Symptoms of Brain Stem Stroke: Causes, Risk Factors, and Treatment

Brain Stem Stroke: What You Need to Know

The brainstem sitting right above the spinal cord is responsible for many vital functions of the central nervous system. When the flow of blood supply to the base of the brain gets disrupted, a brain stem stroke occurs. This happens due to either the clot in the blood vessels or the blood rupturing from any weakened blood vessel. The former is known as an ischemic attack while the latter is a haemorrhagic stroke.

Symptoms of Brain Stem Stroke 

The brain stem stroke symptoms depend on the type of the stroke and its severity. There are three parts of the brain stem which are the midbrain, pons, and medulla. These parts are responsible for carrying the blood in the left and right sides of the brain. 

1. Midbrain Stroke Symptoms

Midbrain stroke symptoms can cause a wide range of difficulties that include: 

• Weakness or loss of sensation may develop on one side of the body, which is the opposite side of the damaged brain stem. 
• As the brainstem controls the eye movement, it can disrupt normal movement, leading to double vision and uneven pupils. 
• Dizziness is a common symptom with the brainstem stroke.
• The numbness in the facial muscle can lead to one side of the mouth sagging which further leads to difficulties in swallowing or slurring speeches. 

2. Pontine Stroke Symptoms 

Pontine stroke or brain stem stroke happens in the largest part of the brain, known as pons. Pontine stroke symptoms are slightly different from normal stroke symptoms because it controls the body's movement and other essential functions of the body. Here are the pons stroke symptoms that the affected person goes through: 

• Issues with blinking 
• Uncontrolled eye movements 
• Paralysis in both arms and legs  
• Loss of consciousness
• Hearing loss
• Difficulties in moving both eyes together

One of the major conditions that occurs due to the pontine stroke symptoms is locked-in syndrome. This happens when the signal between the pons and spinal cord is disrupted. The brain fails to interpret the information which fails muscle movement. 

Due to such stroke syndromes, the person becomes quadriplegic, which means they have no control left in their legs, torso, and arms. 

Brain Stem Stroke Causes

Brain stem stroke occurs due to the complete cut-off of the blood supply to part of the brain stem. Now, the causes of ischemic and haemorrhagic stroke are entirely different. 

1. Causes of Ischemic Stroke

Here are the details of the conditions for which ischemic stroke happens in the brain stem: 

• Atherosclerosis: This condition is where plaques are built up on the walls of arteries. This causes blockages in arteries. 
• Artery dissection: A common cause of strokes in younger individuals occurs when the inner lining of the arteries is torn, leading to blood accumulation. Further, this blood clot leads to an ischemic attack. Artery dissection is also responsible for brain aneurysms, which makes the arteries weakened, and this could further increase the scope of haemorrhagic strokes. 
• Small vessel disease: This is an all-encompassing term responsible for many changes in the brain arteries and vessels. The continued damage to blood vessels increases the chances of stroke in brain stem. The most common reason for this small vessel disease is uncontrolled blood pressure. 

2. Causes of Haemorrhagic Stroke 

A haemorrhagic stroke happens when the blood ruptures out from the vessels and creates pressure in and around the brain tissues. The initial phase of this stroke can cause swelling and inflammation within the brain walls creating more pressure. The severity of the haemorrhagic stroke depends on the bleeding. If this continues and swells further, it can lead to severe complications. 

Risk Factors of Brain Stem Stroke

Mostly, the common risk factor of brain stem stroke is high blood pressure. Nearly three-quarters of the people having this stroke are found to have uncontrolled blood pressure for a longer period. 

High blood pressure does not show many symptoms unless it reaches a severe level. Hence, it is known as the silent killer, affecting many individuals. In addition to these, high cholesterol, diabetes, and heart disease are also the risk factors that can cause brainstem stroke. 

