Brain stem and syndromes of its damage. Brainstem stroke: types (ischemic, hemorrhagic), causes, symptoms, treatment, prognosis Rehabilitation after brainstem stroke

Oculolethargic syndrome. Predominant damage to the oral parts of the trunk (nuclei of the oculomotor nerves), the hypothalamic region and the reticular formation of the trunk.

Damage to the left nucleus of the spinal tract.

Segmentally dissociated type of sensitivity disorder.

Oral parts of the nucleus of the spinal tract of the trigeminal nerve (pons) on the left.

Alternating Weber syndrome. Damage to the brain stem, mainly the base of the midbrain (peduncle) on the right.

Alternating syndrome. Damage to the brain stem, mainly the pons on the right.

Alternating Millard-Gubler syndrome. Damage to the lower part of the bridge on the right.

Alternating Jackson syndrome. Medulla oblongata on the right.

Pseudobulbar palsy. Bilateral damage to the corticobulbar tract (more pronounced on the right).

Bulbar palsy. Predominant damage to the tegmentum of the brain stem at the level of the nuclei of the 12th, 9th, 10th cranial nerves (medulla oblongata).

4. Damage to the cerebellum

Right hemisphere of the cerebellum.

5. DAMAGE TO THE SUBCORTICAL NODES

Lesion of the left visual thalamus.

Parkinsonism syndrome. Predominant damage to the pallidal system (globus pallidus, substantia nigra).

Choric hyperkinesis syndrome. Predominant damage to the striatal system (putamen, caudate nucleus).

6. DAMAGE TO THE HYPOTHALAMIC-PITITUITARY AREA

Hypothalamic-pituitary syndrome. Predominant damage to the pituitary gland.

Sympathetic-adrenal crisis. Predominant damage to the hypothalamus (diencephalic region).

Itsenko-Cushing syndrome. Damage to the pituitary-hypothalamic region.

7. DAMAGE TO THE INTERNAL CAPSULE

Central palsy of the facial and hypoglossal nerves.

Internal capsule on the right.

8. DAMAGE TO THE LOBE, GYRIUS OF THE BRAIN

Predominant damage to the frontal lobe on the left.

Lesion of the left frontal lobe.

Predominant damage to the frontal lobe on the left (with symptoms of irritation of the second frontal gyrus).

Disorders of muscle-joint, tactile sensitivity, sense of localization in the left hand, disorder of the “body diagram”. Damage to the right parietal lobe, mainly the superior parietal lobule and interparietal sulcus.

Predominant damage to the left temporal lobe.

9. Task-schemes

Lateral pyramidal tracts at the level of the cervical segments.

The anterior horns of the spinal cord or anterior roots at the level of segments C 5 -C 8 on the right.

Damage to the nucleus of the facial nerve on the left (pons) and the lateral pyramidal tract at the same level (alternating paralysis)

The lesion is on the right (cerebral peduncle, internal capsule, corona radiata, anterior central gyrus). Hemiplegia on the left.

Multiple lesions of peripheral nerves (polyneuritis).

The anterior horns of the spinal cord and the lateral pyramidal tract on the left at the level of segments C5-C7.

The anterior horns of the spinal cord or the anterior roots of the spinal nerves at the level of segments L 1 -S 1 on both sides.

Lateral pyramidal tract at the level of segment D 12 on the left or the upper part of the right precentral gyrus.

Bilateral damage to the lateral pyramidal tracts at the level of segments D 9 - D 10 or the upper parts of the precentral gyri.

The anterior horns of the spinal cord at the level of segments C 5 -C 8 and the lateral pyramidal tracts at the same level on both sides.

Internal capsule or thalamus, or corona radiata, or postcentral gyrus.

The hearth is on the left.

Multiple lesions of the peripheral nerves of the extremities (polyneuritic type of sensitivity disorder).

Posterior columns of the spinal cord at the level of segment D 4 (Gaull's bundles).

Posterior horns at the level of segments C 5 - D 10 on the right.

The posterior column of the spinal cord and the lateral spinothalamic tract on the right at the level of segments D 5 - D 6.

Lateral spinothalamic tract and deep sensory pathways (medial lemniscus) at the level of the brain stem (pons), sensory nuclei of the trigeminal nerve, ibid.

Lateral spinothalamic tract at the level of segments D 8 - D 9 on the left.

Right brachial plexus.

Spinal nerve roots at the level of segments S 3 -S 5 on both sides:

Lateral spinothalamic tracts on both sides at the level of segments D 10 - D 11 and the posterior cords of the spinal cord at the same level.

Anterior horns of the spinal cord at the level of segments L 2 -L 4 on both sides. Peripheral paralysis of the lower extremities (mainly thigh muscles).

Anterior roots of the spinal nerves at the level of segments L 4 -S 1 on both sides. Peripheral paralysis of the muscles of the legs and feet.

Anterior roots of the spinal nerves at the level of segments C 5 -C 8 on the right. Peripheral paralysis of the right arm.

Anterior horns of the spinal cord at the level of segments L 1 -L 2 on both sides. Peripheral paralysis of the thigh muscles.

Lateral pyramidal path at the level of segments L 2 -L 3.

Spastic paralysis of the lower limb.

Lateral pyramidal tract at the level of segment D 5 on the left. Spastic paresis of the left leg, absence of abdominal reflexes on the left.

Anterior horns of the spinal cord at the level of segments C 1 - C 4 on the left.

Anterior horns of the spinal cord and lateral pyramidal tracts on both sides at the level of segments C5-C8.

Peripheral upper and central lower paraparesis, urinary and fecal retention.

Anterior horns of the spinal cord, lateral pyramidal tract on the right at the level of segments L 1 -L 2.

Peripheral paresis of the muscles of the thighs, central paresis of the muscles of the leg and foot on the right.

Anterior horns of the spinal cord at the level of segments C 5 -C 8 on the left. Peripheral paralysis of the left arm.

The anterior horns of the spinal cord and the lateral pyramidal tract on the right at the level of segments C5-C8. Peripheral paresis of the right arm with fibrillations, central paresis of the right leg. Peripheral paralysis of the neck muscles, paralysis of the diaphragm.

Lateral pyramidal tract on the left at the level of segment D 12. Spastic paralysis of the lower limb while maintaining the upper and middle abdominal reflexes.

Anterior roots of the spinal nerves at the level of segments S 3 -S 5 on both sides. Peripheral sphincter paralysis (urinary and fecal incontinence).

There are no paresis of the limbs.

Transverse lesion of the spinal cord at the level of segment C4. Central tetraplegia, anesthesia of the entire surface of the body; dysfunction of the pelvic organs.

Possible paresis of the diaphragm.

The posterior roots of the spinal nerves at the level of segments S 3 -S 5 on both sides. Anesthesia in the area of the external genitalia and anus. - Posterior and anterior roots at the level of segments L 4

S 1 on the left. Peripheral paresis of the left leg, disturbance of all types of sensitivity.

