Hardened arteries are often the cause of a brainstem infarction. If a brainstem infarction occurs, it is important to act quickly.

What is a brainstem infarction?

A brainstem infarction is a special form of stroke and therefore a disease of the brain. If a brainstem infarction affects, among other things, centers of the brainstem that are responsible for a person’s level of consciousness or breathing control, for example, a brainstem infarction can be life-threatening.

A brainstem infarction can take various forms, each of which is often accompanied by specific symptoms: According to medical information, the so-called locked-in syndrome is the most severe form that a brainstem infarction can take. An affected patient is almost completely paralyzed and can only perform vertical eye movements; Nevertheless, after a brainstem infarction of this type, the person affected is usually fully conscious and able to absorb complex connections.

If a brainstem infarction occurs in the form of a so-called Wallenberg syndrome, the spinal cord is insufficiently supplied with blood; As a result, such a brainstem infarction can lead to sensory and swallowing disorders and/or movement disorders.

Causes

The main cause of a brainstem infarction is what is known as arteriosclerosis, i.e. hardening of the arteries. Arteries that run in the area of ​​the brainstem and can therefore also play an important role in brainstem infarction are two vertebral arteries. These vertebral arteries ensure adequate blood supply to the brainstem.

If one or both vertebral arteries are hardened, the blood supply is restricted and a brainstem infarction can occur. If the vertebral arteries become occluded, this is referred to in medicine as basilar thrombosis. Such basilar thrombosis can lead to a severe brainstem infarction or locked-in syndrome, the most severe form of brainstem infarction.

Symptoms, Ailments & Signs

Brainstem infarction is a particularly severe form of stroke and affects vital functions such as breathing, swallowing and consciousness. Therefore, a heart attack in the area of ​​the brainstem can be fatal. The brainstem infarction is announced with dizziness, nausea, vomiting and often also with visual disturbances. Sometimes there is also a loss of consciousness, but only if blood clots in a vertebral artery. The sudden onset of symptoms is typical.

Sometimes these are triggered by just simple head movements. Symptoms include intense vertigo accompanied by vomiting. In addition, paralysis and hoarseness can also occur. Loss of consciousness occurs, but is rare. Uncoordinated and uncontrolled movements, also known as ataxia, may be possible.

Unilateral paralysis of the arms and legs is common. The paralysis always occurs on the opposite side of the damaged brain area. Other symptoms often include visual disturbances. This can lead to what is known as oscillopsia. The patient perceives blurred images with every body movement. These disappear again when you close your eyes.

The eyes can also move uncontrollably and rhythmically (nystagmus). Furthermore, the affected person often sees double vision. After all, it is not uncommon for visual field defects to occur due to damage to the visual cortex in the brain. Since the optic nerve and the eye are not affected in these cases, these failures can be trained away.

Diagnosis & History

If there is a suspicion of a brainstem infarction in a patient, a diagnostic clarification is usually carried out using a computed tomography ( CT ) of the skull (also referred to as cranial computed tomography).

Less commonly, magnetic resonance imaging ( MRI ) is used to diagnose a brainstem infarction; in the event of a possible brainstem infarction, a visual representation of the cranial tissue is possible. If the exact location of a vascular occlusion in the skull is to be localized in the event of a brainstem infarction, this can be done with the help of MR angiography (a method for imaging vessels).

The course of the disease depends, among other things, on the severity of the infarction and on rehabilitation measures; After a minor brainstem infarction (such as Wallenberg syndrome), those affected are often able to live independently again. A severe brainstem infarction can often lead to long-term disabilities; after a brainstem infarction in the form of a locked-in syndrome, for example, the restricted movement sequences are often permanent.

Complications

In the worst case, the brainstem infarction can lead to the death of the person concerned. For this reason, rapid and immediate treatment is always necessary. This leads to paralysis in various regions of the body. This causes extreme movement restrictions and the affected person often loses consciousness.

In addition to the paralysis, there are also sensory disorders throughout the body. Shortness of breath, which can lead to sweating or panic attacks, is not uncommon. The affected person can no longer speak and think clearly and there is adeptness and coordination disorders. The patient’s everyday life is extremely restricted by the brainstem infarction.

Without treatment, the brain can become permanently damaged, making these symptoms irreversible. The diagnosis of a brainstem infarction is usually relatively easy and quick. This means that treatment can be initiated at an early stage, with no further complications usually occurring.

However, the success of the treatment depends heavily on the severity and duration of the infarction, so that the affected person may suffer from symptoms or paralysis even after the treatment. However, these problems can be solved with various exercises.

When should you go to the doctor?

People who suffer from severe tiredness and tire unusually quickly despite a restful night’s sleep should have a check-up. An incomprehensible increased need for sleep despite good sleep hygiene is often a warning sign from the organism that should be followed up. In the case of disturbances and limitations in consciousness, interruptions in speech or speech failure, a doctor’s visit is necessary.

