information on brain stem strokes

My 51 year old brother had a brain stem stroke and is parallized on both sides from the neck down.  The only way he can communite now is his eyes.  He hears, sees, understands right now.  Will he be parallized the rest of his life?  Also his throat is swollen.  What are other complications he may go through.  Could he die from this anytime?  Could he have another stroke?  Please explain what he is facing long term?

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to review your brother's medical history and examine him, I can not unfortunately predict exactly what complications he will face, what his prognosis is, etc. but I will try to provide you with some useful information.

It sounds like your brother has sufferred a brainstem stroke which has left him paralyzed but able to communicate with his eyes. This is very unfortunate and must be very difficult for you and your family to go through.

The causes of stroke are multiple and could include embolism from the heart or other areas (such as the aorta or other parts of the body), bleeds, artherosclerosis of the blood vessels to the brainstem, vasculitis (or inflammatory processes affecting the blood vessels of the brain), and others.Whether or not your brother could have another stroke depends on what caused the first one. In addition, there are certain medications which are helpful in preventing further strokes (depending on the cause of the stroke, they may include aspirin, certain blood thinners, or cholesterol-lowering medications). If there is diabetes, control of that will hopefully improve the risk of stroke as well.

Regarding your brother's prognosis in terms of recovery of motor function, this is a question to best ask his/her neurologist, as it really depends on to what extent his brainstem is damaged and his neurologist can review his MRI and examine him and determine that. however in general, unfortunately many patients with brainstem stroke recover little if any motor function and may remain paralyzed for life. It is important to help him utilize his eye movements and any other means of communication he might have in order to help him maximize these skills; there are electronic devices available that I recommend you look in to. Some patients do benefit from intensive physical therapy, so your brother will probably be assessed for that to determine that.  

After a stroke of this type, the risks of aspiration are high, because throat muscles are not working well (basically, food or water or even saliva, goes down "the wrong tube", to the lungs instead of the esophagus). That is why feeding tubes placed in the stomach, called PEG tubes or J-tubes depending on where they are inserted, and important to use. Also, very vigorous skin treatment and frequent turning of the patient to prevent bed sores, care of the urine catheter (or removal of it all together when possible) to prevent urinary tract infections, are also important. Depression understandibly occurs in many patients in your brother's condition and recognizing and treatment depression with medications and counseling is important.

This clinical syndrome whereby someone is paralyzed but can still understand and communicate with his/her eyes carries the name "locked-in syndrome". I am just providing you with this name so you can have a search term to easily use to obtain more information.

Thank you for using the forum, I hope you find the information I provided useful, good luck.