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Brainstem Injuries

Brainstem Anatomy

The brainstem is a vital component of the brain. It is the structure that connects the brain to the spinal cord, sending and receiving messages between the brain and the body. Additionally, it maintains some critical survival functions, such as respiration and regulation of the heart. Damage to the brainstem is considered a serious traumatic brain injury (TBI). Doctors consider the complete loss of brainstem function an indicator that death has occurred. While it’s possible to survive without some parts of the brain, the body cannot live without the brainstem.

What is the Function of the Brainstem?

The brainstem connects the brain to the spinal cord. The spinal cord runs down through the spine and carries signals from the brain to the rest of the body. Lines of communication that control movement, touch, sensation, body-awareness (proprioception), pain, and temperature run through the brainstem. Together, the brain and spinal cord make up the central nervous system (CNS).

Cranial and spinal nerves branch off from the brain and spinal cord respectively, sending and receiving signals to and from specific areas of the body. Ten of the twelve cranial nerves originate in the brainstem. These nerves provide sensory and motor function to the face and neck.

Additionally, the brainstem is an important regulator. It regulates cardiac (heart), respiratory (breathing), and central nervous system (brain and spinal cord) function, and also plays a role in consciousness and the sleep cycle.

A set of interconnected nuclei, or nerve clusters, called the reticular formation is found in the brainstem. It is involved in movement, pain, autonomic reflexes, arousal, and consciousness.

The three main parts of the brainstem and their functions are the:

Midbrain

  • Eye movement, vision
  • Hearing
  • Motor control
  • Sleep cycles, alertness
  • Temperature regulation

Pons

  • Eye and facial movements, facial sensation and expression
  • Hearing, taste, swallowing
  • Posture, balance
  • Communication between parts of the brain
  • Respiration
  • Bladder Control
  • Sleep

Medulla Oblongata

  • Breathing, respiratory system
  • Blood pressure and heart rate
  • Swallowing
  • Vomiting
What are the Common Causes of Brainstem Injuries?

Traumatic Brain Injuries (TBI) are common, ranging in severity from a mild concussion to coma or death. Blows to the head from falls and car accidents are the most common causes of TBI. The effect of deceleration, or suddenly coming to a stop, can be just as significant as a direct hit to the head. Wounds from violence, such as gunshots, and concussions from sports and recreational activities are also common. Car accident and premises liability are examples of civil lawsuits that may arise from these types of injuries.

Strokes are a common cause of brain damage. Oxygen deprivation, or hypoxia, can result in brain damage as well. Drowning, respiratory failure, heart attacks, and childbirth are examples of scenarios where the brain can be deprived of oxygen. Other causes include environmental toxins such as carbon monoxide, lead, and certain insecticides, tumors, neurodegenerative diseases, and infections. These types of injuries sometimes result in, for example, medical malpractice, products liability, and workplace lawsuits.

What are the Symptoms of a Brainstem Injury?

A traumatic brain injury affects the damaged part of the brain’s ability to carry out its normal functions. Symptoms of a TBI may include headache, confusion, fatigue, blurred vision, habit changes, loss of consciousness, sensitivity to light and sound, and nausea. More severe injuries result in persistent headaches, speech problems, seizures, repeated vomiting, prolonged loss of consciousness, enlarged pupils, numbness, clumsiness, and confusion.

Some of the terms used to describe brain injuries include:

  • Lesion: Term referring to damage on any part of the brain, may get progressively worse
  • Stroke: When blood supply to part of the brain is reduced or disrupted due to blocked or ruptured blood vessels
  • Anoxia/Hypoxia: Decreased supply of oxygen to the brain
  • Hemorrhage: Bleeding in the brain; a type of stroke caused by a burst blood vessel, can be caused by high blood pressure or trauma
  • Ischemia: Limited blood flow to the brain; a type of stroke caused by a blood clot or an otherwise blocked blood vessel
  • Concussion: Mild brain trauma that causes temporary headaches, nausea, confusion, lack of coordination, fatigue, dizziness, and ringing in the ears
  • Laceration: When brain tissue is cut or torn by an object, such as pieces of the skull
  • Herniation: When the brain bulges through an opening
  • Shearing/Diffuse Axonal Damage: The shearing, or tearing, of long nerve fibers (axons) caused by severe movement/shifting/rotating of the brain inside the skull
  • Hematoma/Contusion: A bruise; a collection of pooled blood, puts damaging pressure on the brain
  • Ataxia: Lack of coordination and poor speech that can mimic drunkenness
  • Encephalitis/Encephalopathy: A general term describing diseases and conditions that affect the brain
  • Meningitis: Inflammation of the meninges, the membranes that cover the brain and spinal cord, caused by a viral or bacterial infection

Damage to the brainstem is not likely to occur in isolation. However, the specific effects associated with brainstem injuries have to do with the brainstem’s structures and function. Examples include:

Cranial Nerve Defects/Sensory Loss: These defects are characteristic of brainstem lesions. May affect swallowing, salivation, chewing, taste, vision, hearing, speech, balance, heart, facial expressions, and back/neck muscles. May cause facial paralysis/numbness.