Facial nerve (central palsy on the left).

Facial nerve (peripheral paralysis on the left).

Oculomotor nerve (ptosis of the right upper eyelid).

Oculomotor nerve (divergent strabismus, mydriasis).

Trigeminal nerve (innervation of the face and head by segments, Zelder zones).

Trigeminal nerve (peripheral innervation of the skin of the face and head).

Hypoglossal nerve (peripheral palsy on the left).

Abducens nerve (when looking to the left, the left eyeball is not diverted outward).

Focal (partial) motor seizure in the right leg.

Adverse seizure (turning the head and eyes to the right)

Auditory hallucination (aura).

Complex visual hallucination (aura).

Simple visual hallucination (aura).

Olfactory, gustatory hallucination (aura).

Motor aphasia (Broca's center).

The head and eyes are turned to the left (gaze paresis), agraphia.

Central paralysis of the right leg.
Quadrant hemianopsia (lost lower left quadrant).
Left-sided hemianopsia with preservation of the central visual field.
Visual agnosia.
Astereognosia, apraxia.
Sensory aphasia.
Amnestic, semantic aphasia.
Gustatory, olfactory agnosia.

Quadrant hemianopsia (the right upper quadrant has fallen out).

A brainstem stroke is an acute disruption of blood circulation in this area, which is accompanied by the sudden onset of symptoms of neurological deficit that last longer than a day.

In Russia, the incidence rate is 3.3 per 1000 population per year, with most of them being people over 70 years of age. Mortality within the first month from the onset of the disease is 15-25%, and 70% of victims suffer disability.

Thanks to the development of medicine, in recent years there has been a trend towards a decrease in the incidence and mortality from strokes. However, there is a “rejuvenation” of this disease.

Most often, stroke strikes older people, but thanks to the development of medicine, mortality is decreasing

A little about the structure

The brain consists of the cerebral hemispheres and the brainstem.

Brain structure

The structure of the trunk includes the medulla oblongata, midbrain, diencephalon, and pons.

Brain stem structure

It performs the following functions:

provides reflexive behavioral activity;
connects the upper and lower parts of the central nervous system via conductive pathways;
connects brain structures.

The composition includes gray and white matter. Gray – neurons located in the form of nuclei that have specific functions. White – conductive paths. To distinguish a stroke in the brain stem from others, as well as to accurately determine the location of the lesion, you need to understand the functions of its parts.

Functions of the medulla oblongata:

Innervation of the muscles of the tongue (nucleus of the XII pair of cranial nerves) and some muscles of the head (nucleus of the XI pair), larynx and oral cavity (nucleus of the IX pair).
The work of the parasympathetic nervous system (vagus nerve - X pair).
Maintaining vital functions (breathing, heartbeat) is the core of the reticular formation.
The implementation of some motor functions is carried out by the extrapyramidal nuclei (oliva).

Bridge functions:

Conduction of auditory impulses (nuclei of the VIII nerve).
Providing facial movements, as well as tear and salivation (nuclei of the VII nerve).
Carrying out the abduction of the eye outwards (nuclei of the VI pair).
Chewing movements are carried out by the nuclei of the V pair of cranial nerves.

Functions of the midbrain:

Other movements of the eyeball, eyelids, pupil (IV and III pairs of nerves).
Regulation of muscle movement and tone (nucleus of the substantia nigra).
Reflex response to light and sound impulses.
Muscle sensitivity of the face and neck.
Coordination of joint rotation of the neck and eyes.
Collection of sensitive information from internal organs.

The brain stem coordinates the work of all internal organs, reflex activity, and some important motor acts. Depending on the location of the lesion, symptoms will vary.

Etiology

By origin, brainstem stroke occurs:

ischemic is associated with a lack of blood flow due to blockage (obstruction) of the artery supplying the area;
hemorrhagic due to rupture of the artery and bleeding from it.

Types of brainstem stroke

The first type is much more common than the second, accounting for 75-80% of all cerebrovascular accidents.

Causes of ischemic stroke

Risk factors for ischemic stroke include old age, high blood pressure, increased cholesterol in the blood, atherosclerosis, smoking, heart disease, and diabetes.

It should be noted that the increase in blood pressure is above 140/90 mm. Hg, relative to normal, doubles the risk of stroke.

All causes of ischemic stroke can be divided into groups:

Atherothrombotic - ischemia occurs due to a slowly increasing plaque in the area of the vessel. Such a stroke is preceded by symptoms of transient cerebrovascular accident, signs of prolonged “robbing” the brain of oxygen and nutrients: memory loss, absent-mindedness, development of tearfulness or irascibility, and others. More often happens at night or early in the morning.
Embolic develops suddenly; a sharp and rapid blockage of the afferent artery occurs with an embolus. More often it occurs with heart diseases (atrial fibrillation, defects, artificial valves), which are characterized by the formation of blood clots in the cavities of the heart and their spread through the bloodstream. More often happens during the day, during emotional or physical overload.
Ischemia may develop with a decrease in blood pressure, when there is insufficient blood flow to the brain. This is a hemodynamic type.
Lacunar is characterized by damage to small arteries located deep in the brain. It often develops during the day, against the background of high blood pressure. Since small areas are deprived of blood supply, the symptoms are erased, and its prognosis is better than that of others.
Hemorheological is rare and develops due to increased blood viscosity.

One of the causes of ischemic stroke is high blood pressure

The brain is an organ where chemical processes actively occur, but it does not have its own reserves of nutrients. This means that any reduction in blood flow with oxygen and nutrients quickly affects its function in a negative way. Without a blood supply, a neuron can survive for a maximum of five to eight minutes, after which it dies.

Normally, 50-55 ml of blood flows through 100 g of brain per minute; with a stroke, this figure drops to 10.

After blockage of a vessel, the following is possible: ischemia occurs in the area it fed, neurons die, and their function is lost. But next to it there is another area (ischemic penumbra or penumbra), in which the blood supply has not reached a dangerous minimum. However, the brain cells in it also suffer from ischemia and damage from the decay products of dead neurons. They are viable, but they are also at risk of death, so it is important to start therapy as early as possible. This will reduce the affected area and preserve more brain functions.

Due to the accumulation of breakdown products, edema develops in this area, which compresses adjacent structures, pushing them to the side, further impairing blood flow and functioning.

Anatomy of ischemic stroke

Causes of hemorrhagic stroke

It occurs less frequently, but its symptoms are more severe and the prognosis is worse. Highlight:

With parenchymal hemorrhage, changes occur in the substance of the brain. This is possible with arterial hypertension, bleeding disorders or weakness of the vascular wall (aneurysm).
Subarachnoid - bleeding onto the surface of the brain due to pathology of the vessels in the membranes. More often, it is caused by an aneurysm, so it usually affects young, apparently healthy people.

A brainstem stroke develops when there is a lesion in the vertebrobasilar vascular system.

