Brain stem syndromes are characterized by reduced blood flow to the vessels supplying the brain stem. There are various brainstem syndromes that are named after their first describer, for example Foville syndrome, Weber syndrome or Wallenberg syndrome. Acute brainstem syndromes are caused by cerebral hemorrhage, cerebral infarction or inflammation.
What is Brainstem Syndrome?
Brainstem syndromes are caused by cerebral ischemia, i.e. an insufficient supply of blood to the cerebrum. In most diseases, a circulatory disorder of the vertebral or basilar artery is the main cause. The vertebral artery, together with the clavicle artery, is one of the arteries supplying the brain.
The basilar artery is one of the arteries and supplies the brain with oxygen-rich blood. If the blood supply is reduced by a cerebral infarction, cerebral hemorrhage or inflammation, various brainstem syndromes can develop depending on the local location.
The main causes of brainstem syndrome are cerebral ischemia, which leads to a reduced supply of blood to the cerebrum. These circulatory disorders occur most frequently in the area of the vertebral artery and the carotid arteries, which belong to the arteries supplying the brain. Infections, injuries, tumors, obesity, high blood pressure and multiple sclerosis can also lead to an undersupply of blood to the brain.
There are different brainstem syndromes, which are mainly divided into three subtypes depending on the location of the damage:
- Circulatory disorder of the brainstem (pons), which is part of the central nervous system
- Circulatory disorder in the midbrain
- Circulatory disorder in the area of the spinal cord extension (medulla oblongata)
The three different syndromes are named after their first describers: Millard-Gubler syndrome, Weber syndrome and Wallenberg syndrome. Depending on the type of symptoms and the location of the damage, medicine knows a few other brainstem syndromes, for example Foville syndrome, Nothnagel syndrome or Babinski-Nageotte syndrome.
Symptoms, Ailments and Signs
Depending on the type of brainstem syndrome, there are different symptoms. Almost all brainstem syndromes are characterized by failure of the cranial nerves and damage to the long nerve tracts responsible for motor function and sensitivity. Other prominent complaints are dizziness, headaches, fatigue, hallucinations, intracranial pressure and stiff neck.
Accompanying phenomena are photophobia and vegetative disorders such as vomiting, nausea, sweating and psychological changes. From the sum of the symptoms, the doctor treating you can deduce the location of the damage. Wallenberg syndrome is characteristic of damage to the lengthening of the spinal cord, other alternating syndromes are also possible.
Damage to the caudal foot of the bridge (pons) usually results in Foville or Millard-Gubler syndrome with paralysis of the horizontal gaze. Causes can be tumors and circulatory disorders in the arteries and their flow areas. The Weber, Benedikt and Notnagel syndromes are characteristic of midbrain lesions.
Patients often experience visual disturbances and drowsiness. Severe damage with separation of the brainstem and cerebral cortex leads to primitive brain reflexes in the form of apallic syndrome, which leads to brain death. Brainstem syndromes that are not fully or typically developed often occur, which makes a conclusive diagnosis difficult.
Diagnosis and course of the disease
In the case of incomplete brainstem syndromes, the symptoms occur alternately or bilaterally. Depending on the location of the damage, the symptoms appear either on the same or the opposite side of the body. In the case of general damage, there are sensory deficits such as disturbances in the sense of vibration, the sense of touch and temperature as well as signs of paralysis.
The parts of the body that are supplied by the longest nerve tracts, i.e. the feet, are particularly affected. As the disease progresses, these sensory disturbances spread proximally to the body. If individual nerves are damaged locally, different symptoms and complaints occur.
In addition to the sensory failure symptoms, there are motor failures and damage to the autonomic nervous system. These manifest themselves as disturbances in the circulatory and perspiration regulation in connection with the loss of balance and coordination ( ataxia ). Damage to the nerve roots, which is reflected in weakened reflexes and muscle weakness, can be caused by damage to the intervertebral disc.
Modern medicine offers different diagnostic methods to reliably diagnose brainstem syndrome. The first step is a clinical anamnesis, with which the doctor asks the patient all the important questions about symptoms, previous illnesses and lifestyle and behavior in order to create a clinical picture.
If this survey is not possible, for example in an acute emergency, a diagnosis is made immediately using MRI, CT and ultrasound. With this modern diagnostic technique, doctors can rule out other complaints and diseases such as tumors or inflammation if they are not responsible for the circulatory disorder in the brain.
Brainstem syndrome leads to reduced blood flow in the brain. This condition can lead to many different complications, which usually occur as a result of an infarction or inflammation. The patient suffers from dizziness and severe headaches. Furthermore, exhaustion and fatigue occur.
Paralysis and various sensory disorders can also occur. However, it cannot be predicted which areas of the body will be paralyzed by brainstem syndrome. Furthermore, the affected person may suffer from vomiting and nausea and also lose consciousness. It is not uncommon for hearing problems or visual disturbances to occur.
The symptoms severely restrict the patient’s everyday life. In the worst case, the brainstem syndrome leads to brain death and then to the complete death of the patient. For this reason, prompt treatment by a doctor is necessary for the patient to survive.
The treatment is carried out with the help of medication and does not lead to any complications. However, consequential damage cannot be ruled out. These depend heavily on when treatment was started. The life expectancy of the patient may also be reduced by the brainstem syndrome.
When should you go to the doctor?