Movement Disorders: A stroke or other damage to the brainstem can cause hemiparesis, weakness on one side of the body, or quadriparesis, weakness in all four limbs. Ataxia is another potential condition that impairs an individual’s balance and coordination. Spastic hypertonia is another such disorder characterized by muscle spasms that are made worse by movement. Victims may also experience tremors, involuntary twitching movements which occur in the hands, arms, eyes, face, head, and legs. Drop attacks, or sudden falls to the ground, are also possible.

Respiratory and Cardiac Problems: Brainstem injuries can cause irregular heartbeats, blood pressure fluctuations, and breathing problems.

Sleep Problems: Damage to the brainstem has been tied to sleep apnea and chronic fatigue syndrome.

Cognitive Impairment: Brainstem injuries are severe and lifechanging, possibly altering memory, attention, executive function, spatial skills, intellectual capacity, language, and even personality traits.

Loss of Consciousness: Lesions in the brainstem can cause comas due to the role of the reticular formation in consciousness.

Can You Recover From a Brainstem Injury?

A brainstem injury is a medical emergency. Many patients are immediately operated on to stop any bleeding. Others fare better when surgery is postponed until the right moment. Patients are closely observed to make sure that lesions, hematomas, and contusions are not getting larger.

Since little can be done to reverse brain damage, the main goal of medical treatment is to prevent a secondary injury. The primary injury is the original cause of trauma, e.g. a car accident or stroke. However, as time passes, a domino effect can cause an injury to worsen. Doctors carefully monitor swelling and oxygen flow for days or weeks after a patient is admitted to the hospital.

Damage to the brain has different effects on the body depending on the location of the injury. In general, injuries to the brain have debilitating or deadly effects. In cases of TBI, the presence of damage to the brainstem is considered by many to be a bad sign since the brainstem is so vital to survival.

A marker called the Glasgow Coma Scale is widely used to predict how a patient will recover from a head injury. It measures a patient’s eye-opening, verbal, and motor responses. Many patients with TBIs recover fully. In severe TBI cases, as is likely with brainstem injuries, around 30% of patients do not survive, and very few remain in comas. 25% have good recoveries. The remainder have some degree of disability.

Researchers are investigating new therapies to improve the prognosis for traumatic brain injury victims. We now know that the brain is “plastic.” In other words, it can reorganize itself and change throughout life, sometimes in order to compensate for an injury. Stem cells, which are able to take the form of different cell types, may also be useful for healing brain damage.

Verdicts & Settlements

Below you will find verdicts and settlements that plaintiffs with brainstem injuries have won in the past. These examples are taken from other law firms from around the country. Your case is unique and there is no formula that can tell us how much a case will be worth. However, as you can see, brainstem injury cases often value in the millions of dollars. This is due to the severity of the injury and the fact that many of the plaintiffs require expensive, involved, and prolonged medical care.

