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A clinician needs to distinguish between ischemia and its differential diagnosis, causing various neurological deficits. If in the case of deficits arising in one's sleep, last known normal is the time the patient went to bed. Patients, family members, attenders, co-workers, first responders, or any reliable witness can determine the time the patient was last known normal. Assessment of airway, breathing and circulation, and its stabilization as a patient with brainstem stroke can present with trauma, altered mental status, altered respiratory drive, hypoxia, vomiting, and or mechanical airway obstruction.Įstablishing the time of ischemic insult is critical.

Hence a targeted approach must be followed with clear objectives. Ī loss of about 1.9 million neurons in the brain happens each minute in an untreated stroke. Risk factors for stroke, in general, include hypertension, diabetes mellitus, metabolic syndromes, hyperlipidemia, tobacco use, obesity, history of ischemic heart disease, atrial fibrillation, sleep apnea, lack of physical activity, use of oral contraceptives, fibromuscular dysplasia, trauma, and spinal manipulation. However, the number of infarcts due to cardioembolic etiology increase to 8% in pontine infarcts and 20% to 46% in midbrain infarcts. In medulla oblongata infarcts, 73% are due to stenosis of the vertebral artery, 26% due to arterial dissection, and rest being caused by other causes like cardioembolic. The most common etiologies for brainstem infarction are atherosclerosis, thromboembolism, lipohylanosis, tumor, arterial dissection, and trauma. Occlusion and stenosis of the posterior circulation cause significant hypoperfusion in the brainstem. The blood supply can be divided into a group of arteries supplying each region: īrainstem infarction refers to the sequelae of ischemia to any part of the brainstem, due to the loss of blood supply or bleeding. The blood supply to the brainstem is mostly from the vertebrobasilar system. The white matter of the brainstem carries most of the signals between the brain and the spinal cord and helps with its relay and processing. The cranial nerve nuclei that are present in the brainstem have a crucial role in vision, balance, hearing, swallowing, taste, speech, motor, and sensory supply to the face. The brainstem is responsible for multiple critical functions, including respiration, cardiac rhythm, blood pressure control, consciousness, and sleep-wake cycle. White matter in the form of various ascending and descending tracts can be found mainly in the basis lamina, which is the most anterior part. Gray matter in the brainstem is found in clusters all along the brainstem to forming mostly the cranial nerve nuclei, the pontine nuclei, and the reticular formation. The brainstem is organized internally in three laminae: tectum, tegmentum, and basis.

Embryologically, it develops from the mesencephalon and part of the rhombencephalon, all of which originate from the neural ectoderm. It is a connection between the cerebrum, the cerebellum, and the spinal cord. The brainstem is composed of the midbrain, the pons, and the medulla oblongata, situated in the posterior part of the brain.