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Brainstem Stroke

(Stroke, Brainstem)

Definition

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.
Brainstem
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There are 2 main types of stroke: ischemic and hemorrhagic. An ischemic stroke is the most common type of stroke.

Causes

An ischemic stroke is caused by a blockage of the blood flow, which may be due to:
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.

Risk Factors

Certain factors increase your risk of stroke, but can not be changed, such as:
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:
Risk factors specific to women include:

Symptoms

The symptoms of a brainstem stroke can be severe and may include:
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.

Diagnosis

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:
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.

Treatment

Immediate treatment is needed to:
If needed, steps may be taken to help support your heart and lungs. A tube may be placed into the windpipe to provide oxygen.

Medications

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

Surgery

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.

Rehabilitation

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

Prevention

Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:

RESOURCES

American Heart Association http://www.heart.org

National Stroke Association http://www.stroke.org

CANADIAN RESOURCES

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

Stroke Survivors Association of Ottawa http://www.strokesurvivors.ca

References

Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227-276.

Hemorrhagic stroke. National Stroke Association website. Available at: http://www.stroke.org/understand-stroke/what-stroke/hemorrhagic-stroke. Accessed November 18, 2014.

Hemorrhagic strokes (bleeds). American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds%5FUCM%5F310940%5FArticle.jsp. Updated September 16, 2014. Accessed November 18, 2014.

Intracerebral hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 6, 2014. Accessed November 18, 2014.

Ischemic strokes (clots). American Stroke Association website. Available at:American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots%5FUCM%5F310939%5FArticle.jsp#.Vk3ipE2FPIU. Updated August 29, 2014. Accessed November 18, 2014.

Jensen M, St. Louis E. Management of acute cerebellar stroke. Arch Neurol. 2005;62(4):537-544.

Long-term management of stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 30, 2014. Accessed November 18, 2014.

Mena F, Fruns M, Contreras A, Soto F, Mena I. Acute brainstem infarct: multidisciplinary management. Alasbimn Journal website. Available at: http://www.alasbimnjournal.cl/revistas/5/mena5.htm. Published October 1999. Accessed November 18, 2014.

Neuroimaging for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 26, 2015. Accessed November 18, 2015.

Recognizing stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SYMP. Accessed November 18, 2014.

Stroke (acute management). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 17, 2014. Accessed November 18, 2014.

Subarachnoid hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 28, 2014. Accessed November 18, 2014.

2/7/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Randel A. AHA/ASA guideline for the prevention of stroke in women. Am Fam Physician. 2015;91(5):330-331.

6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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.ebscohost.com/dynamed: 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.

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