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Neurology (Expert Forum)
Brainstem lesion and symptoms
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Brainstem lesion and symptoms
by BenG, Feb 24, 2005 12:00AM
I am 29 year old male. I had a car accident in 1997, which caused severe whiplash & damage to the brainstem (vestibular nuclei). The brainstem lesion was only diagnosed in 2002 via ENG and other functional tests.
MRI of the brain/brainstem was and still is completely normal.
MRA of the neck vessels was only performed in 2002 - completely normal.
Aside from balance symptoms, I have other strange symptoms which no one has an explanation for:
1. My neck (and other spinal) muscles are very weak (despite doing pilates and cervical stability exercises every day). There are marked degenerative changes and I have a pinched nerve (C6 root, identified via EMG).
2. I can have trouble with breathing. If I strain my neck (there is definitely a correlation here), it affects my breathing mechanism for days/weeks. I awake gasping for air and/or there is a sensation that the "batteries" are low in my breathing mechanism. It improves slowly over time.
3. Ocassionally, my swallowing mechanism is sluggish. I can swallow, but it doesn't go down as quick as normal. This also is related to straining my neck, but it recovers slowly over time.
I know breathing and swallowing are brainstem functions - is this all related?
I never had the breathing and swallowing issues until 2002 when I had a fall.
Thanks
Ben
MRI of the brain/brainstem was and still is completely normal.
MRA of the neck vessels was only performed in 2002 - completely normal.
Aside from balance symptoms, I have other strange symptoms which no one has an explanation for:
1. My neck (and other spinal) muscles are very weak (despite doing pilates and cervical stability exercises every day). There are marked degenerative changes and I have a pinched nerve (C6 root, identified via EMG).
2. I can have trouble with breathing. If I strain my neck (there is definitely a correlation here), it affects my breathing mechanism for days/weeks. I awake gasping for air and/or there is a sensation that the "batteries" are low in my breathing mechanism. It improves slowly over time.
3. Ocassionally, my swallowing mechanism is sluggish. I can swallow, but it doesn't go down as quick as normal. This also is related to straining my neck, but it recovers slowly over time.
I know breathing and swallowing are brainstem functions - is this all related?
I never had the breathing and swallowing issues until 2002 when I had a fall.
Thanks
Ben
Doctor's Answer
by CCF-Neuro-M.D.-CS, Feb 25, 2005 12:00AM
It would be unusual for the symptoms to be caused by the accident in 1997 when they did not start until 2002
breathing and swallowing are controlled in part by the lower brainstem or 'medulla'. While this can be injured by trauma or shearing injury, it would be unusual not to have other symptoms such as weakness, sensory or clumsiness. The medulla is a tightly packed area, and a small injury can do a lot of damage. If damage is done to the swallow, breathing center, it is usually severe and the patient requires a breathing or feeding tube. Conceivably a very small injury could affect them in isolation. However, the 'motor nucleus of the vagus', and the medullary breathing nuclei are deep to the vestibular nuclei so a lesion involving all three would have to be faitly big, and therefore cause many other symptoms. Depending on how long the MRI was done after the accident, it may be normal.
There is a lot of sensory input from the neck into the brainstem/vestibular nuclei, and the primary problem may be in the neck. In this case, a physical therapy to the neck by a sepcialist could help.
There are other cause to waking gasping for air, including heart problems so you should ask your doctor about this also
breathing and swallowing are controlled in part by the lower brainstem or 'medulla'. While this can be injured by trauma or shearing injury, it would be unusual not to have other symptoms such as weakness, sensory or clumsiness. The medulla is a tightly packed area, and a small injury can do a lot of damage. If damage is done to the swallow, breathing center, it is usually severe and the patient requires a breathing or feeding tube. Conceivably a very small injury could affect them in isolation. However, the 'motor nucleus of the vagus', and the medullary breathing nuclei are deep to the vestibular nuclei so a lesion involving all three would have to be faitly big, and therefore cause many other symptoms. Depending on how long the MRI was done after the accident, it may be normal.
There is a lot of sensory input from the neck into the brainstem/vestibular nuclei, and the primary problem may be in the neck. In this case, a physical therapy to the neck by a sepcialist could help.
There are other cause to waking gasping for air, including heart problems so you should ask your doctor about this also
