Introduction:
The brainstem lies at the bottom of the brain and helps in regulating body functions like breathing, maintaining balance, reflexes, heart rhythms, and coordination. The brainstem acts as a relay station that passes information from the brain throughout the body. Brainstem injuries can affect the functioning of the brain. Any damage to the brainstem can have an impact on basic life functions like breathing.
What Is the Brainstem?
The brainstem is the lower-most stalk-like portion of the brain located at the base of the skull that links the brain to the spinal cord. The brainstem is responsible for several important functions like maintaining consciousness, heart rate, blood pressure, and sleep. Ten out of the 12 cranial nerves originate from the brainstem. The brainstem is one of the most crucial areas of the brain, as it controls the critical functions that keep a person alive.
What Are the Parts of the Brainstem?
The brainstem consists of three parts, and each part is responsible for different functions. The parts are:
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Midbrain: Midbrain is the uppermost part of the brainstem. It plays a vital role in controlling muscle movements, particularly eye movements.
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Pons: Pons is the center portion of the brainstem and plays a major role in coordinating balance, hearing, and facial movements.
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Medulla Oblongata: The medulla oblongata is the lowest part of the brainstem and regulates essential life functions like breathing, heart rate, blood pressure, and swallowing.
What Is Brainstem Death?
Brainstem death occurs when the brainstem completely stops functioning. Brainstem death occurs when the blood or oxygen supply to the brain is completely stopped or when an injury completely damages the brain stem. As the brainstem controls all the essential life functions, a person who undergoes brainstem death may not be able to regain consciousness. The affected person will be able to survive only with the help of artificial life support. Brainstem death is commonly known as brain death.
What Are the Causes of Brainstem Injury?
The various causes of brainstem injury are as follows:
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Motor vehicle accidents like motorcycle crashes and car accidents.
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Falls from stairs, bed, and ladder.
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Slipping and falling inside a bathroom causing a severe head injury.
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Stroke (a condition in which the blood supply to the brain is stopped).
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A traumatic injury like a severe blow or jolt to the head.
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Gunshot wounds.
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Explosive blasts.
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Domestic violence and child abuse.
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Traumatic sports injuries that are caused during boxing, soccer, football, hockey, skateboarding, and other extreme sports.
What Are the Symptoms of Brainstem Injury?
The symptoms seen in patients with brainstem injury are as follows:
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Severe headaches.
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Sleeplessness or disturbed sleep patterns.
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Loss of balance or dizziness.
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Loss of consciousness.
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The confused state of mind.
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Difficulty in speaking.
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Difficulty in breathing or shortness of breath.
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Nausea or vomiting.
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Drowsiness or fatigue.
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Difficulty in swallowing.
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Impaired vision.
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Memory or concentration problems.
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Feeling anxious or depressed.
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Clear fluids draining from ears or nose.
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Seizures (sudden uncontrolled disturbance in the brain).
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Dilation of pupils of the eyes.
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Sudden mood changes.
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Lack of coordination and disorientation.
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Coma.
How to Diagnose Brain Stem Injury?
The doctor uses the following methods to diagnose brain stem injury. They are as follows:
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Medical History and Physical Examination: The doctor takes a detailed history of the nature of the accident that caused the injury and the symptoms experienced by the patient. If the patient is unconscious, information is collected from the person who accompanies the patient. The doctor also makes a thorough physical examination of the patient to evaluate the ability of the patient to maintain balance and coordination.
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Glasgow Coma Scale: The doctor conducts a 15-point test to assess the severity of the initial stages of the brainstem injury. The doctor checks for the patient’s ability to speak, follow directions and move eyes, legs, and hands. The ability of the patient is rated on a Glasgow coma scale from three to fifteen. A high score indicates less severity of injuries.
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Computerized Tomography (CT) Scan: CT scan is usually the first imaging test to be done on a patient who has been suspected of brainstem injury. CT scan is useful in obtaining a clear image of the brain using various X-rays. A CT scan helps in detecting the presence of fractures, blood clots, bleeding, and tissue swelling inside the brain.
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Magnetic Resonance Imaging (MRI): MRI of the brain uses powerful magnets, a computer, and radio waves to create detailed images of the brain. MRI is usually taken after the patient’s condition is stabilized or if the patient’s symptoms do not improve after initiating the treatment.
How Is Brainstem Injury Treated?
The treatment options for brainstem injury vary from patient to patient based on the severity of the injury. The treatment measures are as follows:
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A patient with mild injury does not usually require any treatment other than rest and pain-relieving medications and would be monitored closely to detect the worsening of symptoms. The doctor would advise the patient to refrain from activities that require heavy mental and physical involvement for the first few days and would be asked to resume normal activities gradually.
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Patients with moderate to severe injuries would be admitted to the intensive care unit or emergency room to prevent bleeding or decreased oxygen supply to the brain, maintain blood pressure and prevent further injury to the head and neck.
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Medications:
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In some cases, the doctor may use coma-inducing drugs to put the patient into a temporary coma, as the comatose brain requires a reduced oxygen supply to function.
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In some patients, diuretics are given intravenously to decrease the pressure inside the brain. Diuretics are drugs that reduce the fluid content in tissues by increasing urine output.
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Patients with moderate and severe brain stem injury are usually given anti-seizure medications during the first week to avoid further brain damage which might occur due to seizures.
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Surgery: Emergency surgery may be needed in patients with severe injuries. Surgeries are usually done to remove blood clots present in the brain and to stop bleeding inside the brain. Surgery may also be indicated to repair skull fractures and remove pieces of the skull from the brain. In some patients, surgery is done by creating a window opening in the skull to relieve pressure caused due to excess fluid accumulation.
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Rehabilitation Therapy: Even though the damaged nerve cells cannot be recovered, the brain has the capability of rewiring, which makes the healthy nerve cells take up the functions of the damaged cells. This process of creating new pathways by the brain to relearn the lost functions is called neuroplasticity. In order to activate neuroplasticity, the patient should be engaged in various therapies to stimulate the brain. They are as follows:
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Physical and Occupational Therapy: In physical therapy, a physical therapist helps the patient to relearn movement patterns like walking and maintaining balance. Occupational therapy helps the patient to improve the skills needed to perform everyday life activities.
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Speech Therapy: A speech therapist helps the patient to improve communication skills and swallowing abilities through simple exercises involving the tongue and mouth.
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Psychological Therapy: A neuropsychologist helps the patient to improve psychological and emotional well-being by learning coping strategies and behavioral management.
Conclusion:
Since the brainstem sends signals from the brain to other parts of the body, brainstem injuries can have a severe impact on basic life functions. However, as the brain is an adaptive organ, early diagnosis, the right treatment, and enough perseverance would help the patient to recover and lead a normal life.