Pontine Stroke

A stroke can be ischemic (lack of blood flow often due to obstruction created by a blood clot or plaque in the artery) or hemorrhagic (lack of blood flow due to leakage of blood in the brain). According to the scientific definition, interrupted blood supply to the brainstem is known as pontine stroke.

Human brain is divided into forebrain (cerebrum, thalamus, and hypothalamus), midbrain (tectum and tegmentum), and hindbrain (cerebellum, pons and medulla).

The brainstem is the posterior part of the brain adjacent to the spinal cord which consists of midbrain, pons and medulla. Sometimes, parts of the diencephalon are also considered as parts of brainstem.

The brainstem controls vital life functions like breathing, heartbeat and blood pressure. Interrupted blood supply to the parts of brainstem affects the functions of those parts seriously. Here is an overview of symptoms and effects of this brain stroke.

Rupturing of a blood vessel, often due to hypertension, leads to hemorrhage in pons or other parts of the brainstem, resulting in a brain attack (stroke). This does not mean that all those who have hypertension will be victims of pontine stroke. Hypertension is one of the main risk factors for this stroke. Symptoms of this type of stroke are almost similar to the symptoms of other types of stroke.

The midbrain controls your vision, hearing, eye movement and body movement. The nerve fibers along with other structures control the voluntary motor function. Pons plays an important role in motor control (movement and posture) and data (sensory) analysis. Important centers which regulate our consciousness and sleep are located in pons. Medulla oblongata, the tail like structure between the pons and spinal cord governs breathing and heart rate.

Brainstem is involved in transportation of information from the body to the brain and from brain to the body. Certain cranial nerves have their origin in the brain stem. It is the brainstem with the help of which you sense pain, you become alert.

Proper functioning of the brainstem is essential for normal awareness and consciousness. As brainstem is the part which controls cardiovascular and respiratory systems, any damage to brainstem can prove to be life-threatening.

The symptoms of pontine stroke may vary from person to person as they depend upon which part of the brainstem is seriously affected. The severity of the symptoms varies according to the severity of the damage caused by hemorrhage/blockage in the brainstem. Lack of oxygen and blood to the brainstem results in following symptoms:

• Difficulty in breathing
• Irregular, rapid heartbeat, palpitations
• Difficulty in speaking, slurred speech
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Vertigo, spinning sensation and loss of balance

• Sudden confusion, patient is unable to understand what others are asking or telling
• Partial or total paralysis of the body (if all the motor nerves of the brainstem are damaged)

• Loss of voluntary muscle control leading to unsteady body movements (motor ataxia)
• Vision problems, sudden trouble seeing in one or both eyes
• Sudden dizziness leading to loss of coordination
• 'Locked-in' syndrome, despite being conscious, the person does not respond to any stimuli

• Sudden, severe headache with no apparent cause
• Difficulty in swallowing (dysphagia), which may lead to choking
• Coma (if the brainstem gets pressed due to swelling in the surrounding area)
  
  
  

As the effects of brainstem stroke are often serious and life-threatening, stroke patients should be immediately hospitalized. Recognizing the stroke symptoms is therefore very essential. People who always suffer from headaches or migraines, need to understand the difference between sudden headache due to stroke and normal regular headache.

If you notice above mentioned symptoms, you should call the local emergency helpline number (or 911) immediately. Stroke patients need prompt medical attention. If they receive proper medications and oxygen therapy within few minutes or hours, they can recover fast. In that case, the effects of stroke would be mild.

Otherwise, the patient will have to face lifelong disability. Rehabilitation of stroke patients involves physiotherapy, regular exercises, healthy diet (low sodium, low fat to maintain weight and heart health), proper medications, stress relieving activities, etc.

A pontine stroke can result in abnormalities in the function of the eyes like pupil abnormalities. It can lead to changes in sensation, muscle weakness, voice change and coordination problems. Along with swallowing, walking and speech difficulties, the person may suffer from hearing loss and vertigo.

Percentage of people having brainstem stroke is less than the percentage of people having cortical stroke. Although pontine stroke is a rare condition, those who are at risk for a stroke should take proper care.