Symptoms

Brainstem stroke manifests itself in different ways, depending on the location of the lesion. It is characterized by the appearance of alternating (cross) symptoms, that is, the organs of the head and neck are affected on the side of the lesion, and the movements of the limbs and the sensitivity of the skin of the body are affected on the opposite side.

Medulla

If the medulla oblongata is damaged, there will be a complete or partial impairment of the motor function of the tongue (its tip deviates in the direction of the lesion), the muscles of the soft palate, neck, vocal cords (hoarseness) on the side of the stroke, and loss of sensitivity of the facial skin. On the opposite side there is a violation or inability to move the arms or legs, numbness of half the body.

Brain structure

Stroke has a poor prognosis in the presence of bulbar palsy. It develops when blood circulation in the vertebral arteries is impaired, which causes bilateral damage to the IX, X, XII pairs of cranial nerves located in the medulla oblongata. In this case, such disorders as choking when swallowing, overhanging soft palate, impaired diction, hoarseness of voice, small twitching of the tongue and limited mobility are noted. It is often followed by impairment of vital functions and death.

Bridge

If the pathological focus is in the bridge, then on the affected side there is an inability to move the facial muscles, loss of superficial sensitivity on the face, decreased hearing, the gaze is directed towards the focus. On the opposite side, motor disturbances in the limbs and decreased sensitivity are detected. Often accompanied by impaired consciousness up to coma.

Pseudobulbar palsy manifests itself in the same way as bulbar palsy, but its cause is damage to the pathways at the level of the pons and above, so the prognosis is more favorable, since disturbances in vital functions usually do not follow. A distinctive feature is the absence of tongue twitching, the pharyngeal and palatal reflexes are preserved or increased, and symptoms of oral automatism are detected.

With thrombosis of the basilar artery, “locked-in syndrome” develops. While consciousness is preserved, the patient does not move any muscles except the eyeballs and blinking.

Midbrain

A brainstem stroke localized in the midbrain is manifested by the inability to make eye movements and lack of pupillary response on the affected side. On the opposite side, the movement of the limbs is disrupted, and tremor (involuntary shaking) of the hand appears. Pseudobulbar palsy may develop.

Decerebrate and decortication rigidity syndrome indicates a poor prognosis. The cause is a brainstem stroke in the area of the midbrain pathways at a level above the vestibular nuclei. Decerebrate rigidity is manifested by coma in combination with an increase in the tone of all muscles, mainly extensors, when the arms and legs are brought to the body and the head is thrown back. Decortication - the upper limbs are bent and the lower limbs are extended.

If the lesion is localized below the vestibular nuclei, then coma occurs with a lack of muscle tone.

Diagnostics

If a brainstem stroke is suspected, as with other lesions, magnetic resonance or computed tomography is performed, if possible. This makes it possible to identify the presence and location of an area of impaired blood circulation. The speed of correct diagnosis directly affects the final prognosis of the disease.

Doppler ultrasound is a technique for studying blood flow in vessels. It identifies areas of missing blood supply or hemorrhage.

An important indicator of the functional characteristics of the body are general clinical tests (general blood and urine analysis), biochemical blood test, ECG, and, if necessary, EchoCG (visual ultrasound examination of the heart).

All this information allows us to establish the diagnosis of stroke, its localization, which determines the prognosis of recovery and treatment tactics.

Treatment

If a stroke of any localization is suspected, hospitalization in the neurological department is required.

If you suspect a stroke, seek medical attention

Trunk stroke is treated according to the same principles as any other. Basic therapy includes maintaining vital body functions: breathing, blood pressure, heartbeat, body temperature, as well as reducing cerebral edema.

Specific therapy is aimed at eliminating the causes of the disease. This includes, for example, thrombolysis, normalization of blood viscosity. Measures are being taken to provide neuroprotection and restore neuronal function.

The faster the symptoms of neurological deficit pass, the better the future prognosis.

Consequences

Unfortunately, brainstem stroke often has an unfavorable prognosis. The patient remains with dizziness, speech and swallowing disorders, muscle paralysis of various locations and functions, and loss of sensitivity for a long time.

Rehabilitation aimed at replacing these functions is long-term and permanent, and the improvements that occur are slow and insignificant.

However, this does not mean that you need to give up rehabilitation. Recovery is possible only by working on impaired functions.

Alternating syndromes with damage to the middle. brain: Sind-m Weber– lesion in the area of the nuclei or fibers of the III CN: lesion of the III CN on the side of the lesion, contralateral – central hemiplegia, central paralysis of the muscles of the face and tongue (involvement of the corticonuclear pathways to the nuclei of CN 7 and 12). Sm Benedicta(the focus is located more dorsally, with the involvement of the nigra and red nucleus, with the preservation of the pyramids of the path): on the side of the lesion - peripheral paralysis of the extraocular muscles, on the opposite side - intentional hemitremor. Claude syndrome– a combination of peripheral paralysis of the oculomotor muscles (nucleus III of the CN) with impaired coordination, hemihyperkinesis, muscle hypotonia on the opposite side (superior cerebellar peduncle). S-m Nothnagel– with extensive lesions of the midbrain involving the nuclei of the oculomotor CN, superior cerebellar peduncles, lateral lemniscus, pyramidal and corticonuclear tract. On the affected side - ataxia, peripheral paresis of the oculomotor muscles, mydriasis, hearing impairment, hemiparesis with central paresis of the muscles innervated by the 7th and 12th nerves. Alternating syndromes with damage to the bridge. S-Millard-Gübler(damage to the nucleus or fibers of the VII nerve and pyramidal tract): peripheral paralysis of the facial muscles on the affected side and central hemiplegia on the opposite side. Sm Fauville(more extensive damage involving the nucleus or fibers of the VI nerve in the pathological process): Millard-Hübler symptom complex and paralysis of the abductor muscle of the eye (convergent strabismus, diplopia, failure to bring the globe outward). Sm Brissot-Sicart - spasm of facial muscles on the affected side (irritation of the facial nerve nucleus), contralateral spastic hemiparesis (damage to the pyramidal tract). Sm Raymond-Sestan- combined lesions of the posterior longitudinal fasciculus and pontine center of gaze, middle cerebellar peduncle, medial lemniscus and pyramidal tract - paresis of gaze towards the lesion, ataxia, choreoathetoid hyperkinesis, contralateral spastic hemiparesis and hemianesthesia. S. Grene(damage to the nucleus of the superficial sense of the V nerve and the spinothalamic tract): loss of superficial senses (pain and temperature) on the face in a segmental type on the side of the lesion, contralateral loss of superficial senses in a conductive type on the trunk and limbs. Altering syndromes with damage to the medulla oblongata. Sin-m Jackson- lesion at the level of the nucleus of the hypoglossal nerve: on the side of the lesion - peripheral paralysis of the tongue muscles, contralateral central hemiplegia. Sm Avellisa- combined lesion of nucl. ambiguus or associated fibers of the IX, X nerves and pyramids of the path: on the affected side - paresis of the soft palate and vocal cords with impaired swallowing, phonation, speech, contralateral spastic hemiparesis. S-ohm Schmidt- combined damage to the motor nuclei or fibers of the IX, X, XI nerves and pyramids of the pathway: on the side of the lesion, paresis of the vocal cords of the soft palate, trapezius and sternocleidomastoid muscles, contralateral spastic hemiparesis. From Wallenberg-Zakharchenko: on the affected side - symptoms of nucl involvement in the process. ambiguus (paralysis of the soft palate and vocal cords), descending sympathetic fibers to the smooth muscles of the eye ( Bernard-Horner syndrome), rope body (vestibular-cerebellar disorders), nucl. spinalis (disorder of sensations on the face), on the opposite side - loss of pain and temperature sensations (damage to the fibers of the spinothalamic tract). It is observed when there is a circulatory disorder in the posterior inferior cerebellar artery. Sm Tapia– combined damage to the nuclei or fibers of the XI, XII nerves and pyra tract: on the side of the lesion - paralysis of the trapezius, sternocleidomastoid muscles and 1/2 of the tongue, contralateral spastic hemiparesis. S-m Voleshteina– combined lesion of the oral part of nucl. ambiguus and spinothalamic tract: on the side of the lesion, paresis of the vocal ligament, contralateral hemianesthesia of the superficial senses. Glick syndrome(damage to several parts of the trunk) – combined damage to the II, V, VII, X nerves and pyramidal tract; on the side of the lesion, paresis of facial muscles with spasm, pain in the supraorbital region, ↓ vision and difficulty swallowing, contralateal spastic hemiparesis.

