HomeHealth articlesbrainstem lesionWhat Is Brainstem Injury?

Brainstem Injury - Causes, Symptoms, Diagnosis, and Treatment

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The brainstem is the lowest portion of the brain that connects the brain and the spinal cord and carries messages from the brain to other parts of the body.

Medically reviewed by

Dr. Prakashkumar P Bhatt

Published At January 5, 2023
Reviewed AtJanuary 5, 2023

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:

  • Midbrain: Midbrain is the uppermost part of the brainstem. It plays a vital role in controlling muscle movements, particularly eye movements.

  • Pons: Pons is the center portion of the brainstem and plays a major role in coordinating balance, hearing, and facial movements.

  • 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:

  • Motor vehicle accidents like motorcycle crashes and car accidents.

  • Falls from stairs, bed, and ladder.

  • Slipping and falling inside a bathroom causing a severe head injury.

  • Stroke (a condition in which the blood supply to the brain is stopped).

  • A traumatic injury like a severe blow or jolt to the head.

  • Gunshot wounds.

  • Explosive blasts.

  • Domestic violence and child abuse.

  • 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:

  • Severe headaches.

  • Sleeplessness or disturbed sleep patterns.

  • Loss of balance or dizziness.

  • Loss of consciousness.

  • The confused state of mind.

  • Difficulty in speaking.

  • Difficulty in breathing or shortness of breath.

  • Nausea or vomiting.

  • Drowsiness or fatigue.

  • Difficulty in swallowing.

  • Impaired vision.

  • Memory or concentration problems.

  • Feeling anxious or depressed.

  • Clear fluids draining from ears or nose.

  • Seizures (sudden uncontrolled disturbance in the brain).

  • Dilation of pupils of the eyes.

  • Sudden mood changes.

  • Lack of coordination and disorientation.

  • Coma.

How to Diagnose Brain Stem Injury?

The doctor uses the following methods to diagnose brain stem injury. They are as follows:

  • 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.

  • 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.

  • 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.

  • 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:

  • 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.

  • 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.

  • Medications:

  1. 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.

  2. 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.

  3. 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.

  • 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.

  • 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:

  1. 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.

  2. Speech Therapy: A speech therapist helps the patient to improve communication skills and swallowing abilities through simple exercises involving the tongue and mouth.

  3. 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.

Frequently Asked Questions

1.

What Occurs if the Brain Stem Is Hurt?

Depending on the location and severity of the injury, a brain stem injury can cause a variety of serious and sometimes fatal symptoms, such as altered consciousness, breathing problems, irregular heartbeats, and different neurological abnormalities.

2.

What Kind of Brain Stem Damage Might Occur?

Damage to the brain stem can occur in a number of ways, such as acute injury from accidents, strokes, tumors, or infections. A wide range of neurological symptoms and disabilities may result from this injury.

3.

Can a Damaged Brain Stem Be Repaired?

An injured brain stem can now only be partially repaired, and recovery is primarily based on the severity and kind of the injury. While medical treatment and rehabilitation can help with some symptoms, it might be difficult for the damaged brain stem to fully regenerate.

4.

Has Anyone Who Had a Brain Stem Death Recovered?

No, brain stem death cannot be stopped. It is impossible to recover from brain stem death once it has been declared. Many nations believe brain stem death to be irreversible and use it as a legal and medical definition of death. When a person is diagnosed with brain stem death, it indicates that they have lost all brain functions, including those governed by the brain stem, which governs vital physical processes such as breathing and heartbeat.

5.

What Phases of Brain Death Are There?

Brain death normally occurs in two stages:


- Clinical Symptoms of Brain Death: During this stage, all brain activity—including consciousness and brainstem reflexes—is lost, resulting in the clinical manifestations of brain death.


- Legal Brain Death: Once clinical brain death has been established, a certain set of requirements and tests must be met in order to formally declare brain death. These requirements and tests may differ depending on the jurisdiction. For organ donation and other legal reasons, it is vital to make this legal decision.

6.

What Dangers Do Brain Stems Pose?

Damage to the brain stem, a crucial component of the brain, can result in major hazards like reduced consciousness, breathing issues, irregular heartbeats, and different neurological abnormalities. The precise risks vary depending on where and how much damage has been done.

7.

How Can My Brain Stem Be Strengthened?

Although the brain stem itself cannot be strengthened directly, one can promote overall brain health by engaging in routine exercise, eating a balanced diet, getting enough sleep, managing stress, and engaging in mental activities. These techniques support healthy brain development and general wellbeing.

8.

What Percentage of Brain Stem Stroke Victims Survive?

The likelihood that a brain stem stroke victim will survive might vary greatly depending on the severity of the attack and how fast they receive medical care. However, compared to strokes in other areas of the brain, brain stem strokes can be extremely devastating and have a greater fatality rate. Depending on the conditions of each person and the accessibility of rapid medical assistance, survival rates can range from about 20 % to 70 % or more.

9.

Is It Possible to Survive Without a Brain Stem?

No, surviving without a brain stem is not conceivable. Basic bodily functions like breathing and heart rate regulation depend on the brain stem. These essential abilities can be lost instantly in the event of brain stem damage, which can be fatal.

10.

How Much Time Does the Body Have Left After Brain Death?

The body often has a finite period of time left after brain death, usually hours to days, depending on a number of conditions. While temporary bodily functions may be maintained by life support techniques, the body cannot exist for very long without brain activity. Depending on the conditions of each person and any medical interventions, the precise timeframe may change.

11.

What Is the Brainstem’s Blood Supply Like?

The basilar artery and the vertebral arteries are just two of the arteries that deliver blood to the brainstem. For the brainstem to function properly and to control vital body processes, these arteries must deliver oxygen and nutrients.

12.

How Risky Is a Brain Stem Operation?

Because the brain stem performs such important activities, brain stem surgery is extremely complicated and regarded as a serious procedure. The dangers can include significant neurological abnormalities, problems, and harm to crucial structures. The particular ailment being treated and the surgical team's expertise both influence how dangerous the procedure will be. Usually, it's only used in situations where the potential advantages outweigh the hazards.

13.

What Is the Location of BrainStem?

The cerebrum, the main portion of the brain, is connected to the spinal cord through the brain stem, which is situated near the base of the brain. It is in charge of several crucial processes, such as controlling respiration, heart rate, and fundamental consciousness. It is located slightly above the spinal cord and beneath the cerebrum.

14.

What Are the Brainstem’s Three Primary Purposes?

There are three main purposes for the brainstem:


- Relay Center: It acts as a relay center, sending messages from the brain to the rest of the body.


- Basic Life Functions: It controls vital physiological processes like breathing, heartbeat, and blood pressure.


- Consciousness and Alertness: It contributes to the preservation of basic levels of consciousness and alertness.

15.

The Brain Stem: A Bone or Not?

The brain stem is not a bone, but rather a key component of the central nervous system found at the base of the brain. It connects the brain to the spinal cord and is in charge of several essential life activities including breathing, heartbeat, and blood pressure.

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Dr. Prakashkumar P Bhatt
Dr. Prakashkumar P Bhatt

Neurology

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