Midbrain syndrome is the result of an increase in intracranial pressure in the median cranial fossa and is associated with compression of the midbrain structure. The most common causes of the syndrome are bleeding and edema. Treatment is usually in intensive care and, in addition to maintaining vital functions, includes a mostly neurosurgical pressure reduction.
What is midbrain syndrome?
The mesencephalon forms part of the brainstem. Neurologists also refer to the part of the brain between the pons and diencephalon as the midbrain. Railway systems and nerve nuclei, which are vital for humans, are located in the midbrain. Midbrain syndrome includes pressure damage to the midbrain, which can be accompanied by various symptoms. See ablogtophone for MMND which stands for Motor Neuron Disease Madras.
An increase in intracranial pressure primarily forms the framework for acute midbrain symptoms. With increasing intracranial pressure, brain structures can leave their physiological position and be squeezed. As a rule, the midbrain gets stuck in the tentorium cerebelli, the so-called cerebellar tent.
This is a transverse meningeal structure between the occipital lobes in the supratentorial space and the cerebellum in the infratentorial space. The brain section can only become jammed after an increase in pressure in the area of the fossa cranii media. The causes for an increase in pressure in this area can be of different nature.
An acute midbrain syndrome is preceded by cerebral pressure-increasing processes such as edema formation. Such edema formation can occur as part of various diseases, such as brain tumors, cerebral infarctions or toxic ischemia. A stroke can also result in cerebral edema.
In principle, however, strokes and tumors can also result in a midbrain syndrome without accompanying edema formation. All of the processes mentioned increase intracranial pressure. There is limited space within the skull. Leaking blood during a stroke takes up more or less space.
The same applies to masses in the brain and accumulation of water in the sense of edema. Since the brain structures can hardly move within the cranial cavity, they are pushed against each other and get stuck. The result can be the midbrain syndrome.
In individual cases, CSF outflow disorders are also the primary cause of an obstruction. The cerebrospinal fluid that flows around the central nervous system is called liquor. In individual cases, the midbrain syndrome can also be caused by craniocerebral trauma, poisoning or cardiac arrest.
Symptoms, Ailments & Signs
From a clinical point of view, midbrain syndrome can be divided into three different stages, each characterized by different symptoms. Basically, there is a progressive loss of consciousness. In addition, there is a loss of pupillary reflexes over the course of the disease. The initial stage is characterized by tachycardia and pathological Cheyne-Stokes respiration.
Those affected sweat and no longer have any pain stimulus reactions. Pathological reflexes set in. For example, the Babinski signs are positive. In the third stage of acute midbrain syndrome, patients suffer from rigid pupils. In addition, stretch synergisms occur in the form of a so-called decerebration rigidity. This symptom is explained by the failure of all inhibitory pathways.
The reflexes are overactive in this phase. This is also referred to as hyperreflexia. Since the midbrain syndrome ends in a coma during the third stage, the vital functions of the patients are threatened in the late course of the syndrome. In the case of progressive damage due to an increasing increase in intracranial pressure, the midbrain syndrome usually transitions smoothly into a life-threatening bulbar brain syndrome.
Diagnosis & course of disease
The neurologist receives the first indications of a midbrain syndrome from the anamnesis. The standard reflex check confirms the first suspected diagnosis. To confirm the diagnosis of a midbrain syndrome, the neurologist uses imaging diagnostics. In most cases, he will order an MRI. The midbrain congestion is clearly visible on the tomogram.
A measurement of the intracranial pressure is absolutely necessary if there is a corresponding indication. The measurement is continuously repeated over the course of the course in order to be able to detect a continuous increase in pressure as early as possible and to be able to intervene. The prognosis for patients with midbrain syndrome depends on the time of diagnosis. Diagnosis in the first stage has a positive prognostic effect.
As a result of the midbrain syndrome, patients experience various limitations and complaints. These can lead to paralysis or other sensory disorders and thus have a very negative effect on the patient’s everyday life and quality of life. Those affected are often dependent on the help of other people in their everyday lives and are usually no longer able to carry out simple activities.
This often leads to rigidity and unusual breathing. Those affected can also fall into a coma and no longer actively participate in life. The midbrain syndrome can lead to very serious psychological problems and stress, especially for relatives, children or partners, so that they too are dependent on psychological treatment.
As a rule, treatment of midbrain syndrome can take place with the help of medication, which is usually aimed at the underlying disease. However, it cannot be generally predicted whether this will lead to a positive course of the disease. As a rule, the life expectancy of patients is not reduced or restricted by the midbrain syndrome.
When should you go to the doctor?
A disturbance of consciousness is a first sign of an existing brain disease. A doctor’s visit is required as soon as there are irregularities in consciousness, headaches or attention deficits. A drop in performance, problems with concentration or functional disorders should be examined by a doctor. If you lose consciousness, an emergency service must be alerted immediately.