Brainstem stroke is one of the localizations of acute pathology in the blood supply to the brain.

2 types of stroke (ischemic and hemorrhagic) have different preferential localizations. If hemorrhages often occur in the cortical structures of the brain, then ischemia develops in the brain stem. The severity of the disease is confirmed by unfavorable statistics: in 2/3 of cases, death is observed in the first two days.

Where is the brain stem located?

The brainstem is the lowest part of the brain, bordering the spinal cord. Anatomically, it is located at the base of the skull. The top and sides are covered by the hemispheres, and the cerebellum is adjacent to the back. In their structure, stem cells are more similar to spinal cord cells. Their tasks:

ensuring the constant functioning of centers regulating and supporting cardiac activity, breathing, muscle tone and movements;
communication between cortical centers and the spinal cord through passing nerve pathways (centripetal - from the cortical centers to the spinal cord, centrifugal - back).

There are 3 parts in the trunk.

The medulla oblongata is the lowest zone, practically a continuation of the spinal cord, containing vital centers of respiration (regulate inhalation and exhalation), blood circulation (accelerates or slows down the rhythm). Malfunction threatens a person with cessation of respiratory movements, a drop in blood pressure, cessation of cardiac activity and death. The nuclei that control coughing, sneezing, vomiting, swallowing, and blinking are also located here.

Important cranial nerves such as the vagus, glossopharyngeal, hypoglossal and accessory nerves originate from the cells of the medulla oblongata. One of the main pathways - the pyramidal one - goes from the motor centers of the cortex to the cells of the spinal cord located in formations called “anterior horns”.

The bridge - all connections of the cerebral cortex with the cerebellum, spinal cord, and the transmission of auditory information pass through it. It contains the nuclei of the trigeminal, statoacoustic, abducens and facial nerves.

Midbrain - neurons in this area regulate muscle tone, provide the possibility of movements, protective reflexes in response to visual or auditory factors, unconscious human reactions, for example, simultaneous turning of the head and eyes towards the light stimulus turned on.

What happens during a stroke?

A brainstem stroke in the form of hemorrhage can occur as an independent focus, then the bridge is most often affected. Such changes often result in a breakthrough of blood into the fourth ventricle. If small hemorrhagic lesions accompany larger damage to the hemispheres, they can merge and aggravate the general neurological symptoms.

Ischemic processes in brain tissue are associated with impaired blood flow through the anterior, middle and posterior cerebral arteries or through external feeding vessels (internal carotid, vertebral). The formation of an infarction zone during a brainstem stroke is accompanied by swelling of the brain tissue, which compresses the nerve trunks and centers, causing venous congestion and hemorrhage.

As a result, brain volume increases and intracranial pressure increases. This promotes the displacement of various brain structures. When part of the medulla oblongata is wedged and pinched in the foramen magnum of the skull, the patient’s condition is extremely serious and ends in death. Such consequences make the main task in stroke therapy the fight against edema and the administration of diuretics in the first hours of the disease.

Causes

The causes of brainstem stroke do not differ from cerebrovascular accidents of other locations:

atherosclerosis of arteries;
diabetes;
hypertension;
rheumatic vasculitis.

Hereditary predisposition affects the regulation of vascular tone, impaired structure of vascular walls, and metabolic changes in brain tissue.

Clinical manifestations

Hemorrhage into the brain stem is characterized by:

sharp constriction of the pupils;
drooping eyelid (ptosis) on the side of the lesion;
floating movements of the eyeballs;
cranial nerve palsy;
rapid development of pneumonia with a tendency to edema;
breathing type disorder (Cheyne-Stokes);
paralysis of the limbs on the opposite side to the lesion;
high blood pressure;
comatose state;
increased body temperature;
wet skin on the affected side due to increased sweating.

Ptosis of the right eyelid indicates a lesion in the right half of the trunk

Trunk ischemia, thrombotic or non-thrombotic, often occurs gradually. Damage to the area of the vertebral and basilar arteries is more typical. All signs alternate between periods of improvement and deterioration, but the disease is steadily progressing. The patient is concerned about:

dizziness;
staggering when walking;
decreased hearing and vision;
double vision;
speech disorder (scanning phrases).

If a heart attack develops in the affected area, the following signs appear:

paralysis of half the body with impaired sensitivity;
impairment of the patient's consciousness to the point of coma;
change in breathing (rare with wheezing), rapid onset of pneumonia.

Alternating syndromes in the stroke clinic

A brainstem stroke differs from impaired blood circulation in the cerebral cortex by the involvement of the nuclei and pathways of the motor nerves. Therefore, patients have a combination of central paralysis with peripheral manifestations due to changes in the pathways of the cranial nerves.

Branches of the facial nerve are affected in alternating syndromes

Syndromes that include sets of symptoms due to ischemia in the area of various nuclei and pathways are called alternating. They accompany truncal paralysis of half the body in different ways, always appear on the affected side, and indicate the level and location of the lesion. Clinical manifestations are named after the doctors who first described these combinations.

Depending on the location, they are divided into syndromes:

lesions of the cerebral peduncles (peduncular);
changes in bridge structures;
disorders in the medulla oblongata (bulbar).

Neurologists are familiar with the descriptions of syndromes and use them in differential diagnosis.

