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Brainstem hemorrhage
Is brainstem hemorrhage serious?
Brainstem hemorrhage is caused by the rupture of small blood vessels in the brainstem, with common causes including hypertension, cerebral arteriosclerosis, vascular degeneration, and microaneurysms of vessels. Clinically, it manifests as sudden onset of consciousness impairment, confusion, coma or deep coma, accompanied by disorders of limb sensory and motor functions, eye movement disorders, and unstable vital signs, among others. If the hemorrhage occurs in the medulla, it can cause death by stopping the patient's heartbeat and breathing within a short period. Brainstem hemorrhage is a severe condition in neurology, and treatment focuses on bed rest to stop bleeding, reducing intracranial pressure, and treating complications. Despite advances in modern medicine, medical professionals often find themselves powerless in the face of many patients with brainstem hemorrhage. For brainstem hemorrhages with more than three milliliters of blood, most patients ultimately succumb to the condition. Therefore, brainstem hemorrhage is a very serious disease with a very high mortality rate in clinical settings.
How to exercise swallowing after a brainstem hemorrhage
Patients with brainstem hemorrhage often have critical conditions. Therefore, after stabilizing their condition, their swallowing function is usually severely impaired. During swallowing training, besides the common use of medications and acupuncture treatment, professional swallowing therapists in a formal rehabilitation medicine department conduct training on swallowing functions. Before starting swallowing training, an accurate assessment of swallowing function is typically conducted first. Swallowing disorders are divided into four stages: the preparatory stage, the oral stage, the pharyngeal stage, and the esophageal stage. In the preparatory stage, coordinating the consistency of the food can aid the patient's swallowing. Proper stimulation of the oral and pharyngeal muscles, including stimulation of the tongue and pharyngeal wall muscles, cold therapy, tongue pressure training, and training of the muscles around the mouth, are used to help restore swallowing function. During the esophageal stage, when the patient's condition has stabilized, videofluoroscopic swallow study can be carried out to assess specific issues in the esophageal stage, which are often related to cricopharyngeal dysfunction. Esophageal dilation with a balloon may also be used. With these accurate assessments and appropriate training, the swallowing function of patients generally shows significant improvement. Therefore, when patients experience these swallowing dysfunctions, it is best to seek treatment from a formal rehabilitation medicine department for better care.
What should the blood pressure control be for brainstem hemorrhage?
For patients with brainstem hemorrhage, it is important to maintain stable blood pressure after the bleeding. The ideal blood pressure should be controlled between 130/80 and 140/90. This is because the blood pressure should not be controlled too low. If the blood pressure is too low, it can lead to insufficient perfusion pressure in the brain tissue or brainstem, thus exacerbating the state of brain tissue ischemia and hypoxia, which may aggravate the local brainstem ischemia and cause new brainstem infarcts. Additionally, blood pressure should not be too high, as excessively high blood pressure can lead to primary brainstem hemorrhage, coagulation dysfunction, and situations where bleeding is difficult to stop. Moreover, it can cause rebleeding of the brainstem, also known as secondary hemorrhage, which, once it occurs, can be life-threatening for the patient.
The difference between brainstem hemorrhage and cerebral hemorrhage.
Cerebral hemorrhage refers to any bleeding caused by the rupture of cerebral blood vessels. Based on the location of the bleeding, there is hemorrhage in the cerebral lobes, thalamic hemorrhage, cerebellar hemorrhage, brainstem hemorrhage, and so on. Consequently, brainstem hemorrhage is a type of cerebral hemorrhage. Because the brainstem is the life center of humans, even a small amount of bleeding can lead to severe consequences, and may even cause death. Therefore, brainstem hemorrhage is one of the most dangerous types of cerebral hemorrhage and has a very high rate of mortality and disability in clinical settings.
Why would there be bleeding in the brainstem?
