Brain Stem Stroke 47-year-old

[shayb]

My 47-year-old uncle had a stroke this Friday, 5/18.  He was taken to the hospital from work via ambulance.  There he was told that he had a minor stroke, and although he had some weakness on his right side and some minor speech problems he was sent home the very next day.  He lives alone and my mom, other uncle and I are his only family and are 800 miles away.  On Sunday, his friends went over to his house to check on him and found him in bad shape.  His right side was totally paralized and his speech sounded like he had cotton filling his mouth, but you could still understand some words.  His friends rushed him back to the hospital.

This time, a neurologist was called in and my mom flew to be with him.  The neurologist is saying that he had a blood clot in an artery in his brain stem that caused the stroke.  Then when he was sent home, the blood clot continued to swell that artery doing damage to other arteries causing another stroke sometime bewteen Saturday and Sunday.  Who knows how long he layed there after having the second stroke.

Today is Wednesday, 5/23 and he is worse.  This morning, his left eye is dropping and he has double vision.  His speech cannot be understood at all now, his words come out like babble/jumble.  The neurologist is running another MRI today to see if something else has happened since yesterday and they are also waiting on some clotting test.

I guess I am just wondering where this will go next.  The doctor keeps telling us that he has a chance to come back from this, but he is getting worse.  Do they go up and down like this for awhile?  They want to start him on physical therapy, but not until they get some more testing done since he has gotten worse.  My mom is scared to come back home, because my uncle will be alone.  I want to bring him here to our home town for rehab, but that is something that is still up in the air at this point.  I'm nervous about him being in a rehab unit without family there to check on him and staff.  He obviously cannot live alone at this point.

He is very depressed and emotional.  He has always been a healthy, strong, active man.  He has been taking medicine for high blood pressure for the past year or so and is a bit over-weight, but nothing out of hand.

I'm wondering if he will ever be able to live on his own again?  I'm wondering if there are questions we should be asking doctors right now?  Something we are missing?  Anything to watch out for?  This is all so new to us, especially for somebody so young.  He is closer to my age, than my mom's age, so he is more like a brother to me than an uncle.

Thanks for any input anyone can give us.  Right now, we just feel like our heads are spinning.

[grandchildren_03]

I had a stroke about l 1/2 years ago.   I was told that the basal artery was about 90% blocked.  The neurologist wanted to have a stent placed in that artery, but because of insurance problems, the hospital(s) refused to do it.  Recently, I went to the doctor who diagnosed the stroke originally and he said the blockage was 100%,  Currently, I take 4 blood pressure medicines (3 of which I take 3 times a day); Coumadin 5 mil. daily; Lipitor, Fluoextine for depression; Metforman; and  Levimir insulin for diabetes.  I am a 65 year old female.  I want to know what to do now.  I'm on Medicare now.  Do you advise that I have the stent put in now?   Please advise.  Liz

[shayb]

Thank you for your reply.  I really appreciate it.

Last night he had a bad night.  Around 11:00 pm he started running a high fever, it got up to 104.

They have taken him to have another MRI and more tests.  We just don't understand what is going on.  

His attitude is really down, as he was telling us how he wanted his funeral and ask to sign a DNR.

I'm hoping that today we can get some answers and figure this out.

Thanks for any more input.

[vega1318]

The doctors should explain to you and to your uncle what they are thinking and not just send him out for tests.  Fever usually comes from infection.  He may have a pneumonia or he may even have something in his brainstem which is infectious.  But the doctors would tell you what they think it is.  He is certainly at risk for aspiration pneumonia since his swallowing is poor.  It must be very difficult for him but he seems to have realistic expectations and, though, you should all hope for the best -- he should be prepared in case things don't start getting better.  A discussion about a DNR order needs to be done with the patient -- it is ok if he signs it, it just means he's expressing his wishes.  It is hard on the family to make those kinds of decisions for someone else.  

Perhaps, an answer will be found soon.  Best wishes.

[vega1318]

Sorry to hear about your uncle.  There are many reasons why someone would have strokes in the brainstem keep reoccurring and it is definitely a serious situation.  It sounds like the doctors are doing a good job in looking for a cause.   They should look for:  narrowing in the basilar artery or source of the clot that could have gone to the basilar artery (most likely from the vertebral arteries).  Basilar artery supplies the brainstem.  It is one of the most important arteries in our brain.  Two vertebral arteries in the neck join up high to become a basilar artery, therefore, any problems in the vertebral arteries would translate into basilar as well.  He may have a blood clotting condition OR he may have a vertebral artery "dissection" or tear which is now sending clots up to his basilar.

Bottom line:  if your uncle is still having new strokes, the doctors should have him on something like Aggrenox or Aspirin and Plavix or even Heparin for now.  They should keep his blood pressure from falling down (even if it means it's a bit higher than usual).  If his strokes stop from happenning, the next step would be rehabilitation,   He clearly cannot go home like this and you need to place him in an acute rehabilitation facility which I hope you have nearby or in the hospital.  He will likely require special diet to help him swallow OR possibly a feeding tube until his own swallowing mechanism comes back.   Sometimes people become "emotional" after brainstem strokes so it does not mean his personality is changing, it will also get better.

But it sounds like the doctors are looking.  He's still not out of the woods.
Best wishes to your family.