Examples of alternating lesions:

Millar-Gubler syndrome - paralysis of the facial nerve (drooping of the eyelid, corner of the mouth);
Brissot-Sicard syndrome - spastic contractions in the area of the branches of the facial nerve;
Jackson syndrome - paralysis of the hypoglossal nerve with impaired swallowing;
Avellis syndrome - paralysis of the soft palate and vocal cords, choking when eating, liquid food flowing into the nose, impaired speech;
Wallenberg-Zakharchenko syndrome - in addition to paralysis of the soft palate and vocal cords, loss of sensitivity on the skin of the face.

Treatment

Treatment of brainstem stroke is carried out from the first hours of detection. Since it is completely impossible to immediately determine the form of the stroke, all prescriptions relate to stabilizing the vital functions of the brain and relieving tissue edema.

To normalize breathing, oxygen therapy is administered through a mask; if breathing is absent or impaired, the patient is intubated and transferred to artificial respiration using a ventilator.

Regulation of cardiac activity requires maintaining blood pressure no higher than 10% of the patient’s normal level; antiarrhythmic drugs are administered, according to indications - cardiac glycosides, nitrates.

To maintain the necessary metabolism, an alkaline solution, preparations with potassium and magnesium are needed.

Reopolyglucin normalizes blood clotting and thickness.

Brain cells are protected with the help of neuroprotective drugs (Cerebrolysin, Piracetam).

To relieve swelling of the brain tissue, magnesium sulfate and diuretics are administered according to indications.

The patient may need symptomatic medications: muscle relaxants, painkillers, anticonvulsants, sedatives. Their administration is determined by the patient’s specific clinic.

The use of such specific agents as thrombolytic therapy is possible only with complete confidence in thrombosis of the cerebral arteries. It is effective only in the first 6 hours of clinical manifestations.

Residual strabismus after trunk stroke

What indicates a negative prognosis?

The consequences of a stroke in the structures of the trunk can be determined in advance after a few days. Neurologists believe that restoration of function is almost impossible with severe bulbar palsy. The patient can live for some time on mechanical breathing, but will die from cardiac arrest.

The presence of the following symptoms indicates a deep impairment of motor functions during paralysis:

“spread hip” - the femoral part of the paralyzed leg becomes wide and flabby due to loss of muscle tone;
hypotony of the eyelid - the inability to independently open the eye on the affected side;
turned foot outward due to atony of the muscles that rotate the leg.

How to predict the prognosis based on stroke symptoms?

Observation of the course of brainstem strokes has led to prognostic assumptions regarding the recovery of patients.

The prognosis is considered unfavorable under the following circumstances:

speech disorder;
rare breathing (there is a possibility of a complete stop during sleep);
tendency to bradycardia and low blood pressure;
altered thermoregulation (a sharp rise in body temperature, then a drop below normal).

Uncertain prognosis for:

impaired swallowing (possibly habituation to liquid, pureed food);
loss of movement in the limbs (recovery should be achieved within a year);
dizziness;
uncoordinated eye movements.

In any case, treatment of trunk stroke requires a competent approach to therapy and the use of all rehabilitation opportunities.

I am 39 years old. In January 2015, I had a mixed type stroke in the vertebral basin. I was left with a spending strabismus. What can be used to restore vision? Thank you in advance!

My husband suffered an ischemic stroke in the brain stem (pons on the left), a month and a half passed, but it got worse, he constantly choked while eating and became weaker. We follow all doctor's orders. Walks with a walker with difficulty. The pressure often jumps to 200. I don’t know what to expect. He is 69 years old and of course has type 2 diabetes.

I have a hemorrhagic stroke in the brain stem, I walk staggering, I have constant dizziness, I talk. Doctors said that this is the first time they have seen such a case. Will the dizziness at least go away and when?

My dad had an ischemic stroke of the brain stem on November 17, 2017. Now he has been in a coma for a month after cardiac arrest. EEG shows little brain activity. Please tell me what the forecasts can be in this case?

Cerebrovascular accident in the brain stem

Quadrant hemianopsia (the right upper quadrant has fallen out).

A brainstem stroke is an acute disruption of blood circulation in this area, which is accompanied by the sudden onset of symptoms of neurological deficit that last longer than a day.

Thanks to the development of medicine, in recent years there has been a trend towards a decrease in the incidence and mortality from strokes. However, there is a “rejuvenation” of this disease.

Most often, stroke strikes older people, but thanks to the development of medicine, mortality is decreasing

A little about the structure

The brain consists of the cerebral hemispheres and the brainstem.

Brain structure

The structure of the trunk includes the medulla oblongata, midbrain, diencephalon, and pons.

Brain stem structure

It performs the following functions:

provides reflexive behavioral activity;
connects the upper and lower parts of the central nervous system via conductive pathways;
connects brain structures.

Functions of the medulla oblongata:

Innervation of the muscles of the tongue (nucleus of the XII pair of cranial nerves) and some muscles of the head (nucleus of the XI pair), larynx and oral cavity (nucleus of the IX pair).
The work of the parasympathetic nervous system (vagus nerve - X pair).
Maintaining vital functions (breathing, heartbeat) is the core of the reticular formation.
The implementation of some motor functions is carried out by the extrapyramidal nuclei (oliva).

Bridge functions:

Conduction of auditory impulses (nuclei of the VIII nerve).
Providing facial movements, as well as tear and salivation (nuclei of the VII nerve).
Carrying out the abduction of the eye outwards (nuclei of the VI pair).
Chewing movements are carried out by the nuclei of the V pair of cranial nerves.

Functions of the midbrain:

Other movements of the eyeball, eyelids, pupil (IV and III pairs of nerves).
Regulation of muscle movement and tone (nucleus of the substantia nigra).
Reflex response to light and sound impulses.
Muscle sensitivity of the face and neck.
Coordination of joint rotation of the neck and eyes.
Collection of sensitive information from internal organs.

The brain stem coordinates the work of all internal organs, reflex activity, and some important motor acts. Depending on the location of the lesion, symptoms will vary.

Etiology

By origin, brainstem stroke occurs:

ischemic is associated with a lack of blood flow due to blockage (obstruction) of the artery supplying the area;
hemorrhagic due to rupture of the artery and bleeding from it.

Types of brainstem stroke

The first type is much more common than the second, accounting for 75-80% of all cerebrovascular accidents.

Causes of ischemic stroke

Risk factors for ischemic stroke include old age, high blood pressure, increased cholesterol in the blood, atherosclerosis, smoking, heart disease, and diabetes.

It should be noted that the increase in blood pressure is above 140/90 mm. Hg, relative to normal, doubles the risk of stroke.

