MS Brain Stem and Cerebellar Attacks

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The second most common region for multiple sclerosis attacks is the brain stem-cerebellar area, making up approximately 38% of all relapses. There is a term called “Charcot’s Triad”, named after neurologist Jean-Martin Charcot, which describes the most prevalent symptoms resulting from these attacks: speech difficulties, compromised balance, and double vision. Brain stem-cerebellar attacks can cause any of the following symptoms in an MS patient:

Loss of Balance and Coordination

These problems can involve walking, rising to a standing position, using the legs, and/or using the arms and hands. MSers can have difficulties with walking and may sway to one side, or possibly experience vertigo or dizziness (along with nausea.) Loss of coordination, also referred to as ataxia, can affect the fine movements of the hands and make writing, combing one’s hair, and tying shoe laces very difficult. Another manifestation of this damage is an intention tremor, where the hand or hands shake. Patients also describe problems with clumsiness and the coordination of limbs.

Eye and Vision Abnormalities

There are two types of eye problems associated with brain stem and cerebellar attacks. The first is eye muscle jerking, or nystagmus, which causes vision to be “jumpy’” or moving. The second type is eye muscle weakness, or gaze palsy, which can cause double vision.

Speech and Swallowing Disturbances

Problems with speech, also known as dysarthria, can affect the rhythm or pronunciation of words. The slurring of words is one disorder, where a person might appear to be intoxicated. Rhythm can be affected too, and a patient may find herself “scanning” or speaking in a jerky or stuttering fashion. Problems with swallowing, or dysphagia, may also occur.

Trouble with Facial Muscles and Nerves

Weakness, muscle spasms, numbness, and pain may occur in facial muscles. A particular facial nerve that may be affected is the trigeminal nerve, which runs along both sides of the face. This can cause severe pain blasts or dull, achy pain along the cheeks and jawlines.

Tinnitus (Ear Pain and Ringing)

This is a less common problem. In severe cases, a loss of hearing may result. This is generally limited to one ear.

Emotional Disturbances

Inappropriate laughing, crying (emotional lability), and euphoria (exaggerated sense of wellbeing) can be noted with brain stem and cerebellar attacks. These symptoms are considered separate from multiple sclerosis depression, which appears to originate from damage to the cerebrum.


Rosner, Louis J., MD and Shelley Ross. Multiple Sclerosis: New Hope and Practical Advice for People with MS and their Families. Simon & Schuster: New York, NY, 2008.


  • You’ve really done a number on this site! Bravo! It’s not only informative, it’s just down right “purdy”, too.

    Linda D. in Seattle

  • Jen

    Thanks. I love going to your site because of its humor, but more so because of its author and her ways of thinking and writing.

  • Yeah it seems that is where my lesions are. I wonder if that is part of why I have felt so crappy emotionally of late is due to these lesions flaring up…

  • Jen

    Most of my own lesions are here and also along my C-spine and T-spine (my neuro suggested a T-spine MRI just to see what he was dealing with.)

  • Nancy

    I just wonder if having lesions on your brain stem means that eventually the mylien sheath will be completely destroyed and my brain can’t tell my lungs to breathe or my heart to beat. Lovely thought.

  • Jen

    Hi Nancy—

    To my knowledge, most MS patients do not experience extreme disability, such as the dysfunctioning of the lungs. Although the disease can progress over time, most MS is not fatal. It can be cumbersome, but there are pharmaceutical options for most patients to delay the onset of progressive disability. And there is no saying that the disease will significantly progress for every patient… Knowing this allows me to sleep at night.


  • My neuro advised me this week that I have a lesion in my brain stem region now. Yikes, I thought the whole time he talked. Hmm, wonder what he said.

    Thankfully, I found clear, concise info for simple minds like mine here that, well…even a person with a lesion on their brain stem could understand.

    Now I’m thinking “BookMark”.

    Be Well Everyone

  • Jen

    Thanks, Dan. And best wishes to you. Thank you for reading. : )


  • Marie

    Hello, just wanted to drop a line to tell you how much I liked your site. I found it very informTIVE. Thanks again.

  • Mary Anne Stima

    I am going for my second MRI next week, they saw something in my brain stem and want to do MRI with contrast. They are looking for MS, this websight is totally me with the walking , balance issues.
    So glad I found this.

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