Dizziness, Vertigo and Brainstem Strokes

The brainstem is the area of the brain that physically and functionally links the brain to the spinal cord. While the brainstem is relatively small in size, it carries neurons that control movement, sensation and coordination of the face, eyes, mouth and body. 

Brainstem Stroke

A brainstem stroke causes a number of effects, including weakness, sensory loss, double vision, trouble swallowing and decreased coordination.

There are a variety of brainstem syndromes. These syndromes are characterized by a collection of symptoms that correspond to a specific area of brainstem damage. Brainstem syndromes include Weber's syndrome (midbrain stroke), Wallenberg's syndrome (lateral medullary stroke), Ondine's curse (medullary stroke),  locked in syndrome (central pontine stroke) and others. These brainstem strokes are quite small because they are caused by bleeding or interruption of blood flow in a very small branch of an artery in the brain.

One effect that most brainstem strokes have in common is that they are characterized by dizziness and vertigo.

How do Brainstem Strokes Cause Dizziness?

Brainstem strokes cause dizziness for a variety of reasons. Some brainstem strokes interrupt the connections between the brain and the cerebellum. The cerebellum controls coordination of the face and body, and when cerebellar function is disrupted, the result is physical imbalance.

Brainstem strokes may interfere with symmetry of eye movement, causing double vision or jerky movements (nystagmus) that contributes to dizziness.

Brainstem strokes may interfere with hearing sensation or with the function of the vestibular nerves that help maintain balance. And some brainstem strokes produce a decrease in sensation, interfering with the ability to sense the position of your body, which produces a type of dizziness.

Describing Dizziness

If you feel "dizzy", it is helpful if you can describe exactly how you feel. "Dizziness" is a word with a vague meaning.

So it is useful to specifically think about and describe your sensations when you feel dizzy. For example, are you lightheaded? Do you feel and nauseated? If your dizziness actually causes you to vomit, does the dizziness improve or get worse after you vomit?

Do you feel jittery when you are dizzy? Sometimes dizziness is associated with a feeling of anxiety. Do you feel dizzy when you have not eaten?

Do you have weakness or numbness when you get dizzy? Do you feel off balance or wobbly? Or do you experience blurry or double vision? Do you have a feeling that the world is spinning around you? This spinning sensation is described as vertigo. Another situation that is often described as dizziness is a sense of feeling like you are 'spacing out.'

What to do About Dizziness

Dizziness is a fairly common problem. Not all dizziness means that you are having a stroke or even that you are at risk of stroke.

Yet, sometimes, dizziness is an indication of a serious problem, such as a stroke or another health condition.

If you have recurrent problems with dizziness, it is important for you to make an appointment to see a healthcare professional. As many different health conditions can cause dizziness, it may take a while for your health care team to figure out the cause of your dizziness.

If you have sudden and extreme feelings of  dizziness, you should get medical attention right away. 

There are also some rare and unusual causes of stroke and dizziness, such as roller coaster rides and animal bites.

What to do About Brainstem Stroke

A brainstem stroke must be treated  as a medical emergency because the brainstem controls many of our most important life sustaining functions, such as our ability to maintain regular breathing and sustain  heart function.

There are several treatments available for brainstem strokes, but for these treatments to be effective they have to be implemented within a short time after symptoms begin. Some of the emergency stroke treatments include tPA and a procedure called intra arterial thrombolysis, which dissolves the blood clot responsible for a stroke.

If you have had a brainstem stroke, you will likely spend some time getting tests and treatment in the hospital, followed by a period of rehabilitation during your recovery. Stroke prevention is an important part of your recovery, because you will want to avoid having another stroke as you recover from your brainstem stroke.

Edited by Heidi Moawad MD


Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo, Lee SH, Kim JS, Neurol Clin. 2015 Aug;33(3):687-98

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