All causes of ischemic stroke can be divided into groups:

Atherothrombotic - ischemia occurs due to a slowly increasing plaque in the area of the vessel. Such a stroke is preceded by symptoms of transient cerebrovascular accident, signs of prolonged “robbing” the brain of oxygen and nutrients: memory loss, absent-mindedness, development of tearfulness or irascibility, and others. More often happens at night or early in the morning.
Embolic develops suddenly; a sharp and rapid blockage of the afferent artery occurs with an embolus. More often it occurs with heart diseases (atrial fibrillation, defects, artificial valves), which are characterized by the formation of blood clots in the cavities of the heart and their spread through the bloodstream. More often happens during the day, during emotional or physical overload.
Ischemia may develop with a decrease in blood pressure, when there is insufficient blood flow to the brain. This is a hemodynamic type.
Lacunar is characterized by damage to small arteries located deep in the brain. It often develops during the day, against the background of high blood pressure. Since small areas are deprived of blood supply, the symptoms are erased, and its prognosis is better than that of others.
Hemorheological is rare and develops due to increased blood viscosity.

One of the causes of ischemic stroke is high blood pressure

Normally, ml of blood flows through 100 g of brain per minute; with a stroke, this figure drops to 10.

Due to the accumulation of breakdown products, edema develops in this area, which compresses adjacent structures, pushing them to the side, further impairing blood flow and functioning.

Anatomy of ischemic stroke

Causes of hemorrhagic stroke

It occurs less frequently, but its symptoms are more severe and the prognosis is worse. Highlight:

With parenchymal hemorrhage, changes occur in the substance of the brain. This is possible with arterial hypertension, bleeding disorders or weakness of the vascular wall (aneurysm).
Subarachnoid - bleeding onto the surface of the brain due to pathology of the vessels in the membranes. More often, it is caused by an aneurysm, so it usually affects young, apparently healthy people.

A brainstem stroke develops when there is a lesion in the vertebrobasilar vascular system.

Symptoms

Medulla

With thrombosis of the basilar artery, “locked-in syndrome” develops. While consciousness is preserved, the patient does not move any muscles except the eyeballs and blinking.

Midbrain

If the lesion is localized below the vestibular nuclei, then coma occurs with a lack of muscle tone.

Diagnostics

Doppler ultrasound is a technique for studying blood flow in vessels. It identifies areas of missing blood supply or hemorrhage.

All this information allows us to establish the diagnosis of stroke, its localization, which determines the prognosis of recovery and treatment tactics.

Treatment

If a stroke of any localization is suspected, hospitalization in the neurological department is required.

If you suspect a stroke, seek medical attention

The faster the symptoms of neurological deficit pass, the better the future prognosis.

Consequences

Rehabilitation aimed at replacing these functions is long-term and permanent, and the improvements that occur are slow and insignificant.

However, this does not mean that you need to give up rehabilitation. Recovery is possible only by working on impaired functions.

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Brain stem tumor: signs, treatment tactics and survival prognosis

Brain stem tumors are one of the diseases of the central nervous system, manifested by many symptoms. The medulla oblongata and midbrain are affected.

In 90% of situations, the disease is of glial origin. Glia are cells that create the necessary conditions for the full functioning of the central nervous system.

Statistics

There are 20 people with this diagnosis per 100 thousand population. The disease develops in people of different ages, races, and genders.

A malignant tumor has ICD-10 code C71.7.[

Brainstem tumors affect nuclear formations and pathways, but rarely cause disruption of the outflow of cerebrospinal fluid. The latter occurs only in advanced stages and when developing near Sylvian aqueducts.

Varieties

Neoplasms affecting the trunk are divided into benign and malignant.

The first type is characterized by a slow increase. Sometimes this takes more than 15 years. Malignant ones lead to rapid death.

Despite the fact that tumors are localized in different areas, they most often affect the bridge.

Stem tumors are divided into:

Primary stem, formed according to the intra-stem or exophytic type. They are formed only from the tumor of the table itself.
Secondary stem, emerging from other brain structures. They develop from the cerebellum, the fourth ventricle, and only over time grow into the trunk.
Parastem formations lead to deformation of the trunk or are simply in close interaction with it.

Tumors are also classified according to their growth characteristics. If they take development from their own cells and form a shell, pushing aside tissue, then we are talking about expansive growth. If the neoplasm grows into other tissues, it is called infiltrating. In a diffuse tumor of the brain stem, which occurs in 80% of cases, the boundaries of the tumor are not determined even microscopically.

Causes

The exact prerequisites for the appearance remain hidden, but experts focus on hereditary factors and receiving high doses of ionizing radiation.

In the first case, the genetic information of the cells changes. This leads to the fact that they begin to have tumor properties, multiply uncontrollably and inhibit the vital activity of other cells.

Those people who have previously received radiation treatment for dermatomycosis of the scalp have a predisposition to neoplasms.

This method is not used today, but modern methods of radiation therapy also lead to the formation of malignant cells.

There are suggestions that vinyl chloride causes brain stem cancer. This gas is used in the production of plastic.

Symptoms of brain stem tumors in adults and children

There are many structures in the brain stem, so the course of the disease can vary. In children, due to the development of compensatory mechanisms of nervous tissue, neoplasms often have a long-term asymptomatic course.

Further symptoms depend on the location of the tumor and the type of tumor. In adults, focal symptoms are difficult to identify.

In preschool children, the first alarming signs are loss of appetite, decreased mental and motor activity. Schoolchildren experience a significant decline in academic performance, changes in behavior, and the appearance of chronic fatigue. A movement disorder almost always occurs.

As the tumor grows, symptoms increase. Frequent migraines, nausea, vomiting are added. The disturbances affect the cardiovascular and respiratory centers of the trunk. This is what causes death.

The emergence of new behavioral reactions is noted

If the neoplasm is malignant, convulsions and fear of light occur.

Diagnosis of neoplasms

The study involves carrying out a full range of diagnostic measures. A preliminary diagnosis is established by a neurologist.

The main importance is given to:

Computed tomography, which makes it possible to obtain information about the composition of tissues, identify pathologies and carry out monitoring over time. During the procedure, images of brain slices at different levels are obtained.
SCT is a method that allows ultra-fast scanning of structures, therefore it is used for patients in serious condition. Allows you to record even the smallest deviations in the structure.
MRI with contrast agent injection. This method reveals small formations and makes it possible to determine the presence of an exophytic component. This also allows for a preliminary assessment of the presence of tumor growth and the degree of infiltration.

Thanks to these techniques, a brain stem tumor is differentiated from multiple sclerosis, encephalitis, stroke, and hematoma.

Additionally, angiography is performed. The method is necessary to determine the specifics of the blood supply to the formation and the vessels feeding the tumor. A biopsy is performed to obtain samples of the tumor. The procedure is performed using minimally invasive surgical methods using ultrasound or X-ray guidance.

Treatment of pathology

Only a radical integrated approach, consisting of:

The first technique is aimed at removing the formation while preserving as much healthy trunk tissue as possible. Surgical intervention becomes possible after performing a craniotomy, that is, making an opening in a pre-selected location to gain access to the tumor.

Radiation therapy can also be performed in situations where surgical treatment is contraindicated. The method is not recommended for children under three years of age, as physical and intellectual retardation develops later. To carry out the procedure, special installations are used that allow the tumor to be exposed from different angles.

