Which of the following symptoms might indicate a stroke has affected the brain stem?

When a stroke occurs in the brain stem, it can significantly impact vital functions and basic reflexes. The brain stem is responsible for controlling several essential functions, including respiratory regulation, heart rate, and the coordination of movements, as well as the reflexes associated with swallowing. Therefore, difficulty swallowing, also known as dysphagia, is a common symptom when a stroke affects this area. It indicates that the pathways responsible for the swallowing reflex and coordination of muscles involved in swallowing are disrupted.

The other symptoms, while potentially relevant in the context of various types of strokes, are less specifically associated with the brain stem. Impaired judgment may relate more to higher cognitive functions affected by strokes in different brain regions. Loss of consciousness can occur with strokes but is not exclusively tied to brain stem involvement and could also occur due to severe effects on widespread brain areas. Difficulty speaking, or dysarthria, can arise from strokes affecting different parts of the brain, particularly in the left hemisphere affecting language centers, rather than specifically indicating brain stem involvement. Thus, difficulty swallowing is a direct and often significant indicator that a stroke has affected the brain stem.