Excerpted and adapted from "Surviving a Brain Stem Stroke", Stroke Connection January/February 2003 (Science update May

2008) Brain stem strokes can have complex symptoms, and they can be difficult to diagnose, according to Dr. Richard Bernstein, assistant professor of neurology in the Stroke Program at Northwestern University in Chicago. A person may have vertigo, dizziness and severe imbalance without the hallmark of most strokes weakness on one side of the body. The symptoms of vertigo dizziness or imbalance usually occur together; dizziness alone is not a sign of stroke. Brain stem stroke can also cause double vision, slurred speech and decreased level of consciousness. Only a half-inch in diameter, the brain stem controls all basic activities of the central nervous system: consciousness, blood pressure, and breathing. All of the motor control for the body flows through it. Brain stem strokes can impair any or all of these functions. These complications are often predictable and, with prompt recognition, can be treated, Dr. Bernstein says. If complications are dealt with quickly, there is a good chance of recovery. More severe brain stem strokes can cause locked-in syndrome, a condition in which survivors can move only their eyes. If a stroke in the brain stem results from a clot, the faster blood flow can be restored in this critical area, the better the chances for recovery. It is important that the public and healthcare professionals know all of the symptoms of a stroke and are aware that some brain stem strokes heave distinct symptom, Dr. Bernstein says. Patients need to receive treatment as soon as possible to promote the best recovery. Like all strokes, brain stem strokes produce a wide spectrum of deficits and recovery. Whether a survivor has minor or severe deficits depends on the location of the stroke within the brain stem, the extent of injury and how quickly treatment is provided. Risk factors for brain stem stroke are the same as for strokes in other areas of the brain: high blood pressure, diabetes, heart disease, atrial fibrillation and smoking. Like strokes in other areas of the brain, brain stem strokes can be caused by a clot or a hemorrhage. There are also rare causes, like injury to an artery due to sudden head or neck movements. Dramatic recovery from a brain stem stroke is possible, says Dr. Richard Harvey, director of stroke rehabilitation at the Rehabilitation Institute of Chicago. Because brain stem strokes do not usually affect language ability, the patient is able to participate more fully in rehabilitation therapy. Most deficits are motor-related, not cognitive. Double vision and vertigo commonly resolve after several weeks of recovery in mild to moderate brain stem strokes.