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By Matt Sowell and Fadi Chakour, M.D.

Lately we’ve noticed a growing trend in our stroke litigation practice. There are more cases involving the misdi­ag­nosis of brain stem strokes, resulting in signif­icant disabling brain damage to patients.

Brain stem strokes comprise a relatively small percentage of strokes. They occur when blood flow to the brain stem is signif­i­cantly reduced due to a clot, blood vessel tear, blood vessel occlusive disease, etc.

The brain stem sits above the spinal cord and connects it to the brain. Only half-inch in diameter, the brain stem controls the basic activ­ities of your central nervous system including your heartbeat, blood pressure, breathing, speech, swallowing, eyesight and hearing. Brain stem strokes can impair any or all of these functions. When blood flow to the brain stem stops, the brain stem tissue begins to die and brain function is lost along with it. In severe cases, patients are left with Locked-in syndrome; they cannot move anything but their eyes. They are alert, but cannot commu­nicate, use their arms or legs, or take care of their basic needs.


Patients with blood stem strokes exhibit coordi­nation and vision problems. Other symptoms include nausea, vomiting, headaches or passing out. Symptoms are more subtle and complex than classic stroke symptoms – such as a slurred speech, a drooping face weakness of one side of the body. Brain stem strokes are often difficult to diagnose because they mimic other condi­tions.

Improving Outcomes

Recog­nizing symptoms of stroke and obtaining immediate evalu­ation at an emergency room –not a walk-in clinic – can improve outcomes. If you think your loved one is having a stroke, ask that a stroke code be called and insist on being seen by a neurol­ogist immedi­ately. Having a plan and identi­fying a compre­hensive stroke care center in your city before you need one is also important.

Treatment for brain stem strokes includes the clot busting drug, tPA, or intra-arterial inter­ven­tions. The faster blood flow is restored to the brain, the better the outcome. Time is brain.

Attorneys Matt Sowell and Fadi Chakour, M.D., are national leaders in stroke litigation. Matt Sowell is the founding chairman of the Stroke Litigation Group for the American Associ­ation for Justice, the nation’s largest organi­zation of trial attorneys; Fadi Chakour is the current co-chair. They may be reached at (904) 722‑2228.