What to know about brain stem strokes
In this article, we take a close look at brain stem strokes, including the symptoms, diagnosis, recovery, and outlook.
What is brain stem stroke?
The brain stem controls breathing, eye movement, facial movement, heart rate, and blood pressure.
According to the World Health Organization (WHO), stroke is the "second leading cause of death and the third leading cause of disability" worldwide.
A stroke occurs when the blood supply to a part of the brain is interrupted, either due to a blocked artery or a leaking blood vessel.
The brain stem is located at the base of the brain and is responsible for receiving and relaying information throughout the body.
The brain stem controls essential body functions, such as:
- eye movement
- facial movement and sensation
- heart rate
- blood pressure
Brain stem strokes can affect a person's fundamental bodily functions and may lead to long-term complications.
Types of strokes
There are two main types of strokes, both of which can affect the brain stem:
Ischemic strokes occur when blood clots form in the narrow arteries in the head or neck, cutting off the blood supply to an area of the brain.
A transient ischemic attack (TIA), also called a mini-stroke or a warning stroke occurs when the blood supply to the brain is interrupted briefly. TIAs cause milder symptoms than full ischemic strokes, and most symptoms go away within an hour.
Hemorrhagic strokes, or brain bleeds occur when a weak blood vessel leaks or breaks open, creating swelling and pressure. This pressure damages tissues and cells in the brain.
Hemorrhagic strokes are less common than other types of stroke, but they account for 40 percent of all stroke deaths.
Symptoms of a brain stem stroke
Dizziness and loss of balance are common symptoms of stroke.
Because the brain stem controls a variety of motor functions, strokes in this area of the brain cause a diverse range of symptoms.
Brain stem strokes can disrupt vital bodily functions, such as:
- heart rate
The brain stem receives various signals from the brain and sends them to different parts of the body. Brain stem strokes disrupt these signals, which is why people experience physical symptoms, including numbness or weakness in the face, arms, or legs.
Other common stroke symptoms include:
- loss of balance
- blurred or double vision
- problems with speech or swallowing
- a headache
Diagnosing a brain stem stroke
If a person experiences symptoms of a stroke, their doctor will use imaging tests, such as CT and MRI scans to determine whether the stroke is ischemic or hemorrhagic.
Doctors may also order additional procedures, such as blood tests, echocardiograms, carotid ultrasounds, and cerebral angiography.
Because the brain stem is responsible for several vital bodily functions, a stroke in this area of the brain can have devastating effects on necessary motor-skills and processes, such as eye movement, speech, and spatial reasoning.
A rare, but severe type of brain stem stroke can result in a person developing locked-in syndrome, which causes full-body paralysis—except for the muscles that control eye movement.
A brain stem stroke is a medical emergency. It requires immediate treatment to save lives and reduce the risk of lasting complications.
Treatment depends on the type, location, and severity of stroke:
Treatment for an ischemic stroke involves restoring blood flow by eliminating the clot. Methods include the following:
- Clot-busting drugs, such as tissue plasminogen activator (t-PA), which will help dissolve the clot and restore blood flow to the affected area.
- Anti-platelet drugs, such as warfarin. A doctor may recommend aspirin if a person has a high risk of a heart attack or stroke and a low risk of bleeding. Current guidelines do not recommend the regular use of aspirin for most people, as was the case in the past.
- Endovascular therapy, which is a surgical procedure that involves the use of mechanical retrievers to remove blood clots.
- Other devices, such as balloons or stents, which can be used to open up narrowed blood vessels and improve blood flow.
Treatment for hemorrhagic strokes focuses on controlling bleeding and reducing pressure in the brain. Treatment methods include:
- Administering drugs to control blood pressure and prevent seizures.
- Coil embolization, which is a surgical procedure that helps form a blood clot in the weakened vessel. The clot will reduce bleeding and stop the blood vessel from breaking open again.
Once bleeding in the brain is under control, doctors may perform surgical procedures to repair the broken blood vessel to prevent it from hemorrhaging again.
Risk factors for stroke
High blood pressure can increase the risk of stroke.
Anyone can have a stroke, but specific genetic factors, such as family history, gender, race, and age put some people at higher risk for stroke than others.
According to the American Stroke Association, women have more strokes than men and are more likely to die from a stroke than men.
Some risk factors that are unique to women include:
- use of hormone replacement therapies
- long-term use of birth control pills in combination with other risk factors, such as smoking
People of African-American and Hispanic descent are also at higher risk of stroke.
The majority of strokes occur in people over the age of 65. However, research suggests that the rate of stroke hospitalizations and the presence of stroke risk factors in younger adults has increased significantly.
Medical conditions that increase the risk of stroke include:
- high blood pressure
- high cholesterol
- arterial fibrillation (AFib)
- cardiovascular disease (CVD)
- Lifestyle risk factors
People cannot control genetic factors, but they can control lifestyle factors that increase the risk of stroke. Behaviors that increase high blood pressure or the risk of clot formation can lead to a higher risk of stroke.
Behaviors that can increase the risk of stroke include:
- smoking tobacco
- excessive alcohol use
- illegal drug use
- a sedentary lifestyle
- poor diet
An estimated 80 percent of strokes are preventable. People can reduce their risk of stroke by making the following lifestyle changes:
- monitoring lipid and cholesterol levels
- controlling blood pressure with medication and behavioral changes
- controlling medical conditions, such as diabetes
- quitting smoking
- eating low-fat, low-sodium diets
- ensuring that the diet contains plenty of fresh fruits and vegetables
- engaging in moderate intensity aerobic exercise for at least 150 minutes a week or vigorious intensity aerobic exercise for at least 75 minutes a week
Recovery and outlook
A brain stem stroke can result in severe long-term complications. Medication and behavioral changes can help reduce the risk of future strokes.
Physical therapy can improve muscle strength, coordination, and ultimately help people regain lost motor skills.
Occupational and speech and language therapy can help people improve their cognitive abilities, such as memory, problem-solving, and judgment.
Some people who have had a brain stem stroke and have severe disabilities may require psychological counseling to help them adjust.