Munson Health
 
Brainstem Stroke

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by Stahl RJ

(Stroke, Brainstem)

 

Risk Factors

Certain factors increase your risk of stroke but can not be changed, such as:
  • Race—People of African American, Hispanic, or Asian/Pacific Islander descent are at increased risk.
  • Age: Older than 55 years of age
  • Family history of stroke
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:
  • Previous pre-eclampsia
  • Use of birth control pills, especially if you are over 35 years old and smoke
  • Long-term use of hormone replacement therapy
  • Menopause
  • Pregnancy—due to increased risk of blood clots
 

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.
Images may be taken of your bodily structures. This can be done with:
Your bodily fluids may be tested. This can be done with:
  • Blood tests
  • Tests to check the level of oxygen in the blood
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:
  • Dissolve or remove a clot for ischemic stroke
  • Stop bleeding for hemorrhagic stroke
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:
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:
  • Exercise regularly.
  • Eat more fruits, vegetables , and whole grains . Limit dietary salt and fat .
  • If you smoke, talk to your doctor about ways to quit.
  • Increase your consumption of fish.
  • Drink alcohol only in moderation. This means 1-2 drinks per day.
  • Maintain a healthy weight.
  • Check your blood pressure frequently . Follow your doctor's recommendations for keeping it in a safe range.
  • Take aspirin if your doctor says it is safe.
  • Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
  • Talk to your doctor about the use of statins. These types of drugs may help prevent certain kinds of strokes in some people.
  • Seek medical care if you have symptoms of a stroke, even if symptoms stop.
  • Stop abusing drugs such as cocaine. Your doctor can refer you to rehabilitatin programs.
 

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 . 2010 October 21.


Hemorrhagic stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=HEMSTROKE. Accessed November 15, 2013.


Hemorrhagic strokes (bleeds). American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds%5FUCM%5F310940%5FArticle.jsp. Updated November 7, 2013. Accessed November 15, 2013.


Intracerebral hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated
August 14, 2013. Accessed November 15, 2013.


Ischemic strokes (clots). American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots%5FUCM%5F310939%5FArticle.jsp. Updated November 7, 2013. Accessed November 15, 2013.


Jensen M, St. Louis E. Management of acute cerebellar stroke. Archives of Neurology website. Available at: http://archneur.ama-assn.org/cgi/reprint/62/4/537.pdf. Published April 2005. Accessed November 15, 2013.


Long term management of stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated October 28, 2013. Accessed November 15, 2013.


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 15, 2013.


Nueroimaging for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 15, 2013. Accessed November 15, 2013.


Stroke (acute management). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated October 24, 2013. Accessed November 15, 2013.


Subarachnoid hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated October 14, 2013. Accessed November 15, 2013.


What is stroke? National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SYMP. Accessed November 15, 2013.


2/7/2014 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Bushnell C, et al. AHA/ASA Guideline for the Prevention of Stroke in Women. Stroke. 2014 Feb 6. [Epub ahead of print]


6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Myint PK, Cleark AB, 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 Feb;45(2):373-82.


6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Imfeld P, Bodmer M, et al. Risk of incident stroke in patients with Alzheimer disease or vascular dementia. Neurology. 2013 Sep 3;81(10):910-919.

 

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