Brain stem syndrome

Brainstem syndromes are characterized by a reduced blood supply to the vessels supplying the brain stem. There are different brainstem syndromes named after their first description, for example Foville syndrome, Weber syndrome or Wallenberg syndrome. Acute brainstem syndromes are caused by cerebral haemorrhage, cerebral infarction or inflammation.

What is brain stem syndrome?

Brainstem syndromes are caused by cerebral ischemia, that is, an insufficient supply of blood to the cerebrum. In most diseases, a circulatory disorder of the vertebral artery or basilar artery is the main cause. The vertebral artery, together with the clavicle artery, is one of the arteries that supply the brain.

The basilar artery is one of the arteries and supplies the brain with oxygen-rich blood. If the blood supply is reduced due to a cerebral infarction, cerebral haemorrhage or inflammation, different brain stem syndromes can develop depending on the local settlement.

causes

The main causes of brain stem syndrome are cerebral ischemia, which leads to an insufficient supply of the cerebrum with blood. These circulatory disorders occur most frequently in the area of ​​the vertebral artery and the arteries, which belong to the arteries supplying the brain. Infections, injuries, tumors, obesity, high blood pressure and multiple sclerosis can also lead to an insufficient supply of blood to the brain.

There are different brainstem syndromes, which are mainly divided into three subspecies depending on the location of the damage:

• Circulatory disorder of the brain stem (pons) belonging to the central nervous system
• Circulatory disorder in the midbrain
• Circulatory disorder in the area of ​​the spinal cord elongation (medulla oblongata)

The three different syndromes are named after their first description: Millard-Gubler syndrome, Weber syndrome and Wallenberg syndrome. Depending on the nature of the complaints and the location of the damage, medicine knows a few other brain stem syndromes, for example Foville syndrome, Nothnagel syndrome or Babinski-Nageotte syndrome.

Symptoms, ailments and signs

Symptoms vary depending on the type of brainstem syndrome. Almost all brain stem syndromes are characterized by a failure of the cranial nerves and damage to the long nerve tracts responsible for motor skills and sensitivity. Other prominent complaints are dizziness, headache, tiredness, hallucinations, intracranial pressure and stiff neck.

Accompanying phenomena are photophobia and vegetative disorders such as vomiting, nausea, sweating and psychological changes. The attending physician can determine the location of the damage from the sum of the symptoms. Wallenberg syndrome is characteristic of damage to the spinal cord extension, other alternating syndromes are also possible.

If the caudal foot of the bridge (pons) is damaged, the foville or Millard-Gubler syndrome with horizontal paralysis is usually present. The cause can be tumors and circulatory disorders in the arteries and their flow areas. Weber, Benedikt and Notnagel syndromes are characteristic of midbrain lesions.

The patients often suffer from visual disturbances and drowsiness. In severe damage with separation of the brain stem and cortex, primitive brain reflexes occur in the form of Apallic syndrome, which leads to brain death. Often, brainstem syndromes occur that are incomplete or typical, which makes a final diagnosis difficult.

Diagnosis and course of disease

If the brainstem syndromes are incomplete, the symptoms appear alternating or bilateral. 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 sensitive failures such as disturbances of the sense of vibration, the sensation of touch and temperature as well as symptoms 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 disorders spread proximally to the body. If individual nerves are damaged locally, different symptoms and complaints occur.

In addition to the sensitive symptoms of failure, there are motor failures and damage to the autonomic nervous system. These manifest themselves in disorders of the circulatory and sweat regulation in connection with the loss of balance and coordination (ataxia). Damage to the nerve roots, which is manifested by weakened reflexes and muscle weakness, can be caused by a damaged disc.

Modern medicine offers different diagnostic methods to reliably diagnose brain stem syndrome. The first step is a clinical anamnesis, with which the doctor asks the patient all the important questions about symptoms, previous illnesses as well as lifestyle and behavior in order to create a clinical picture.

If this survey is not possible, for example in the event of an acute emergency, a diagnosis is made immediately using MRI, CT and ultrasound. With this modern diagnostic technology, doctors can rule out other complaints and diseases such as tumors or inflammations, if they are not responsible for the circulatory disorder in the brain.

Complications

The brainstem syndrome leads to a decreased blood flow in the brain. This complaint can lead to a wide variety of complications, usually resulting from a heart attack or inflammation. The affected person suffers from dizziness and severe headaches. There is also a feeling of exhaustion and tiredness.

