Calcified arteries often underlie a brainstem infarction. If a brainstem infarction occurs, rapid action is important at first.
What is a brainstem infarction?
Smoking, an unhealthy diet and little exercise greatly favor a brain stem infarction. Brain stem infarction is a special form of stroke and therefore a disease of the brain. If a brainstem infarct affects, among other things, centers of the brainstem that are responsible, for example, for a person’s level of consciousness or breath control, a brainstem infarct can be life-threatening. A brainstem infarction can take various forms, each of which is often accompanied by specific symptoms: According to medical data, 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 form, the affected person is usually fully conscious and capable of absorbing complex relationships. If a brainstem infarction occurs in the form of a so-called Wallenberg syndrome, the spinal cord is insufficiently supplied with blood; as a consequence, such a brainstem infarction may cause, for example, sensory and swallowing disturbances and/or movement disorders.
Causes
The main cause of brainstem infarction is so-called arteriosclerosis, or hardening of the arteries. Arteries that run in the area of the brainstem and thus may also play an important role in brainstem infarction are two vertebral arteries. These vertebral arteries ensure an adequate blood supply to the brain stem. If arteriosclerosis is present in one or both of the vertebral arteries, the blood supply is restricted and a brainstem infarction can occur. If occlusions of the vertebral arteries are present, this is referred to in medicine as basilar artery thrombosis. Such basilar thrombosis can lead to severe brainstem infarction or locked-in syndrome, the most severe form of brainstem infarction.
Symptoms, complaints, and signs
Brainstem infarction is a particularly severe form of stroke and affects vital functions such as breathing, swallowing, and consciousness. Therefore, brainstem infarction can be fatal. Brainstem infarction announces itself with dizziness, nausea, vomiting, and often visual disturbances. Sometimes there are also disturbances of consciousness, but this only occurs when blood clots in a vertebral artery. The sudden onset of symptoms is typical. Sometimes these are triggered only by simple head movements. Symptoms include intense spinning vertigo accompanied by vomiting. In addition, there may also be paralysis of swallowing and hoarseness. Disturbances of consciousness occur, but are rare. Uncoordinated and uncontrolled movements may be possible, also known as ataxias. Unilateral paralysis of the arms and legs is common. In this case, the paralyses always occur on the opposite side of the damaged brain area. Other symptoms often include visual disturbances. So-called oscillopsia may occur. In this case, the patient perceives blurred images with every body movement. These disappear again after closing the eyes. The eyes may also move uncontrollably and rhythmically (nystagmus). Furthermore, the affected person often sees double images. Finally, it is not uncommon for visual field loss 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 deficits can be trained away.
Diagnosis and course
If a patient is suspected of having a brainstem infarction, diagnostic workup is usually performed with the aid of computed tomography (CT) of the skull (also referred to as cranial computed tomography). Less commonly, magnetic resonance imaging (MRI) is also used to detect a brainstem infarction; this allows imaging of the skull tissue in the event of a possible brainstem infarction. If the exact location of a vessel occlusion in the skull is to be localized in the case of a brainstem infarction, this can be done with the aid of MR angiography (a procedure for imaging vessels).The course of the disease depends, among other things, on the severity of the infarction and on rehabilitation measures; after a mild brainstem infarction (such as Wallenberg syndrome), it is often possible for those affected to live independently again. A severe brainstem infarction can often lead to long-term limitations; after a brainstem infarction in the form of locked-in syndrome, for example, the restricted movements are often permanent.
Complications
Brainstem infarction can cause the death of the affected person in the worst case. For this reason, rapid and prompt treatment is always necessary. Paralysis occurs in various regions of the body. This results in extreme restrictions of movement and the affected person often loses consciousness. In addition to the paralyses, sensory disturbances also occur over the entire body. It is not uncommon for shortness of breath to occur, which can lead to sweating or panic attacks. The affected person is no longer able to speak and think clearly, and there is a loss of composure and coordination. The patient’s daily life is extremely limited by the brainstem infarction. Without treatment, the brain may be permanently damaged, making these symptoms irreversible. Diagnosis of brainstem infarction is usually relatively simple and quick. This also allows early treatment to be initiated, with usually no further complications. However, the success of the treatment depends greatly on the severity and duration of the infarction, so that the affected person may still suffer from discomfort or paralysis after treatment. However, these discomforts can be resolved through various exercises.
When should you see a doctor?
People who suffer from severe fatigue and tire unusually quickly despite a restful night’s sleep should seek a checkup. An untraceable increased need for sleep despite good sleep hygiene is often a warning sign from the organism that should be investigated. In case of disturbances and restrictions of consciousness, interruptions of speech or lapses of speech, a visit to the doctor is necessary. If there are difficulties in swallowing, refusal of food intake or insufficiency of the body, a doctor should perform further examinations and initiate treatment. In the case of paralysis of swallowing, urgent action is required. The affected person should be taken to a hospital immediately. If the affected person suffers from respiratory discomfort, a lack of air supply or shortness of breath, a doctor should be consulted as soon as possible. In the event of respiratory arrest, an emergency physician must be called, as this is a life-threatening condition for the affected person. First aid measures must be taken until the arrival of the rescue service to ensure the survival of the affected person. A loss of performance level, attention problems or disturbances in memory performance must be examined by a doctor. A visit to the doctor is necessary as soon as internal weakness, general malaise or a diffuse feeling of illness occur. Disturbances of blood circulation, headaches or a feeling of pressure inside the head should be medically clarified.
