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Clinical characteristics of patients with brainstem strokes admitted to a rehabilitation unit
Robert Teasell1, Norine Foley, Timothy Doherty
1Department of Physical Medicine and Rehabilitation, St Joseph's Health Care, London, Ont, Canada. robertteasell@sjhc.london.on.ca
Objective:
To examine the clinical characteristics of patients with brainstem strokes admitted to a rehabilitation unit.
Design:
Retrospective cohort.
Setting:
Inpatient rehabilitation unit.
Participants:
Eighty-five consecutive admissions (56 men, 29 women; mean age, 61.9+/-14.4y; range, 18-85y) with radiologically confirmed focal evidence of specific lesions within the pons, midbrain, cerebellum, and medulla.
Interventions:
Not applicable.
Main Outcome Measures:
Various clinical characteristics, including stroke-related deficits and stroke risk factors, were identified and compared between brainstem subgroups. The incidence of complications, including pneumonia, deep vein thrombosis, and seizure disorder, was also reported.
Results:
Seventy (82%) of the strokes resulted from infarctions and 15 (18%) were caused by hemorrhages. The functional deficits of hemiparesis, ataxia, and diplopia were present in 41 (48%), 73 (86%), and 32 (38%) patients, respectively. Dysarthria was reported in 42 patients (49%) and dysphagia in 40 (47%). Pneumonia during hospitalization was a complication in 9 (11%) of the patients with brainstem stroke. The risk factors of diabetes and hypertension were present in 22 (26%) and 47 (55%) patients, respectively. Fourteen (17%) of these patients had suffered a previous stroke.
Conclusions:
Rehabilitation patients experience a variety of functional impairments as a consequence of brainstem stroke. These include hemiparesis, dysarthria and dysphagia, diplopia, and ataxia. A significant number of patients had pneumonia as a complication. The characteristics and impairment profiles of patients within the subgroups were similar, with the exception of the incidence of ataxia and hemiparesis.