This direction is called stereotactic radiosurgery. First, a study is conducted to accurately determine the location. Then irradiation is carried out using special equipment.

Chemotherapy is aimed at suppressing the growth of malignant cells. For this purpose, medications are used that act on formations, causing a minimum of side effects. This method can also be used for children who have not yet reached three years of age.

Most drugs are administered intravenously into the blood using droppers and injections. Sometimes the doctor decides to give medications through a long tube that connects to a large vein in the chest. Chemotherapy is carried out cyclically.

Disease prognosis

It is believed that when a brain stem tumor is removed in childhood, the prognosis is several times better than in adults.

Benign tumors can grow for up to 15 years without symptoms, but most tumors in the brain stem are malignant.

In this case, death occurs within several years or months from the onset of symptoms. Typically, treatment only slightly prolongs life.

What is a brainstem infarction?

In fact, the trunk is nothing more than a “bridge” connecting the spinal cord to the brain. It is he who is responsible for transmitting all the “orders” of the brain throughout the body.

Brainstem infarction is accompanied by damage to the cerebellum, thalamic region, medulla oblongata and midbrain, and pons.

In this area are also located the nuclei of the cranial nerves, which “guide” the contraction of the muscles of the eyes, face, and also the muscles that help make swallowing movements. The trunk also contains the most important centers for human life, which are responsible for respiratory function, thermoregulation, and blood circulation.

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A cerebral infarction is a hemorrhage in the brain followed by the formation of a hematoma that cuts off the supply of oxygen to the damaged area.

As a result of the development of hypoxia, that is, lack of oxygen, atrophy of the brain stem occurs, which leads to disruption of the functioning of all internal organs.

Depending on the mechanism by which the lesion develops, ischemic and hemorrhagic infarction are distinguished. Currently, the first, according to mortality statistics, ranks second. It is also called cerebral infarction.

An ischemic heart attack is an extensive damage to brain tissue caused by a serious disruption in blood circulation. Blood simply does not reach certain areas of the brain, which leads to softening and death of tissue in them.

The causes of brainstem infarction are varied, but the main one is atherosclerosis. It can also develop due to diabetes mellitus, and in some cases due to rheumatism and hypertension.

When a patient experiences decreased motor activity, dizziness, problems with coordination, and nausea, all this indicates the development of an ischemic heart attack.

Symptoms

Hemorrhage, or the so-called infarction of the brain stem region, occurs suddenly. As a rule, this is accompanied by dizziness, blurred speech, the occurrence of autonomic disorders, such as a decrease and then an increase in body temperature, redness or pallor of the face, and sweating.

Pulse tension and increased blood pressure are also observed. Further, circulatory and respiratory problems are added to this list of symptoms. A cerebral infarction can be suspected by the occurrence of rapid, infrequent breathing, complicated by exhalation and inhalation.

Sometimes, against the background of a cerebral infarction, some patients experience “locked-in man” syndrome - due to a disruption in the distribution of electrical impulses from the brain throughout the body, the patient experiences paralysis of the limbs.

At the same time, the intellectual ability and ability to evaluate and understand what is happening around remains. These patients can actively help during their recovery.

When a cerebral infarction occurs, 2/3 of all cases end in death in the first two days due to damage to the most basic vital functions of the body. If medical care is provided in a timely manner, death can be avoided. A favorable outcome can also occur if brainstem infarction occurs in young people.

When the first signs of a heart attack appear, even minor ones, you should immediately call an ambulance or consult a doctor.

Prognosis for dysfunction

The prognosis for brain stem infarction is very disappointing. 30% of patients experience speech problems. She becomes inarticulate, quiet and incomprehensible. However, this problem can be slightly solved by using the services of a speech therapist. In the case of the development of “locked-in person” syndrome, such a solution to the problem is impossible, since patients can only move their eyelids.

Most often, with a cerebral infarction, disruptions in the swallowing function occur (according to statistics, about 65%);
for patients with dysphagia, i.e. with inflammatory processes in the pharynx or mouth, the prognosis for recovery is uncertain;
The only option is to re-teach patients to swallow ground or soft food using various techniques.

when a truncal infarction occurs, patients experience a malfunction of the limbs, and they begin to move spontaneously;
a positive prognosis for such a function is possible only in the first 2-3 months;
in the future, the more time passes from the moment of illness, the more recovery decreases;
sometimes the recovery process can last for a year;
longer periods are extremely rare.

if during a trunk infarction the respiratory section is affected, then patients are simply unable to breathe on their own;
unfortunately, the prognosis for them is very disappointing: their life will completely depend on the artificial respiration apparatus;
if the respiratory center is not completely damaged, then patients may experience sleep apnea;
this is nothing more than stopping breathing during sleep for a short period;
Slow breathing may also occur while you are awake.

the earliest sign indicating that a cerebral infarction has occurred is dizziness;
as a rule, this symptom goes away quite quickly with proper treatment and recovery;
The time until the symptom completely disappears is uncertain and depends solely on how severely the brain was affected.

a heart attack of the trunk can also lead to a malfunction of the cardiovascular system;
in this case, rapid heartbeat and increased blood pressure are observed;
when the heart rate decreases, the prognosis for the patient is, alas, unfavorable;
in this case, the patient is in a serious condition, which can be fatal.

Also, with a heart attack of the trunk, thermoregulation may be affected, indicating a serious condition of the patient;
as a rule, there is a rise in temperature to 39 degrees or more on the first day of a heart attack;
this condition is difficult to regulate;
if the patient’s body temperature is lowered, this indicates that the brain cells will soon die.

Quite often, a heart attack affects the visual center located in the brain stem;
therefore, the patient may experience spontaneous eye movement (either one or both);
a person’s ability to focus his gaze on some object or image is also impaired, it becomes difficult to move his eyes up and to the sides, and strabismus may develop.

Read about the consequences and rehabilitation after large-focal myocardial infarction in another publication.

Brainstem infarction requires professional and long-term treatment. In severe conditions, it may require surgery.

Treatment of brainstem infarction

As mentioned above, even if a cerebral infarction is suspected, the patient must be urgently taken to the hospital. The very first task that needs to be solved is to stop blood circulation in the brain, including the affected part, and also to normalize the functioning of the lungs and heart.

In severe cases of cerebral infarction, surgical intervention is performed. As a rule, it is carried out in the first hours after the onset of an attack.

Unfortunately, quite often the infarction of the trunk is so severe that it does not allow the use of angiographic examination or even surgery. In this case, doctors carry out the necessary resuscitation measures.

Patients with brainstem infarction, even after surgery, require long-term treatment and rehabilitation therapy in order to reduce and eliminate possible consequences.

To prevent a recurrent attack, it is necessary to promptly treat chronic heart and vascular diseases, as well as regulate atherosclerotic processes by changing the diet.

