From the Guidelines
A brainstem cerebrovascular accident (CVA) can have severe cardiovascular effects, including bradycardia and irregular breathing patterns, which can lead to sudden apnea 1.
Key Cardiovascular Effects
- Increased risk of myocardial infarction: Patients with ischemic stroke or nonischemic stroke in the setting of CHD risk equivalents are at increased risk for myocardial infarction and coronary heart disease–mediated death 1.
- Coronary heart disease: Patients with transient ischemic attack and ischemic stroke are at risk for coronary heart disease, and potential sources of cardioembolism and ipsilateral large-artery stenosis should be excluded 1.
Clinical Implications
- Monitoring: Clinicians should frequently monitor level of arousal and new brainstem signs in patients with cerebellar stroke at high risk for deterioration 1.
- Recognition of deterioration: Gradual development of midposition pupils and worsening of motor response may indicate deterioration, and clinicians should be aware of these signs to provide timely intervention 1.
From the Research
Cardiovascular Effects of Brainstem CVA
The cardiovascular effects of a brainstem cerebrovascular accident (CVA) can be significant due to the brainstem's role in regulating cardiorespiratory function.
- The brainstem is responsible for controlling various autonomic functions, including heart rate and blood pressure regulation 2.
- Damage to the brainstem due to a CVA can disrupt these functions, leading to cardiovascular complications.
- Electrocardiographic (ECG) abnormalities have been observed in patients with CVAs, including nonspecific ST-T changes and corrected QT interval (QTc) elongation 3.
- These ECG changes are not specific to a particular CVA location, suggesting that widely distributed neurons and pathways within the central nervous system may influence ECG.
Clinical Characteristics of Brainstem CVA
Patients with brainstem CVAs often experience a range of clinical characteristics, including:
- Hemiparesis, ataxia, and diplopia 4
- Dysarthria and dysphagia 4
- Pneumonia as a complication 4
- Risk factors such as diabetes and hypertension 4
- Previous stroke 4
Anatomy and Pathophysiology of Brainstem CVA
The brainstem is a complex anatomical structure with a rich vascular supply.
- Brainstem infarcts comprise approximately 10% of all first ischemic brain strokes 5, 6.
- The intrinsic vascularization of the brainstem can be conceptualized in terms of four relatively constant and distinct vascular territories 6.
- The anatomic structures found within each intrinsic territory determine the symptomatology associated with infarction of that territory 6.