Brain Stem Injury: Symptoms, Treatment & Effects

Instructor: Lisa Millraney

Lisa has 27 years of experience treating speech, language, memory and swallowing disorders. She has a master's degree in speech pathology from Vanderbilt University.

In this lesson, you will learn about what the brain stem does, injuries to the brain stem and how they affect the patient. We will look at the symptoms and long term effects of brain stem injury, as well as treatment and potential for improvement.

Trouble at the Crossroads

The brain is the center of thought and awareness. The information the brain needs and the orders it sends out pass through one area, the brain stem. This is where the nerves from the body converge into the spinal column and connect at the base of the skull to the brain. It is a vital connection, and a vulnerable one. The bony structures surrounding the brain stem do not give, so in the event of an accident or trauma, the soft tissues are easily damaged. Swelling may also occur, causing further injury. Strokes can occur there, damaging tissues due to bleeding.

Brain stem injuries do not affect cognition (thinking) but can be disastrous to the unconscious processes that keep us alive. Consciousness, heartbeat, breathing, and swallowing are some activities controlled through the brain stem.

Crash

17-year-old Morgan and her 21-year-old brother Jacob were driving home from a friend's graduation on a rainy night. Jacob lost control on a curve and the car went off the road, glancing off a light pole. The airbags deployed. Jacob was only slightly injured. When he turned to Morgan, she looked unharmed but was unconscious. Jacob found his cell phone and called for help.

In minutes, paramedics were on the scene. As they carefully moved Morgan out of the wreck, she stopped breathing. They quickly slid a tube down her throat, attached a device to breathe for her, and rushed her to the hospital. Jacob called their parents who met him there, and they all waited for word on Morgan.

An ER doctor explained that the impact had caused diffuse axonal injury, shearing or tearing of nerves in Morgan's brain stem. She was receiving mechanical ventilation to keep her breathing, and medications to stabilize her heart rate and minimize swelling. He used a diagram to show the family the area and described what it controls. They were frightened, but the doctor assured them Morgan's young age and good health, and the fact that her skull appeared unfractured, were factors in her favor.


Diagram of the brain including the brain stem
diagram of the brain


Starting Back

The next day, Morgan began to rouse. She was dazed at first, but only briefly. The nurse caring for her told her and her family that since her cerebrum, the main area of the brain, was intact, her thought and memory should be too.

More tests were run: X rays, a CT scan to study structures more closely, and an MRI to assess blood flow and functional activity. The results were good. There was very little swelling of the brain stem and only a small amount of bleeding.

The medical staff let Morgan try breathing without the ventilator, and were pleased when she was able to do so. Her speech was slurred, though, and she felt dizzy. When she tried to stand and walk, her gait was uncoordinated. ''I feel like I'm drunk!'' she complained. The physical and occupational therapists explained this was called ataxia and was common after a brain stem injury. They started working to improve her balance while sitting and standing.

More troubling to Morgan and those around her was her difficulty swallowing. She coughed and choked on nearly everything. Ron, a speech pathologist, told her that dysphagia or trouble with swallowing is one of the most frequent effects of a brain stem injury.

He took her to the radiology department for evaluation. Morgan sat in an imaging machine and ate and drank a variety of items while Ron and the radiologist watched. Thin liquids went down the wrong way, but thicker liquids and pudding were safer. Ron started teaching Morgan exercises to improve swallowing functions, and tricks for safety at mealtime. He used chilled medical tools and tart flavors to stimulate her swallow. She wasn't happy with the mashed food, but it was better than getting aspiration pneumonia if food or liquid went into her lungs.

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