Treatment and therapy
To be able to treat a brainstem infarction with treatment success, an important point is first to start treatment as soon as possible. The treatment methods that are then used for a brainstem infarction depend on the form that a brainstem infarction takes and also on a patient’s physical constitution. If a patient’s brainstem infarction is caused by acute occlusion of the vertebral arteries, one method of treatment is often so-called local lysis; in the course of such local lysis, the blood clots in the vertebral artery are dissolved with the aid of medication. Alternatively, the clots may be surgically removed. If a brainstem infarction results in symptoms such as dysphagia or impaired breathing, it may be necessary to intervene promptly with the aid of a stomach tube or long-term ventilation. Regardless of the treatment method, experts usually advise that therapy after a brainstem infarction be carried out in specialized medical centers.After a brainstem infarction has been treated acutely, consistent physiotherapeutic (physiotherapy) exercises can bring about a gradual improvement in movement restrictions that have occurred – especially after a mild brainstem infarction.
Outlook and prognosis
The prognosis for brainstem infarction depends largely on the timing of initial emergency medical care, the general initiation of treatment if no acute situation has occurred, and the extent of damaged tissue in the brain. The faster comprehensive medical care can be provided, the better the prospects for recovery. If medical treatment takes place late or not at all, a fatal course of the disease occurs. Calcification of the arteries causes the blood vessels in the brain to burst, which, if left untreated, inevitably leads to the premature death of the affected person. Most patients of a brainstem infarction experience lifelong impairments of various functions. In addition to paralysis or other restrictions of mobility, there may be speech disorders, digestive disorders or other interruptions of the organism’s ability to function. Often, improvements in the patient’s general health after the infarction are achieved in an optimal therapy and rehabilitation of the patient. However, complete recovery or freedom from symptoms rarely occurs. The majority of those affected experience a change in lifestyle and daily routines, as there are severe health impairments as well as a loss of general performance. This often triggers secondary symptoms, as an unusually high psychological burden is demanded. Sufferers of a brainstem infarction often suffer depression, anxiety disorders or permanent limitations in memory performance in the further course.
Prevention
Conditional prevention of brainstem infarction can be achieved primarily by preventing or combating arteriosclerosis (the main cause of brainstem infarction): Arteriosclerosis is favored by obesity and high blood pressure, among other things; thus, a conscious diet and a healthy lifestyle can prevent a brainstem infarction in many cases. Regular checkups can also prevent brainstem infarction in high-risk patients.
Follow-up care
Aftercare is mainly provided through rehabilitation measures, which must be started as early as possible to give patients the best possible chance of improvement. The German Federal Association for Rehabilitation (BAR) has divided these measures into six phases. While phase A comprises acute treatment and thus the actual therapy, phase B already consists of rehabilitation, which begins while patients may still be receiving mechanical ventilation. Phase C takes place in the context of a rehabilitation measure and helps the affected person to achieve more independence in everyday life. As soon as they have achieved this, phase D can begin, in which targeted work is done to counteract existing functional and cognitive defects. Phases E and F describe additional follow-up treatments and support services that may be required. In recent years, stroke rehabilitation has evolved tremendously. Treatment outcomes are monitored by imaging. A new approach is to restrict the movement of healthy limbs so that the patient is forced to use the parts of the body that are actually impaired in order to reach the goal. Mirror therapy is also becoming more and more common. Here, a mirror is positioned to show the healthy limbs. Each movement signals the brain to move the impaired limbs and actually leads to recovery of motor functions.
Here’s what you can do yourself
Self-help options are available to the affected person himself only in cases where the cerebrovascular accident was mild. Thus, self-help measures mainly consist of the affected person performing exercises to improve movement, speech, and swallowing at home after extensive therapy under medical supervision, once he or she has gained a certain degree of independence. Third party assistance may become necessary. In addition, an artery-sparing lifestyle is appropriate to counteract the further progression of any underlying atherosclerosis.In severe cases (especially those associated with locked-in syndrome), no self-help measures are possible for the affected person himself. Thus, only on the part of the personal and medical environment can work to improve the quality of life. This includes enabling communication and simply being there for friends and relatives. It is important to note at this point that a brainstem infarction by no means has to mean a cognitive impairment of the affected person. Thus, paternalistic treatment is not appropriate with regard to conversations and general communication, at least verbally, and in the worst case leads to the affected person feeling devalued. Nevertheless, comprehensive care of motor-impaired people is often necessary, and their environment should take care to promote and maintain independence even in very small steps.