Firstly, hemorrhaging can occur anywhere there are blood vessels. The brainstem is an important functional area of the human brain, connecting the cerebrum above and the spinal cord below, with the cerebellum closely positioned behind it. It serves as a crucial relay station for neural connections. This area is the control center of human life, managing vital functions such as breathing and heartbeat. Additionally, this area is densely packed with blood vessels. For patients with chronic hypertension, unstable blood pressure control can lead to degeneration and necrosis of the vessels, and even the formation of dissecting aneurysms or microaneurysms, which can cause the vessels to rupture and bleed under certain conditions. Like the vessels in other parts of the intracranial space, the blood vessels in the brainstem can also bleed. This is referred to as brainstem hemorrhage.
Causes of brainstem hemorrhage
The causes of brainstem hemorrhage mainly include the following aspects: The first aspect is hypertension; arteriosclerosis is the most important cause of brainstem hemorrhage because prolonged high blood pressure and continuous impact of blood flow easily lead to damage and disease of the blood vessels, forming small aneurysms. These aneurysms eventually rupture, causing brainstem bleeding. The second aspect is vascular malformations in the brainstem area, which are another major cause of bleeding. Most patients under 40 with normal blood pressure and no coagulation disorders can find vascular malformations in the brainstem area after undergoing DSA examinations following brainstem hemorrhage. The third aspect is heavy drinking leading to increased blood pressure, impaired liver function, abnormal coagulation, etc., ultimately causing bleeding in the brainstem area.
Can brainstem hemorrhage be cured?
For brainstem hemorrhages that have already occurred, the patient should be immediately taken to a local hospital. Initially, a cranial CT scan should be performed to determine the location and amount of bleeding in the brainstem. For minor brainstem hemorrhages, it is recommended to first use medication for treatment. This involves administering drugs that stop bleeding, enhance brain function, promote dehydration, and nourish the nerves, aiding in the gradual cessation of bleeding and the absorption of cerebral hematomas. Most patients can achieve very good treatment outcomes. However, if the brainstem hemorrhage is extensive, it often leads to severe brainstem dysfunction and typically has a poor prognosis.
What does it mean to perform a tracheotomy on a patient with brainstem hemorrhage?
In general, tracheostomy for brainstem hemorrhage refers to situations where the patient suffers from a degree of consciousness impairment, presenting in a state of stupor or coma, and it is anticipated that the patient's consciousness will not regain clarity in the short term. In such cases, we generally recommend performing a tracheostomy on the patient as soon as possible. Early tracheostomy can help smoothly suction deep phlegm and better protect lung function. Timely use of oxygen nebulization helps dilute the phlegm and promotes its expulsion, which is beneficial in preventing and treating pneumonia.
How long is the edema period for brainstem hemorrhage?
The edema phase of the brain stem generally lasts for two to three weeks, with the peak of swelling occurring around seven to ten days. For some patients, the swelling completely subsides nearly a month later. Only after the peak of the swelling has passed can patients be out of life-threatening danger. As the swelling gradually subsides, the patient's consciousness, vital signs, limb movements, eating, and other symptoms will also gradually improve. Once patients get through the swelling phase, we can start early bedside rehabilitation as soon as possible. In addition to using some drugs that nourish brain nerves, passive limb movements, proper limb positioning, early exercise, and acupuncture can all be started early to accelerate the patient's early rehabilitation and prevent complications such as muscle atrophy, relaxation, and dependent pneumonia, which can be improved early on.
Key Points in Nursing Care for Patients with Brainstem Hemorrhage
For patients with brainstem hemorrhage, due to the special location of the bleeding which affects crucial neural functions, these patients often need to be transferred to the intensive care unit (ICU) for examination and treatment. In the ICU, close observation of changes in the patient's condition is essential, along with monitoring vital signs including blood pressure, respiration, heart rate, and blood oxygen saturation. Nursing care should focus on the patient's pupils, consciousness, and limb activity. It is necessary to manage and stabilize the patient’s blood pressure, blood sugar, and blood lipids through medication, regularly draw blood, and analyze the patient’s biochemical system to prevent severe water and electrolyte disturbances.