Emergency care and intensive medical care for the person concerned are required. Medical tests are carried out so that the cause of the symptoms can be determined and treated. Those present are obliged to take first aid measures until the arrival of the emergency doctor. This is the only way to ensure the survival of those affected.
In the case of an irregular breathing activity, disturbances in the reflexes and heavy sweating, a doctor is required. In particular, the loss of pupillary reflexes must be discussed with a doctor. If there is a loss of pain sensitivity or existing symptoms increase in intensity, a doctor must be consulted. A pale complexion, apathy and apathy are signs of an existing disease.
Because midbrain syndrome can lead to a life-threatening condition, you should see a doctor if you start to feel unwell or sick. Disorders of memory, disorientation and losses in cognitive performance must be examined by a doctor.
Treatment & Therapy
The therapy of a midbrain syndrome depends on the stage and the cause of the phenomenon. The main focus of the treatment is to secure the vital functions. In addition, the cerebral metabolism must be kept going and the intracranial pressure must be monitored. Patients receive ventilation with controlled hyperventilation to maintain vital functions.
The conservative drug therapy corresponds to the administration of catecholamines. In addition, a volume substitution usually has to be carried out. Once the vital functions are stabilized, the reduction in intracranial pressure is the ultimate goal of therapy. The most effective method of lowering intracranial pressure depends on the primary cause of the increase in pressure. In addition to neurosurgical lowering, mannitol or ventricular drainage can be important starting points.
During the pressure reduction, it is not only the pressure conditions that have to be continuously monitored, but also the vital functions of the patient. This monitoring is done via intensive care monitoring. The elimination of the primary cause follows the acute drop in intracranial pressure. This cause is eliminated by means of neurosurgical intervention.
If the primary cause was, for example, leaking blood, the causal therapy is to remove the hematoma. In the case of causative masses, on the other hand, a tumor extirpation is carried out. Whether patients fully recover from midbrain syndrome depends on the severity of the contusions and the areas affected. Rehabilitation measures can promote the resolution of any long-term sequelae.
Outlook & Forecast
The midbrain syndrome offers a relatively poor prognosis and means a significant reduction in the quality of life for those affected. When the syndrome occurs, there is usually already significant brain damage, which leads to serious complications or the death of the patient. Severe symptoms such as increased intracranial pressure or coma often take a severe course. The patients have to be artificially ventilated and are usually not responsive.
If the course is positive, there is a chance of recovery, as long as no serious physical damage has occurred. In general, the prognosis depends on the timing of treatment and the severity of the causative traumatic brain injury. If the trauma is treated promptly by a doctor, the prognosis is better. If left untreated, midbrain syndrome is always fatal.
The responsible neurologist makes the prognosis in consultation with surgeons and other specialists. The severity of the trauma is included in the prognosis as well as the previous course and any physical and mental damage. The prognosis is relatively reliable, since organ damage that has already occurred can usually no longer be treated and a traumatic brain injury that has been overcome does not necessarily cause complications.
The midbrain syndrome can only be prevented to the extent that an increase in pressure in the area of the fossa cranii media can be prevented. The preventive measures in the context of cerebral infarction can, for example, be counted among the preventive measures in the broadest sense.
In most cases, the patient with midbrain syndrome has only very few and usually only very limited options for aftercare, so that the person concerned is primarily dependent on an early diagnosis and rapid treatment of this disease in order to avoid further complications and symptoms to prevent. It cannot heal itself, so treatment by a doctor is always necessary.
Most of those affected are dependent on surgery for midbrain syndrome. The affected person should rest after such an operation in any case, whereby bed rest must also be observed. It is also not uncommon for various medications to be taken to alleviate the symptoms.
The instructions of the doctor must be observed, whereby regular intake and also the correct dosage must be ensured. Most patients also need psychological support during treatment and are also dependent on the help of their own families in everyday life. No general prediction can be made about the further course of the midbrain syndrome, as this depends heavily on the time of diagnosis.
You can do that yourself
In most cases, those affected with midbrain syndrome have no options for self-help. Medical assistance is definitely needed to reduce and limit the discomfort and symptoms of this syndrome.
In many cases, the relatives or parents of the person affected also suffer from severe psychological problems or depression. Psychological treatment makes sense in order not to burden the patient with it. The loving help and care of relatives can also have a positive effect on the course of the midbrain syndrome. If the person concerned falls into a coma, no direct help can usually be provided. Daily care and prevention of mental health problems makes sense here. In the case of a midbrain syndrome, those affected are dependent on regular checks and examinations, which should be carried out above all at an older age or if the symptoms persist.
Since breathing is also negatively affected by the syndrome, the person concerned should take it easy and not do any strenuous or sporting activities. Unfortunately, it cannot generally be predicted whether the midbrain syndrome will lead to a reduced life expectancy.