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VERIFIED CONTENTAuthor: lek. Tomasz Nęcki

Brainstem injuries are very dangerous and can even lead to the death of the patient. Both a head injury and a stroke in this part of the brain can damage the brainstem, but not only. What are the causes and symptoms of brainstem injury? How is the treatment going?

Injury to the brainstem is very dangerous as it is the brainstem that controls, among others, breathing or heart rate.The brain stem is one of the structures belonging to the central nervous system. The brainstem includes the midbrain, the bridge, and the medulla. Within this part of the nervous system, there are the nuclei of the cranial nerves, as well as numerous centers controlling basic vital functions. It is the brainstem that controls respiration and also influences blood pressure and heart function.

Within it, there are also structures that control eye movements or centers related to the act of swallowing. In addition to the already mentioned functions of the brain stem, nerve impulses (bilaterally) flow through this part of the brain between the higher levels of the brain and the spinal cord.

Brainstem injuries: causes

The main cause of brain stem injuries is head injuries . Various events can lead to such a state, disturbances in the brain stem function can occur both as a result of an injury that leads to an open skull fracture, as well as due to the patient's experience of a blunt head trauma. The brainstem can also be damaged, e.g. in victims of a shot to the head.

Another possible cause ofbrainstem damageis the stroke of this structure. Typically, patients experience ischemic strokes, which occur when the blood supply to the nerve tissue is interrupted (possibly caused by a blood clot forming in a vessel in the brain).

A hemorrhagic stroke is also possible, i.e. one in which the continuity of blood vessels is broken and in which blood accumulates around the structures of the brainstem.

The causebrainstem damagecan also be intussusception, a condition in which a part of the central nervous system is displaced from its proper location to some otherplaces. Intussusception can be caused by increased intracranial pressure, but also by a brain tumor, meningitis or intracranial hemorrhage, as well as cerebral edema.

Irreversible brainstem damage(sometimes referred to as brain-stem death) can occur as a result of cardiac arrest. One of the tissues most sensitive to hypoxia is the nervous tissue - its cells may die even after a few (even 3-5) minutes after the oxygen supply to the body is stopped.

This is why it is so often emphasized that in people with cardiac arrest, resuscitation activities must be undertaken as soon as possible - the sooner help is provided, the lower the risk of permanent complications of this condition, including damage to the trunk brain.

Brainstem injuries: symptoms

Symptoms of brainstem injury may be extremely drastic, and may include relatively minor ailments.In the most drastic cases (usually after extensive head injuries), patients may experience coma, blood pressure disturbances, slower heart rate, and respiratory disturbances that can eventually develop into complete apnea - extensive damage to the brainstem is usually fatal.

In the event of a brain stem stroke, symptoms similar to those listed above may occur, but patients may also present other, less drastic deviations.

Strokes occurring in this part of the brain can lead to dizziness, imbalance, and various degrees of unconsciousness. Patients may also experience problems with swallowing food or eye mobility disorders (e.g. in the form of nystagmus).

A stroke of the brain stem can also lead to the so-called closure syndrome, which for patients experiencing this unit is certainly an incredibly dramatic experience. In the closure syndrome, all movements apart from eye movements are paralyzed - the patient remains aware of all this, and his only possibility of contact with the outside world is blinking his eyelids and moving his eyes.

Brainstem lesions: diagnosis

Symptoms of the patient may suffice to diagnose brainstem injury.It is also important what events the patient has recently experienced - the news that he or she has suffered, for example, extensive head trauma is already a very direct indication that this one may have been damagedparts of the brain.

If a stroke is suspected, imaging examinations (e.g. computed tomography or magnetic resonance imaging of the head) are usually performed, in which, for example, ischemic changes or hemorrhagic lesions, which have led to damage to the brainstem, may be found.

Particularly extensive diagnostics concern those patients in whom cerebral death is suspected. In order to make this state clear, not only is it necessary to notice signs of brainstem damage (such as complete apnea or no pupil response to light), but functional brain tests may also be required. Such tests can be electroencephalography (EEG), multimodal evoked potential studies, or tests to assess blood flow within the brain.

Brainstem injuries: treatment

If this structure dies as a result ofbrainstem injury(e.g. due to head trauma), it is generally no longer possible to restore the functions of this part of the brain.

Patients with stroke, in whom treatment can actually prevent death, have a better chance. In this case, the therapeutic interactions depend on the etiology of the stroke, e.g. in the case of a hemorrhagic stroke, it is necessary to supply the bleeding vessel, and in the course of ischemic strokes, fibrinolytic treatment may be used, the effect of which is to dissolve the clot blocking the normal cerebral blood flow.

In patients after a stroke, it is important not only to treat the cause of this condition, but also to implement the interventions later - in order to restore patients to the highest level of fitness, it may be necessary to implement long-term rehabilitation.

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