What Is a Brain Stem Infarct?

Brainstem infarction, also known as brain stem infarction, is one of the most severe forms of cerebral infarction. Brainstem infarction refers to the ischemia of the midbrain, pontine, and medulla oblongata due to atherosclerosis, embolism, spasm, and inflammation of the vertebral-basal artery and its branch blood vessels, resulting in ischemia of the midbrain, pontine, and medulla oblongata, resulting in corresponding neurological symptoms and signs . People with severe disease can often be life threatening. Brainstem infarction is most common in the pontine, and the main pathological change is softening of the brain. It is more common in middle-aged and elderly people and often has a history of hypertensive arteriosclerosis or basal artery insufficiency. Brainstem infarction is more acute, mainly manifested as hemiplegia or quadriplegia, difficulty swallowing and pronunciation, high fever, and disturbance of consciousness (coma, mutism, etc.). Due to the different infarcts of the affected blood vessels, infarctions in different parts are caused, showing various types of cross paralysis. Treatment focuses on maintaining vital signs and preventing complications, including thrombolytic therapy, anti-platelet aggregation and anticoagulant drugs, neuropathy protective agents, intravascular interventional and surgical treatment, and traditional Chinese medicine treatment.

Basic Information

English name

brain stem infarction

Visiting department

Neurosurgery, Neurology

Common locations

Brain stem

Common causes

Vertebro-basal artery and its branches, atherosclerosis, or circulatory disorders caused by arterial embolism, spasm, inflammation resulting in narrowing of the lumen and ischemia

Common symptoms

Hemiplegia or quadriplegia, difficulty swallowing and pronunciation, high fever, disturbance of consciousness

Causes of brain stem infarction and common diseases

It is mainly caused by atherosclerosis of the vertebral-basal artery and its branches, or circulatory disturbance caused by arterial embolism, spasm, inflammation, which leads to narrowing of the lumen and ischemia. Common in cerebral arteriosclerosis, often accompanied by hypertension, dyslipidemia. Other causes include various arteritis, congenital arterial stenosis, polycythemia vera, hypercoagulable state, Moyamoya disease, etc.

Differential diagnosis of brain stem infarction

Cerebral hemorrhage

Symptoms are more acute, localized symptoms and signs of nervous system focus appear within minutes or hours, and symptoms of increased intracranial pressure such as headache and vomiting, as well as varying degrees of disturbance of consciousness, increase blood pressure significantly. However, large-scale cerebral infarction and cerebral hemorrhage, as well as mild cerebral hemorrhage, are similar to the symptoms of general cerebral thrombosis. Cranial CT can be used for identification.

Cerebral embolism

Sudden onset of symptoms, peak symptoms within seconds or minutes, often with a history of heart disease, especially when atrial fibrillation, bacterial endocarditis, myocardial infarction or other sources of emboli should be considered.

3. Intracranial Occupation

Some subdural hematomas, intracranial tumors, and brain abscesses also develop rapidly, and symptoms and signs such as hemiplegia appear, which need to be distinguished from this disease. Feasible head CT or MRI identification.

Brain stem infarction

General inspection

Platelet aggregation rate, coagulation function, blood glucose, blood lipid level, liver and kidney function, etc., as well as ECG, chest radiograph. These tests help to clarify the patient's basic condition, and some test results also help to determine the cause.

2. Special inspection

It mainly includes brain structure image assessment, cerebrovascular image assessment, cerebral perfusion and functional examination.

(1) Brain structure imaging examination skull CT; skull MRI.

(2) Cerebrovascular imaging neck vascular ultrasound and transcranial Doppler (TCD); magnetic resonance angiography (MRA) and computer imaging angiography (CTA); digital subtraction angiography (DSA).

(3) Cerebral perfusion examination and assessment of brain function Commonly used methods of cerebral perfusion examination include multi-mode MRI / PWI, multi-mode CT / CTP, SPECT and PET, etc .; brain function assessment: mainly including functional magnetic resonance, electroencephalogram, etc Examination of special brain functions such as cognitive function and emotional state.

Brain stem infarction treatment principles

General treatment

It mainly includes maintaining vital signs and preventing and treating complications, of which controlling risk factors of cerebrovascular disease and initiating standardized secondary preventive measures are important contents.

2. Special treatment

It mainly includes thrombolytic therapy, antiplatelet aggregation and anticoagulant drug therapy, neuroprotective agent application, intravascular interventional therapy and surgical treatment.

3. Chinese medicine treatment

Mainly Yiqi and blood, Tongluo lipid-lowering, blood circulation, and phlegm.