From the Guidelines
Brainstem Stroke Symptoms and Treatment
If a brainstem stroke is suspected, immediate medical attention is crucial. The patient should be rushed to the emergency department for evaluation and treatment. Initial management may include administration of aspirin 325mg orally or intravenously if the patient is unable to swallow, provided there are no contraindications.
Ischemic Brainstem Stroke Treatment
For ischemic brainstem stroke, thrombolytic therapy with tissue plasminogen activator (tPA) 0.9mg/kg, with a maximum dose of 90mg, may be considered if the patient presents within 4.5 hours of symptom onset and meets specific criteria, as recommended by recent guidelines 1. Mechanical thrombectomy is also recommended in addition to i.v. thrombolysis to treat patients with demonstrable proximal artery occlusions in the anterior circulation who can be treated within 24 h of symptom onset 1.
Blood Pressure Management
Blood pressure management is critical, and guidelines suggest maintaining a systolic blood pressure below 220mmHg and a diastolic blood pressure below 120mmHg. For patients with severe hypertension, intravenous antihypertensive agents such as labetalol or nicardipine may be used.
Hemorrhagic Brainstem Stroke Treatment
In cases of hemorrhagic brainstem stroke, blood pressure control is also essential, and antihypertensive agents like nicardipine or clevidipine may be used to maintain a systolic blood pressure below 160mmHg.
Ongoing Management
Close monitoring in an intensive care unit is recommended, with frequent assessments of neurological status, blood pressure, and other vital signs. Further management may involve consultation with neurology and neurosurgery specialists for potential interventions such as surgical decompression or angiographic embolization, depending on the specific circumstances of the stroke.
From the Research
Symptoms of Brainstem Stroke
- Vertigo [ 2 ]
- Cranial nerve symptoms [ 2 ]
- Crossed or uncrossed corticospinal tract findings [ 2 ]
- Isolated vertigo, dysarthria, diplopia [ 3 ]
- Transient isolated brainstem symptoms, such as isolated double vision, transient generalized weakness, and binocular visual disturbance [ 3 ]
Treatment Options for Brainstem Stroke
- Thrombolysis [ 4, 5, 2 ]
- Endovascular therapy [ 4, 5 ]
- Endovascular thrombectomy [ 5 ]
- Intravenous recombinant tissue plasminogen activator (IV TPA) [ 5 ]
- Comprehensive stroke rehabilitation program [ 5 ]
Important Considerations
- Time is brain, and rapid restoration of cerebral blood flow is critical to patient outcomes [ 5 ]
- Knowledge of vascular and cerebral anatomy is important in localizing strokes and understanding their mechanisms [ 6 ]
- Advanced neuroimaging techniques are essential in the decision-making process of brainstem stroke management [ 2 ]