For the treatment of brainstem infarction, the following are usually prescribed:

physiotherapy;
medications that prevent the formation of blood clots in blood vessels;
medications that lead to blood thinning, and, consequently, blood clots;
medications aimed at reducing blood pressure;
medications that lower blood cholesterol levels;
medicines that help control heart rhythm.

Trunk infarction is one of the diseases that is very difficult to treat. Recently, quite often one of the methods of treating this disease is the infusion of platelets into the area of the brain damaged by the infarction.

Rehabilitation therapy can be carried out both at home and in rehabilitation centers or specialized sanatoriums

Treatment also includes resuscitation, inpatient therapy and physical therapy.

Read here about intramural myocardial infarction.

You will find a description of focal infarction in this article.

During the treatment period, it is very important to eliminate all physical and emotional stress on the body, as well as maintain all its important life support functions. This approach allows you to very quickly restore blood circulation in the affected area of the brain.

The next stage of treatment is rehabilitation therapy. You should not postpone it for a long time, as this leads to the loss of certain brain functions, which, unfortunately, will then be impossible to restore.

As a result of acute cerebral circulation, brain neuron cells are damaged. Depending on the location of the disorders, various types of stroke are diagnosed (brain, cerebellar, hemispheric).

Brainstem stroke is a condition in which the brainstem is damaged as a result of a hemorrhagic or ischemic attack. When the blood supply is disrupted, the axons responsible for motor function and facial expressions die.

Causes of brain stem stroke

Any stroke occurs due to acute disruption of blood supply. There are two types of pathological disorders, depending on the etiology:

– a stroke in the trunk area occurs due to internal bleeding. It is the most dangerous lesion, often leading to the death of the patient. Bleeding develops against the background of atherosclerosis and other vascular abnormalities.
– disorders develop gradually, as a result of chronic deterioration of blood supply. Thrombotic neoplasms, cholesterol plaques, injuries and diseases lead to a decrease in the intensity of blood flow. The lack of oxygen and nutrients gradually affects the functioning of nerve cells - axons, and leads to tissue infarction.

The consequences of a brainstem stroke depend on the etiology of the disorders, as well as the extent of the lesion. The outcome of an attack is also influenced by timely assistance. An important condition for recovery is early diagnosis and, if possible, prevention of the development of a crisis state.

Symptoms of brainstem stroke

The stem part is responsible for the functioning of the human muscular system. When damaged, the basic and vital functions of the body, responsible for the mobility of the limbs, swallowing, and breathing, are disrupted. The trunk connects the spinal cord and brain, participates in thermoregulation and other important tasks of the body.

A large stroke in the brainstem leads to death in 70-80% of cases. Therefore, the main task of medical personnel is to diagnose disorders at an early stage and carry out timely rehabilitation procedures.

Symptoms of acute circulatory disorders are:

If you promptly recognize the first symptoms of brain stem damage during a stroke, you can provide first aid and reduce the intensity of complications associated with the attack.

Secondary brainstem stroke

Repeated stroke of any part of the brain manifests itself in more severe symptoms. Particularly dangerous are disorders of the cerebral blood supply to the brain stem.

A stroke causes irreversible damage to nerve cells' axons, causing loss of breathing and other important functions. With a favorable course of the disease, lost abilities are restored due to the fact that intact tissues take over and restore the lost capabilities of the brain. A recurrent stroke in most cases ends in the death of the patient.

What are the dangers of a brainstem stroke?

Hemorrhagic or ischemic brain damage leads to disruption of certain brain functions. Complications after an attack depend on the location of the hemorrhage.

The consequences of a brainstem stroke are:

The consequence of a brainstem stroke with negative dynamics is complete paralysis of the patient with gradual failure of the internal organs and the development of a condition incompatible with the patient’s life.

The most dangerous period of a stroke is the first ten days after the onset of an acute lack of blood supply. At this stage, all possible rehabilitation measures should be taken to prevent the development of complications.

How is a brainstem stroke treated?

Recovery from a brainstem stroke takes a long time. Even with a favorable prognosis for the development of the disease, it will take years for rehabilitation and restoration of normal respiratory, swallowing, speech and other functions. An important part of traditional therapy is the early diagnosis of the development of ischemic or hemorrhagic disease.

Diagnostic methods

It is much easier to prevent a stroke with damage to the trunk than to combat the development of complications and cope with the consequences of an acute circulatory disorder.

Several methods are used for early diagnosis of pathological disorders:

Tomography - at an early stage of disorders, a stroke may not manifest clinically and not be accompanied by neurological symptoms. The only effective and informative diagnostic method is computed tomography or magnetic resonance imaging. If necessary, a contrast study is performed.
Tomography allows you to detect cerebral circulatory disorders long before the development of serious hemorrhagic or ischemic problems.
Angiography – helps to identify existing disorders in the cardiovascular system: thrombosis, atherosclerosis, etc.
Cardiography is necessary to identify changes in heart rhythm indicating changes in the intensity of blood flow.

If the brain stem is affected during a stroke, this will immediately be reflected in characteristic manifestations: impaired motor and swallowing function. The presence of insufficient blood supply can be determined even with a cursory examination of the patient by performing a routine neurological test.

Drug therapy

Regardless of the type of stroke, the patient is prescribed a course of therapy that includes the following:

Rehabilitation after brainstem stroke

Recovery time and the likelihood of complications primarily depend on the timely assistance provided to the patient, as well as the extent of the lesion. In general, the prognosis is quite unfavorable. With a recurrent stroke, death occurs in almost 100% of cases. Limited tissue damage makes at least partial restoration of lost brain function likely.

How long does recovery take?

The recovery process takes a long time. Even with localized and minor brain damage, it will not be possible to completely eliminate all the changes that have appeared. The prognosis is worsened by the need to be connected to an artificial respiration apparatus, as well as prolonged loss of consciousness (coma).

Patients with impaired swallowing function, those who are in a coma or have breathing problems will need an enteral feeding device, which will also complicate rehabilitation. In general, it will take about 1-2 years to normalize the basic functions of the body. Some processes will never be fully restored.

Rehabilitation physical education

As the patient recovers, he is prescribed exercise therapy and additional rehabilitation procedures. The first classes are performed lying down and are aimed at restoring motor functions of the limbs. Over time, exercise therapy is prescribed to improve facial expressions and restore speech functions.

The simultaneous use of the following procedures speeds up recovery:

Massage or manual therapy.
Reflexology.
Acupuncture.
Hirudotherapy.

There is evidence indicating the effectiveness of magnetic therapy, which has an impact on the restoration of nerve endings. This treatment method should be used exclusively during non-exacerbation periods.

The main task of the resuscitator is to prevent the development of a recurrent stroke, therefore, at the first signs of deterioration in health, you should immediately stop the procedure and seek advice from a neurologist.

Stroke of the cerebral column is a serious pathology that can cause irreversible changes and provoke the development of conditions that end in death. The prognosis of the disease is unfavorable. A recurrent stroke most often ends in the death of the patient.