How long can someone with brainstem hemorrhage and hemiplegia survive?

Written by Chen Yu Fei
Neurosurgery
Updated on September 03, 2024
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Patients with brainstem hemorrhage presenting with hemiplegia have varying life expectancies, which depend on their primary diseases. In cases of severe brainstem hemorrhage, extensive bleeding typically causes significant damage to brainstem functions. Patients often remain in a prolonged comatose state, which can even threaten their lives. However, if the brainstem hemorrhage is minor and accompanied by mild limb hemiplegia, it generally does not pose a significant threat to the patient's life. It is crucial to administer medication treatment promptly after the hemorrhage and to start early rehabilitation exercises for the affected limbs. If patients persistently continue these exercises, they often achieve good treatment outcomes and can enjoy a long-term, high-quality life.

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Written by Gao Yi Shen
Neurosurgery
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The acute phase of brainstem hemorrhage lasts for several days.

The acute phase of brainstem hemorrhage generally lasts about two to three weeks, or 14 to 21 days, but it also needs to be specifically assessed based on the different conditions of the patient. If the hemorrhage in the brainstem is relatively severe and located in an important functional area, then the critical period may be appropriately extended. For example, if the hemorrhage is in the medulla oblongata and has already caused respiratory and circulatory failure, as well as unstable vital signs and a comatose state, then the critical period could even reach about one to two months, because it is often necessary to use a ventilator to assist breathing, and the patient's comatose state does not allow for full consciousness. However, for some brainstem hemorrhages, such as a small hemorrhage in the pons that only causes the clinical symptom of headache in the patient, the critical period is generally no more than two weeks. Thus, each patient's condition is different.

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Written by Jiang Fang Shuai
Neurosurgery
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sequelae of brainstem hemorrhage

All the different sequelae of cerebral hemorrhage can potentially occur after a brainstem hemorrhage. This is because the brainstem is a critical link between the brain and the body, acting as the command center within the headquarters. Of course, whether sequelae will occur and which ones will occur after a brainstem hemorrhage primarily depends on the amount of bleeding and the location of the bleed. If the bleeding in the brainstem is minor and occurs in a less critical area, the sequelae are usually minimal, and some people might not experience any sequelae at all. However, if there is substantial bleeding in the brainstem and the area affected is crucial, the patient may remain comatose for a long period. Even if they are revived and regain consciousness, they may suffer from severe functional impairments and experience numerous sequelae.

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Written by Gao Yi Shen
Neurosurgery
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Brainstem hemorrhage blood pressure control range

The range of blood pressure control for brainstem hemorrhage must be specifically judged based on the current medical condition at the time. Generally speaking, it is optimal to maintain the systolic blood pressure between 110-120 mmHg. This can both ensure normal cerebral blood supply and reduce the risk of recurrent cerebral hemorrhage due to high blood pressure. However, each patient's baseline blood pressure is different, and many patients have a baseline systolic pressure higher than 180 mmHg. In such cases, it might be appropriate to adjust the target slightly higher, for instance around 130 mmHg. It is recognized that no one’s blood pressure can be perfectly consistent, so a certain degree of fluctuation is acceptable. Unless there are long-lasting high values, in which case, control within a certain range might be needed.

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Written by Zhang Hui
Neurology
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Is brainstem hemorrhage prone to recurrence?

Brainstem hemorrhage is perilous, and its recurrence largely depends on the cause and the management of risk factors. For instance, one significant cause of brainstem hemorrhage is the presence of certain arterial-venous malformations and sponge-like angiomas. Such conditions tend to recur if not surgically addressed promptly by removing these abnormal vessels, thereby reducing the likelihood of recurrence. Additionally, hypertension is the most common cause of brainstem hemorrhage. Long-term high blood pressure can damage arterial walls and lead to ruptures and bleeding. Stable control of blood pressure, alongside a low-salt, low-fat diet, can prevent recurrence of brainstem hemorrhage. However, poorly controlled blood pressure, resulting in severe fluctuations, can significantly increase the risk of recurrence.

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Written by Huang Lei
Physical Medicine and Rehabilitation
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How to rehabilitate through exercise after brainstem hemorrhage

Regarding the specific measures for rehabilitation exercises for brainstem hemorrhage, it is necessary to analyze specific problems based on the different conditions of the patients. Based on our past experience, several common symptoms of brainstem hemorrhage can be addressed with corresponding rehabilitation measures. The first one is swallowing disorder, which is very common in patients with brainstem hemorrhage. We can provide patients with electrical stimulation and ice stimulation, and teach them morning exercises such as cheek puffing, tongue stretching, and dry swallowing practices. The second common issue is articulation disorder, for which we can teach patients some speech training. Usually, we can prepare patients with rhythm, cadence, and deep breathing exercises for speech training. The third is the dysfunction of limb mobility. For specific activities, we need to conduct training, including some balance function training.