If there are difficulties in swallowing, refusal to eat or an undersupply of the body, a doctor should carry out further examinations and initiate treatment. In the case of paralysis, there is an urgent need for action. The victim should be taken to a hospital immediately. If the person concerned suffers from breathing difficulties, a lack of air supply or shortness of breath, a doctor must be consulted as soon as possible. In the event of a respiratory arrest, an ambulance must be called as this is a life-threatening condition for the person concerned.

Until the arrival of the rescue service, first aid measures must be taken to ensure the survival of the person concerned. A loss of performance level, attention problems or disturbances in memory performance must be examined by a doctor. A doctor’s visit is necessary as soon as inner weakness, general malaise or a diffuse feeling of illness appear. Circulatory disorders, headaches or a feeling of pressure inside the head should be medically clarified.

Treatment & Therapy

In order to be able to successfully treat a brainstem infarction, it is important to start treatment as quickly as possible. The treatment methods that are then used for a brainstem infarction depend on the form that a brainstem infarction shows and also on the physical constitution of a patient.

If a brainstem infarction in a patient is caused by acute occlusions in the vertebral arteries, a treatment method used is often a so-called local lysis; as part of such a local lysis, existing blood clots in the vertebral artery are dissolved with the help of medication. Alternatively, the clots can be surgically removed.

If a brainstem infarction causes symptoms such as swallowing disorders or respiratory impairments, it may be necessary to intervene promptly with the help of a gastric tube or long-term ventilation. Irrespective of the treatment method, experts usually advise that therapy be carried out in specialized medical centers after a brainstem infarction has been suffered.

After a brainstem infarction has been treated acutely, consistent physiotherapeutic (physiotherapeutic) exercises can bring about a gradual improvement in movement restrictions – especially after a mild brainstem infarction.

Outlook & Forecast

The prognosis for a brainstem infarction depends to a large extent on the time of emergency medical first aid, the general start of treatment, provided there was no acute situation, and the extent of the damaged tissue in the brain. The faster comprehensive medical care can be provided, the better the chances of recovery.

If medical treatment takes place late or not at all, the disease can become fatal. The calcification of the arteries causes the blood vessels in the brain to burst, which, if left untreated, will inevitably lead to the premature death of the affected person. Most brainstem infarction patients have lifelong impairments of various functions. In addition to paralysis or other limitations in mobility, speech disorders, digestive disorders or other interruptions in the functionality of the organism can occur.

Optimum therapy and rehabilitation of the patient often results in improvements in general health after the heart attack. However, complete recovery or freedom from symptoms rarely occurs. The majority of those affected experience a change in lifestyle and everyday processes, as there are severe health problems and a loss of general performance. This often triggers consequences, since an unusually high level of psychological stress is required. Patients with a brainstem infarction often suffer from depression, anxiety disorders or permanent impairment of memory performance.

Prevention

A brainstem infarction can be prevented to a certain extent by preventing or combating arteriosclerosis (the main cause of brainstem infarction): arteriosclerosis is promoted, among other things, by obesity and high blood pressure; a conscious diet and a healthy lifestyle can prevent a brainstem infarction in many cases. Regular check-ups can also prevent a brainstem infarction in high-risk patients.

Aftercare

Follow-up care is mainly via rehabilitation measures, which must be started as early as possible to give the patient the best possible chance of improvement. The Federal Working Group for Rehabilitation (BAR) has divided these measures into six phases.

While phase A includes acute treatment and thus the actual therapy, phase B consists of rehabilitation, which begins while patients may still be mechanically ventilated. Phase C takes place as part of a rehabilitation measure and helps those affected to become more independent in everyday life.

As soon as they have achieved this, phase D can begin, in which existing functional and cognitive defects are counteracted in a targeted manner. Phases E and F describe additional aftercare treatments and any support services that may be required.

Stroke rehabilitation has evolved tremendously in recent years. Treatment successes are monitored by imaging measures. A new approach is to restrict the movement of healthy limbs so that the patient is forced to use the affected body parts to get to the goal.

Mirror therapy is also becoming more and more popular. A mirror is positioned so that it shows the healthy limbs. Each movement signals the brain movement of the affected limb and actually leads to a recovery in motor function.

You can do that yourself

Opportunities for self-help exist for those affected only in cases where it was a matter of a mild brainstem infarction. The self-help measures consist primarily of the person concerned doing the exercises to improve movement, speaking and swallowing at home after extensive therapy under medical supervision and after gaining a certain degree of independence. The help of third parties may be necessary. In addition, an artery-friendly lifestyle is appropriate to counteract the further course of any underlying arteriosclerosis.

In severe cases (especially those associated with the locked-in syndrome), no self-help measures are possible for the person concerned. It is only possible to work on improving the quality of life on the part of the personal and medical environment. This includes facilitating communication and simply being with friends and loved ones. It is important at this point that a brainstem infarction does not have to mean a cognitive impairment of the affected person. A paternalistic treatment is therefore not appropriate in relation to conversations and general communication, at least verbally, and in the worst case leads to the person concerned feeling devalued.

Nevertheless, comprehensive care for people with motor impairments is often necessary, whereby those around them should ensure that independence is promoted and maintained even in very small steps.