From the Guidelines
Brain stem infarcts typically present with sudden onset of symptoms such as weakness or paralysis, difficulty swallowing, slurred speech, double vision, vertigo, and coordination problems, which can be life-threatening and require immediate medical attention. These symptoms occur due to the disruption of critical pathways in the brain stem, which connects the brain to the spinal cord and controls vital functions like breathing, heart rate, and consciousness 1.
Common Symptoms
- Weakness or paralysis on one or both sides of the body
- Difficulty swallowing (dysphagia)
- Slurred speech (dysarthria)
- Double vision (diplopia)
- Vertigo
- Coordination problems (ataxia)
- Sensory disturbances like numbness or tingling
- Facial weakness
- Decreased consciousness or breathing difficulties in severe cases The brain stem's role in controlling essential bodily functions makes these symptoms particularly concerning, and prompt treatment is crucial to improve outcomes. According to the ACR Appropriateness Criteria, noncontrast head CT can be used as an initial screening study to assess for brainstem hemorrhage or acute infarct, although it may have limitations in detecting small acute brainstem infarcts 1.
Importance of Prompt Treatment
Given the potential severity of brain stem infarcts, it is essential to seek medical help immediately if symptoms appear, as treatment with thrombolytics within a specific time frame can significantly impact the outcome. The symptoms of a brain stem infarct can vary widely depending on the specific area of the brain stem affected, but they often appear suddenly and can be devastating if not addressed promptly.
From the Research
Symptoms of Brain Stem Infarct
The symptoms of brain stem infarct can be varied and non-specific, making diagnosis challenging. Some common symptoms include:
- Sensory disturbance, which was significantly more common in patients with "invisible" brain stem infarction (IBI) 2
- Dizziness, nausea, and vomiting, which are common symptoms of cerebellar infarction 3, 4
- Unsteady gait and headache, which are also common symptoms of cerebellar infarction 3, 4
- Dysarthria, which was less common in patients with IBI 2
- Coordination and eye movement abnormalities, which can be detected through careful attention to patients' neurological physical examination 3
Diagnostic Challenges
Diagnosis of brain stem infarct can be difficult due to the non-specific symptoms and the limitations of imaging tests such as CT scans 3, 4. However, diffusion-weighted MRI (DWI) has been shown to be effective in diagnosing brain stem infarcts, even in cases where CT scans are normal 2, 5. The use of DWI and careful attention to patients' neurological physical examination can help improve diagnosis and treatment outcomes.
Clinical Presentation
The clinical presentation of brain stem infarct can vary depending on the location and size of the infarct. Patients with smaller infarcts, such as those with IBI, may have minimal signal changes on DWI and ADC maps, making diagnosis more challenging 2. However, the identification of specific symptoms and the use of advanced imaging techniques can help improve diagnosis and treatment outcomes.