  • 2019, New York: $3,860,000 Verdict A man goes to the ER because earlier in the day, he experienced facial drooping, weakness on the left side of his body, and slurred speech. The only symptoms he still has when he arrives at the ER are dizziness and sinus problems. The defendant physician diagnoses the man with a sinus infection and vertigo. The next week, his symptoms still present, he goes to his family practice. A specialist there orders that he comes back the next day for MRI testing. However, overnight, the man suffers a cerebellar and brainstem stroke caused by a vertebral dissection, a tear in a neck artery that results in a blood clot and disruption of blood flow to the brain. As a result, he has difficulties using the left side of his body, a burning sensation in his face, and uncontrolled, repetitive eye movements. He will not be able to return to work. The man alleges that the physicians at the hospital and family practice negligently failed to diagnose the impending vascular dissection. In its defense, the hospital claims that the plaintiff did not properly communicate symptoms such as slurred speech that would have alerted them to the possibility of a stroke. Since the family practice recorded a conversation with the plaintiff’s sister in which they advised her to take the man back to the ER, they are not found to be negligent. However, the hospital and its physicians are found negligent, and the man is awarded nearly $3.9 million.
  • 2019, California: $12,600,000 Verdict A 32-year-old man, employed as a welder, calls the police one evening. He is in his own room and claims that people are sleeping in his bed. He is slurring his words, and it is clear that he is hallucinating. For weeks, he has been ill with a pulmonary infection was acting strangely according to his roommates. The police conclude, after speaking with him and noting several empty beer cans in his room, that he is just drunk. Hours later, he stumbles out onto the street and two passersby call 911 because he looks ill and is requesting an ambulance. However, the same cops show up and, allegedly, relieve the paramedics before they can finish their medical examination. They take him into custody for 13 hours, during which time his condition deteriorates, and he falls and hits his head twice. Finally, he is taken to the hospital and is diagnosed with a life-threatening stroke, likely due to a series of falls. After all the man has already been through, the medical staff at the hospital increase his low sodium levels too quickly, resulting in another brain injury called osmotic demyelination syndrome (ODS). ODS is the destruction of the outer protective layer of neurons in the pons of the brainstem. After this incident, the plaintiff has extensive cognitive and movement disabilities. Despite the defense’s argument that the plaintiff’s alcohol problem was responsible for what happened, several doctors and experts claimed that alcohol had nothing to do with his overall outcome. The verdict awards the plaintiff $4,600,000 in economic damages and $8,000,000 in non-economic damages.
  • 2019, New Jersey: $5,100,000 Settlement The plaintiff, 53 at the time, goes to the ER. Signs point to brain bleeding, such as confusion, sluggishness, headache, and a score on the Glasgow scale that continues to worsen. However, the physicians do not order a CT-scan to look for bleeding, and instead place her under psychiatric care. She has a history of bipolar disorder, but her symptoms—which also include slurred speech and altered mental status—should have made physicians know to check for brain issues. Additionally, her family insists that it is a stroke, not a psychiatric episode, that she is experiencing. Since a CT-scan is not immediately ordered, the severe stroke she is having goes undiagnosed for hours, causing excessive bleeding and possible brainstem herniation. She suffers from brain damage and must live in a group home due to her cognitive impairments. This case, involving the defendant nurses, hospital resident, and emergency practice group, settles prior to trial at $5.1 million.
  • 2019, Ohio: $1,500,000 Settlement A young woman with a congenital spinal defect, chronic scoliosis, and a Chiari II malformation—when the cerebellum and brainstem protrude through the base of the skull—undergoes surgery to repair the Chiari II malformation. The surgeon does not properly perform the procedure, causing her to suffer cranial nerve palsies, paralysis of her face and eyes, severe headaches, nausea, weakness, and an inability to swallow. The surgery was intended to “decompress” the area. By removing part of the skull, the surgery should have relieved pressure on the brain tissue. However, the surgeon put in titanium plates, filling some of the extra space he had just created by removing a portion of the skull. An expert testified that this was an inappropriate decision. Furthermore, the surgeon fails to properly notify the woman and her family that the surgery did not work. She and her parents are awarded $1.5 million. Her parents are included in the settlement because they claim “loss of consortium,” the loss of their daughter’s companionship and association.
  • 2018, Washington: $1,000,000 Settlement The two plaintiffs, a man and a woman, are driving on a motorcycle down a highway in the state of Washington. Ahead of them, oil containers fall off of a truck. The plaintiffs hit the oil spill and the man loses control of his motorcycle. He is pinned under the bike and the woman is thrown onto the roadway. She does not survive her injuries. The man suffers a severe TBI, including a hemorrhage of the midbrain section of the brainstem, a punctured lung, and a facial fracture. He will require life-long care. The man and the woman, who is represented posthumously, sue the trucking company for not properly securing the oil containers. They are collectively awarded $1 million, which in this case was the insurer Progressive’s policy limit.
  • 2018, California: $1,580,000 Settlement A 39-year-old woman who is 40 weeks pregnant is admitted to the hospital by her physician because she has symptoms of pre-eclampsia, a dangerous pregnancy complication involving high blood pressure. She does indeed have pre-eclampsia but is discharged that same day from the hospital. Two days later, she returns to the hospital because she is in labor. Throughout the delivery of her baby, nurses note her deteriorating condition, reporting it to attending physicians. She is given magnesium sulfate in order to reduce the risk of seizure. Shortly after an emergency C-section, testing reveals that she has no brain activity—she suffered brainstem and cerebellar hemorrhages due to her pre-eclampsia. After the woman’s death, her family files suit against the medical professionals who cared for her. They allege that she should have been induced when pre-eclampsia was first discovered and that she was discharged from the hospital without the appropriate testing. Additionally, they allege that during her delivery, the nurses and doctors should have acted faster and administered certain medications to reduce her blood pressure. The defendants settle for $1.6, a sum intended to benefit the woman’s child.

If you or a loved one was injured through the negligence or malice of another, call us at (800) 553-8082 or submit a free online consultation. Our experienced lawyers may be able to help you win a substantial settlement for present and future medical bills, loss of income, pain, and suffering.

SourcesSupporting Literature

Clinical Consequences of Stroke” by Robert Teasell and Norhayati Hussein, Evidence-Based Review of Stroke Rehabilitation, 2018.

A Clinical Research Study of Cognitive Dysfunction and Affective Impairment after Isolated Brainstem Stroke” by Xiujuan Fu et al., Frontiers in Aging Neuroscience, 2017.

Neuroplasticity after Traumatic Brain Injury” by YouRong Sophie Su in Translational Research in Traumatic Brain Injury, 2016.

Severe Traumatic Head Injury: Prognostic Value of Brain Stem Injuries Detected at MRI” by A. Hilario et al., American Journal of Neuroradiology, 2012.

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