Paralysis and various disorders of sensitivity can also occur. However, it cannot be predicted which areas of the body will be paralyzed by brainstem syndrome. Furthermore, the affected person can suffer from vomiting and nausea and also lose consciousness. It is not uncommon for hearing problems or visual disturbances to occur.

The symptoms limit the patient's everyday life extremely. In the worst case, the brain stem syndrome leads to brain death and then to 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 itself. However, consequential damage cannot be ruled out. These depend heavily on when treatment was started. The brainstem syndrome may also reduce the patient's life expectancy.

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 required in the event of loss of vision, hearing problems or ambiguities in language formation. Control examinations must be initiated in order to determine the cause and take appropriate measures. If tiredness, tiredness or inner weakness occur repeatedly, a doctor should be consulted.

Sleep disturbances 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, if your neck is stiff or if your neck is not able to move freely, you should consult a doctor. Dizziness, vomiting and nausea should be medically examined and treated. If there is a fever, high blood pressure, palpitations or circulatory problems, a doctor is needed.

Circulatory disorders, excessive sweating that cannot be explained, or a feeling of illness should be examined by a doctor. Eye 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 in severe cases the brain stem syndrome can lead to a shortened life expectancy, a visit to the doctor is advisable at the first signs and irregularities.

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Treatment and therapy

The preferred method of treatment is lysis therapy, also known as thrombolysis. The thrombus is dissolved with the help of drugs. With local treatment, the patient is injected directly into the affected vessel via a catheter.

With systemic lysis therapy, the drug is administered intravenously so that it can spread through the bloodstream and reach the affected area. If there is an ischemic cerebral infarction, intravenous lysis therapy with recombinant plasminogen activator has proven to be particularly effective. However, treatment must take place no later than 4.5 hours after the onset of symptoms.

The attending physician must weigh up the risks and benefits as there is a high risk of cerebral haemorrhage. Alternatively, surgical removal of the blood clot is also possible. Brainstem syndrome is associated with difficulty swallowing and breathing problems.

Sometimes a nasogastric 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 disease progresses slightly, subsequent physiotherapy.

Outlook & forecast

The prognosis of the brain stem syndrome is determined according to the present cause and must therefore be assessed individually. The more the region of the present infarct was damaged, the less favorable the prospect of a cure. The risk of death in these patients increases sharply. With an early diagnosis, slight damage to the brain tissue and rapid treatment, complete recovery is possible in individual cases. The minor neurological damage can be almost completely corrected after a few months with optimal therapy.

However, medical care must be provided within a few hours after the first signs of an irregularity appear. In addition, the patient must actively contribute to recovery within the treatment and therapy process and adhere to the instructions of the attending physician. The patient should then take part in regular check-ups so that early warning signals can be recognized more quickly and action can be taken immediately 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, there is little chance of survival for the patient. In addition, brainstem syndrome can have lifelong sequelae or dysfunction of individual systems.

prevention

Because brainstem syndromes have a variety of causes, there is no one ideal way to prevent it. In general, however, doctors advise you to rethink your own way of life and to be careful to avoid obesity and thus high blood pressure. Both factors favor the development of a brain stem syndrome.

A conscious diet that avoids too much fat, sugar, and artificial additives can also help prevent this condition. Other harmful factors are excessive alcohol and nicotine consumption, which especially risk patients with a hereditary predisposition and overweight should avoid.

Aftercare

In the case of brainstem syndrome, there are usually few or even no follow-up measures and options available to the person affected, so that the person concerned must primarily consult a doctor to prevent further complications or complaints. In many cases, however, the brainstem syndrome cannot be completely treated, so that the patient's life expectancy is often significantly reduced as a result of this disease.

Treatment of this disease is usually done with the help of drugs. It is important to ensure the correct dosage and regular intake 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. Physiotherapy should be carried out as the disease can also impair movement.

The person affected can do and repeat many exercises from such a therapy in their own home, which may accelerate healing. The 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 psychological upset.

You can do that yourself

The brain stem syndrome is an acutely life-threatening disease for the affected people, so that self-help measures without the consent of the doctor should be avoided. In their own interest, patients seek medical care as quickly as possible so that appropriate therapy can be initiated quickly. The symptoms associated with brainstem syndrome usually noticeably limit the quality of life of patients 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 health.

Symptoms such as dizziness, motor and sensory impairments or visual and hearing impairments force patients to rest and withdraw temporarily from social life. A hospital stay 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 stay in bed at times and reduce physical activity. The diet is also tailored to the disease and condition of the patient, whereby the prescribed nutrition plan must be adhered to by those affected. After successful treatment, patients follow the doctor's advice to avoid relapse.