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Emergency: requires immediate attention
Brain stem stroke
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Other Resources UpToDate PubMed
Emergency: requires immediate attention

Brain stem stroke

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Contributors: Jamie Adams MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

A brainstem stroke involves the brainstem, which is comprised of the midbrain, pons, and medulla oblongata. Symptoms are typically acute in onset and depend on the location of injury, but may include cranial nerve dysfunction resulting in eye movement abnormalities, diplopia, facial weakness or sensory loss, vertigo or dizziness, dysarthria, dysphagia, and/or tongue deviation. There may be decreased level of consciousness, abnormal breathing, nausea, body weakness, imbalance, or coordination problems as well. There are several named syndromes characterized by location of the stroke and resulting symptoms; locked-in syndrome is the most serious. Prognosis depends on the location and size of the stroke as well as timely evaluation and treatment. The brainstem gets its blood supply largely from the posterior circulation (vertebrobasilar system) with little collateral supply.

Risk factors for brainstem strokes are generally the same risk factors as for other cerebrovascular disease, mainly hypertension, hyperlipidemia, diabetes, and tobacco abuse. A history of atrial fibrillation or a history of a hypercoagulable state are also risk factors. Additionally, sympathomimetics, including cocaine, predispose individuals to hemorrhagic strokes.

Related topic: Drug-induced stroke

Codes

ICD10CM:
G46.3 – Brain stem stroke syndrome

SNOMEDCT:
95457000 – Brain stem infarction

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

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Therapy

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References

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Last Reviewed: 11/06/2017
Last Updated: 01/25/2018
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Emergency: requires immediate attention
Brain stem stroke
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Brain stem stroke : Dizziness, Vomiting, Ataxia, Diplopia, Dysarthria, Numbness, Nystagmus, Vertigo, Dysphagia
Imaging Studies image of Brain stem stroke
Axial MR image demonstrates increased signal on DWI and corresponding low ADC values in the right cerebellum and brain stem, consistent with stroke.

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