A doctor’s visit is necessary as soon as the person concerned suffers from various functional disorders. A doctor is needed in the event of loss of vision, problems with hearing or unclear language formation. Control investigations must be initiated in order to determine the cause and to be able to take appropriate measures. If you experience repeated tiredness, a feeling of weakness or inner weakness, you should see a doctor.
Sleep disorders and an increased need for sleep are warning signs of the organism. If they occur over several weeks or if they increase in intensity, the signs should be clarified. If you feel pressure inside your head, have a stiff neck, or have restricted movement of your neck, see a doctor. Dizziness, vomiting and nausea should be examined and treated medically. If you have a fever, high blood pressure, tachycardia or circulatory problems, you need a doctor.
Circulatory disorders, unexplained heavy sweating or a feeling of illness should be examined by a doctor. Gaze paralysis is considered particularly unusual and should be treated as soon as possible. Balance and coordination problems as well as changes in the muscles are reasons that require a doctor’s visit. Since brainstem syndrome can lead to a shortened life expectancy in severe cases, it is advisable to see a doctor at the first signs and irregularities.
treatment and therapy
The preferred treatment method is lysis therapy, also known as thrombolysis. The thrombus is dissolved with the help of medication. In local treatment, the patient is injected with the drug directly into the affected vessel via a catheter.
With systemic lysis therapy, the drug is administered intravenously so that it can circulate through the bloodstream and reach the affected area. If an ischemic cerebral infarction is present, intravenous lysis therapy with recombinant plasminogen activator has proven to be particularly effective. However, the treatment must be carried out no later than 4.5 hours after the appearance of the first symptoms.
The doctor treating you must carry out a risk-benefit analysis, as the risk of cerebral hemorrhage is high. Alternatively, surgical removal of the blood clot is also possible. Is brainstem syndrome associated with difficulty swallowing and breathing.
Sometimes the insertion of a gastric tube or long-term ventilation may be necessary before treatment. Depending on the severity of the course of the disease, doctors recommend long-term therapy in specialized medical centers or, if the course of the disease is mild, subsequent physiotherapy.
Outlook & Forecast
The prognosis of the brainstem syndrome is determined according to the present cause and is therefore to be evaluated individually. The larger the region of the present infarction was damaged, the less favorable the prospect of a cure. The risk of death increases significantly in these patients. With an early diagnosis, minor damage to the brain tissue and prompt treatment, full recovery is possible in individual cases. With optimal therapy, the minor neurological damage can be almost completely corrected after a few months.
However, medical care must be provided within a few hours of the first signs of an irregularity appearing. In addition, the patient must actively work on the recovery within the treatment and therapy process and adhere to the specifications of the treating doctor. The patient should then take part in regular check-ups so that early warning signals can be recognized more quickly and immediate action can be taken if a heart attack occurs again.
In acute situations, the patient has a severe vascular occlusion, which significantly increases the risk of premature death. The probability of death here is 80% of the documented cases. Without treatment, the patient has little chance of survival. In addition, brainstem syndrome can lead to lifelong consequences or malfunctions of individual systems.
Since brainstem syndromes can be traced back to various causes, there is no one ideal way of prevention. In general, however, doctors advise rethinking your own lifestyle and making sure to avoid being overweight and thus avoiding high blood pressure. Both factors favor the development of brainstem syndrome.
A conscious diet that avoids too much fat, sugar and artificial additives can also help to prevent this disease. Other damaging factors are excessive consumption of alcohol and nicotine, which should be avoided above all by high-risk patients with a hereditary predisposition and overweight.
In the case of brainstem syndrome, the person affected usually has few or no measures and options for aftercare, so that the person concerned must primarily consult a doctor in order to prevent further complications or symptoms. In many cases, however, the brainstem syndrome cannot be treated completely, so that the patient’s life expectancy is often significantly reduced as a result of this disease.
The treatment of this disease is usually carried out with the help of medication. It is important to ensure that the dosage is correct and that it is taken regularly in order to prevent further complications. Regular checks and examinations by a doctor are also very important in order to correctly identify and control the symptoms of brainstem syndrome. Since the disease can also lead to movement disorders, physiotherapy should be carried out.
The person concerned can carry out and repeat many of the exercises from such a therapy at home, which may speed up the healing process. Loving care and support from one’s own family or friends also has a positive effect on the course of the disease and can prevent depression or mental upsets.
You can do that yourself
Brainstem syndrome is an acute, life-threatening disease for those affected, so self-help measures without the doctor’s consent should be avoided. In their own interest, patients seek medical attention as quickly as possible so that appropriate therapy can be initiated quickly. The symptoms associated with brainstem syndrome usually noticeably reduce the patient’s quality of life and prevent them from carrying out their usual daily routine. For example, the patients are no longer able to go about their work and should refrain from such attempts in the interests of their health.
Patients are forced by symptoms such as dizziness, motor and sensory limitations or visual and hearing disorders to rest and temporarily withdraw from social life. A stay in a hospital is usually appropriate to treat the acute causes of brainstem syndrome. During inpatient care, patients follow all instructions from hospital staff and doctors.
Patients typically maintain intermittent bed rest and reduce physical activity. The diet is also tailored to the disease and the condition of the patient, whereby the prescribed diet plan must be observed by those affected. After successful treatment, patients follow the doctor’s instructions to avoid recurrence.