Learning objectives
This presentation is aimed to illustrate the anatomy and help the reader understand the complex location-related symptomatology of the brainstem infarcts, that way facilitating their MRI-based detection.
Background
Brain stroke is a leading cause of morbidity and mortality worldwide. In 2016, there were approximately 80,1 million prevalent cases and 13,7 million new cases globally.
Ischemic strokes account for approximately %80-85 of the cases, while the remaining %15-20 are hemorrhagic.
Approximately one-third of the ischemic strokes happen in the vertebrobasilar system. Half of them occur in the brainstem, which is therefore affected in about %10-15 of all ischemic strokes.
Unlike CT, which has a low sensitivity for posterior fossa ischemic stroke diagnosis, high-resolution MR...
Findings and procedure details
Brainstem
Anatomy
The brainstem is the most primitive and caudal part of the brain. It is subdivided into three continuous portions, from rostral to caudal: the midbrain, the pons, and the medulla oblongata.
It has a complex internal structure. It is organized into 3 laminae, which extend into its entire length. From dorsal to ventral, these laminae are the tectum, the tegmentum, and the basis.
Most of the cranial nerve nuclei are located in the brainstem (with the mere exception of the olfactory (I), optic...
Conclusion
Due to its complex internal anatomy and location-related symptomatology, brainstem strokes usually show strong clinical radiological correlation.
High-resolution MR images that provide good anatomic detail, as well as a precise understanding of the functional anatomy of the brainstem, are essential tools that will enable radiologists to make a correct interpretation of the sometimes subtle imaging findings secondary to ischemic lesions in this anatomic area.
Personal information and conflict of interest
M. Saenz:
Nothing to disclose
L. Antón:
Nothing to disclose
J. J. Gómez:
Nothing to disclose
M. d. M. Sarmiento:
Nothing to disclose
E. Onís:
Nothing to disclose
C. García De Andoin Sojo:
Nothing to disclose
I. Alonso:
Nothing to disclose
U. Oiartzabal Elorriaga:
Nothing to disclose
I. Aza:
Nothing to disclose
References
GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019 May;18(5):439-458.
Burger KM, Tuhrim S, Naidich TP. Brainstem vascular stroke anatomy. Neuroimaging Clin N Am. 2005 May;15(2):297-324.
Ortiz de Mendivil A, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM. Brainstem stroke: anatomy, clinical and radiological findings. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41.
Angeles Fernández-Gil M, Palacios-Bote R, Leo-Barahona M, Mora-Encinas JP. Anatomy of the brainstem: a gaze into the...