8/11/2015 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T184935/Cardiovascular-disease-and-obstructive-sleep-apnea: Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015;70(9):888-895.
- Reviewer: Rimas Lukas, MD
- Review Date: 11/2015
- Update Date: 12/20/2014