Other risk factors for brainstem stroke syndromes include: 

• Atrial fibrillation denotes an abnormal heart rhythm. 
• The blood vessels become swollen or inflamed, which further affects the immune system.
• Ageing could be the reason for such a stroke. 
• Certain inherited conditions weaken the blood vessels. 
• Brain infection is another reason for such strokes and many others. 

Diagnosis of Brain Stem Stroke 

A person exhibiting stroke syndromes should be taken to the hospital for immediate diagnosis. Doctors suggest brain scans to confirm the type of strokes. What this scan helps identify:

1. The severity of the stroke 
2. The type of stroke whether it is ischemic or hemorrhagic 
3. How much brain damage has occurred 
4. Any brain abnormalities 

To better understand the brainstem stroke symptoms, doctors suggest the following scans for the individuals:

CT Scan 

CT scan is suggested right after the doctors suspect any symptoms of the stroke. This is the first test and easier than the MRI because it uses X-ray technology to check the different regions of the brain. 

MRI Scan

Magnetic resonance imaging is suggested to get a detailed image of the brain interiors. This scan provides a clear picture of the brain cells to understand how many injuries have occurred.

Angiography and Contrast Dye 

In the initial phase, brain stem stroke symptoms are very mild. So, the blockage in the brain stem is hard to detect through a CT scan.

For that, doctors may put a small amount of dye in the blood and perform the scan. This dye is inserted through an intravenous drip in the arm in the vein on the back of the hand or in another blood vessel through a catheter. 

Treatment and Management

The treatment for brainstem stroke involves a series of methods. Check out below what are the treatments for brain stem stroke applied mostly. 

Thrombolysis 

If the brain stem stroke is caused by a blood clot, this process is applied through medication. It helps in breaking the clot and this process needs to take place immediately as soon as one spots the symptoms.

Haemorrhagic Stroke Treatment

In case of haemorrhages, doctors try to stop the bleeding so that the pressure of the brain is reduced. This includes different treatment patterns like surgery and medications.

Breathing Assistance 

Once this brain stem stroke occurs, an affected person may need help with breathing. Doctors may suggest inserting a windpipe so that the person gets the air in the lungs.

Brain Stem Stroke After Care Treatment

The person affected by brain stem stroke could face restrictions on their physical abilities. It could range from a total numbness of the face to a complete paralysis of the body. Hence, most of these survivors need proper care and the aid of a physical therapist to manage these severe complications.

Often, physical therapists are allocated for these types of patients who help them in dealing with the different challenges related to physical movement, eye movement, wheelchair balancing etc.

Occupational therapists help these survivors with their daily activities like eating, dressing up, and washing the body etc. Similarly, to recover from other challenges like speech problems and emotional difficulties, language therapists and counsellors assist them to get rid of the problems. 

Preventive Measures

10% to 15% of strokes in brain stem are ischemic attacks. The prevention of this stroke is possible if certain healthy lifestyles are maintained. One needs to make some changes in their lifestyle choices to alter such fatal conditions:

• If someone has blood pressure or diabetes, they should consult with their doctors often and manage these conditions. 
• Exercises are proven ways to lower the blood pressure. It is effective if one adds exercise to one's daily routine to maintain a healthy lifestyle. 
• There is no alternative to a healthy diet. People affected by high blood sugar and pressure should follow a healthy diet and say no to junk and other beverages. 
• While putting restrictions on unhealthy lifestyle choices, one needs to control their alcohol intake, stop smoking, and maintain a healthy weight to reduce the chances of such severe strokes. 

Final Words

Brain stem strokes are serious conditions affecting vital functions like movement and breathing. They occur due to blood clots or ruptured vessels, leading to ischemic or haemorrhagic strokes. 

Early diagnosis through CT or MRI scans, followed by immediate treatment, is crucial in preventing lasting damage. Post-stroke care and rehabilitation help manage symptoms like paralysis and speech difficulties. So, if you experience any signs and symptoms of a stroke or have risk factors like high blood pressure, you should consult a doctor immediately.