Brainstem infarction

Often one lies Brainstem infarction underlying calcified arteries. If a brainstem infarction occurs, it is important to act quickly.

What is a brainstem infarction?

At the Brainstem infarction it is a special form of stroke and therefore a disease of the brain. If a brainstem infarction affects 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: the so-called locked-in syndrome is the most severe form a brainstem infarction can take, according to medical information. 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 understand 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 result, such a brainstem infarction can lead to sensory and swallowing disorders and / or movement disorders.

causes

The main cause of one Brainstem infarction is the so-called arteriosclerosis, i.e. hardening of the arteries. Arteries, which run in the area of ​​the brain stem and can therefore also play an important role in brain stem infarction, are two vertebral arteries. These vertebral arteries ensure an adequate supply of blood to the brain stem.

If there is now hardening of the arteries in one or both vertebral arteries, the blood supply is restricted and a brainstem infarction can occur. If there are occlusions of the vertebral arteries, this is referred to in medicine as a basilar thrombosis. Such a basilar thrombosis can lead to a severe brainstem infarction or to 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 awareness. Therefore, a heart attack in the brain stem area can be fatal. The brainstem infarction announces itself with dizziness, nausea, vomiting and often with visual disturbances. Sometimes impaired consciousness also occurs, but only when blood clots in a vertebral artery. The sudden appearance of the symptoms is typical.

Sometimes these are only triggered by simple head movements. Symptoms include intense vertigo, accompanied by vomiting. In addition, swallowing paralysis and hoarseness can occur. Disturbances in consciousness do occur but are rare. Uncoordinated and uncontrolled movements, also known as ataxias, are 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 a so-called oscillopsia. The patient perceives blurred images with every body movement. These disappear again after closing the eyes.

The eyes can also move uncontrollably and rhythmically (nystagmus). Furthermore, the person concerned 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 & course

If a patient is suspected of having one Brainstem infarction, a diagnostic work-up is usually carried out using computed tomography (CT) of the skull (also known as cranial computed tomography).

Magnetic resonance imaging (MRI) is also less commonly used to detect brainstem infarction; in the event of a possible brainstem infarction, a graphic representation of the skull tissue is possible. If the exact location of a vascular occlusion in the skull is to be localized in a brainstem infarction, this can be done with the help of MR angiography (method for vascular imaging).

The course of the disease depends, among other things, on the severity of the infarct and on rehabilitation measures; After a minor brainstem infarction (such as Wallenberg syndrome), those affected are often able to lead an independent life again. 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 death. For this reason, prompt and prompt treatment is always necessary. This leads to paralysis in different regions of the body. This results in extreme movement restrictions and the person affected often loses consciousness.

In addition to paralysis, there are also sensory disorders all over the body. Not infrequently there is a shortness of breath, which can lead to sweating or panic attacks. The affected person can no longer speak and think clearly and this leads to adeptness and coordination disorders. The everyday life of the patient is extremely limited by the brainstem infarction.

Without treatment, the brain can be permanently damaged so that these complaints cannot be reversed. The diagnosis of brainstem infarction is usually relatively easy and quick. This means that early treatment can be initiated, with which no further complications usually occur.

The success of the treatment, however, depends heavily on the severity and duration of the infarction, so that the person affected may suffer from symptoms or paralysis even after the treatment. However, these complaints can be resolved through various exercises.

When should you go to the doctor?

People who suffer from severe fatigue 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 from the organism that should be followed up. A doctor's visit is necessary in the event of disturbances and limitations of consciousness, interruptions in speech or failure of speech.

If swallowing problems occur, if food is refused or if the body is insufficiently supplied, a doctor should carry out further examinations and initiate treatment. In the case of swallowing paralysis, there is an urgent need for action. The victim should be taken to hospital immediately. If the person concerned suffers from breathing difficulties, insufficient air supply or shortness of breath, a doctor should be consulted as soon as possible. If breathing stops, an emergency doctor must be called, as this is a life-threatening condition for the person concerned.

Until the rescue service arrives, first aid measures must be taken to ensure the survival of the person concerned. Loss of performance level, attention problems or memory disorders must be examined by a doctor. A doctor's visit is necessary as soon as an internal weakness, a general malaise or a diffuse feeling of illness occur. Blood circulation disorders, headaches or a feeling of pressure inside the head should be clarified medically.

Doctors & therapists in your area

Treatment & Therapy

To one Brainstem infarction To be able to treat with a successful treatment, an important point is to start treatment as soon as possible. The treatment methods that are then used in the event of a brainstem infarction depend on the form of the brainstem infarction and also on the physical constitution of a patient.

If a patient has a brainstem infarction caused by acute occlusions of the vertebral arteries, one treatment method used is often what is known as local lysis; In the course of such a local lysis, existing blood clots of the vertebral artery are dissolved with the help of medication. Alternatively, the clot can be surgically removed.

If a brainstem infarction causes symptoms such as swallowing disorders or impaired breathing, it may be necessary to intervene promptly with the help of a gastric tube or long-term ventilation. Regardless of the treatment method, experts usually recommend that therapy be carried out in specialized medical centers after suffering a brainstem infarction.

After a brainstem infarction has been acutely treated, consistent physiotherapeutic (physiotherapy) exercises can bring about a step-by-step improvement in movement restrictions, especially after a slight brainstem infarction.

Outlook & forecast

The prognosis for a brainstem infarction depends largely on the time of emergency medical first aid, the general start of treatment, if 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 no medical treatment at all, the course of the disease will be fatal. The calcification of the arteries causes the blood vessels in the brain to burst, which, if left untreated, inevitably leads to the affected person's premature death. Most brainstem infarction patients have lifelong impairments in various functions. In addition to paralysis or other restrictions on mobility, speech disorders, digestive disorders or other interruptions in the functioning of the organism can occur.

Improvements in general health after the infarction are often achieved in optimal therapy and rehabilitation of the patient. However, full recovery or freedom from symptoms rarely occurs. The majority of those affected experience a change in lifestyle and everyday processes, as there is severe damage to health and a loss of general performance. This often triggers sequelae, as an unusually high psychological stress is required. Those suffering from a brainstem infarction often suffer from depression, anxiety disorders or permanent memory impairment.

prevention

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

Aftercare

Follow-up care takes place mainly through rehabilitation measures, which have to be started as early as possible in order to give the patient the best possible chance of improvement. The Federal Association for Rehabilitation (BAR) has divided these measures into six phases.

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

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

Stroke rehabilitation has developed enormously in recent years. The success of treatment is monitored by imaging measures. A new approach is to restrict healthy limbs in their movement, so that the patient is forced to use the actually impaired body parts to get to the goal.

Mirror therapy is also becoming more and more popular. Here a mirror is positioned so that it shows the healthy limbs. Any movement signals the brain to move the affected limbs and actually leads to a recovery in motor functions.

You can do that yourself

There are only opportunities for the person concerned to help themselves in cases of a mild brainstem infarction. The self-help measures consist primarily in the fact that after extensive therapy, accompanied by a doctor and after having achieved a certain degree of independence, the person concerned also carries out exercises to improve movement, speaking and swallowing at home. The help of a third party may be necessary. In addition, a lifestyle that is gentle on the arteries is advisable in order to counteract the further course of a possibly underlying arteriosclerosis.

In severe cases (especially those associated with the locked-in syndrome), self-help is not possible for the person concerned. It is only in the personal and medical environment that we can work to improve the quality of life. This includes enabling 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 person concerned. Paternalistic treatment is therefore not appropriate with regard to conversations and general communication, at least verbally, and in the worst case leads to the person concerned feeling devalued.

Nevertheless, comprehensive care of people with motor impairments is often necessary, whereby their environment should ensure that independence is promoted and maintained even in very small steps.