Is brainstem hemorrhage serious?

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 28, 2024
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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.

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Written by Gao Yi Shen
Neurosurgery
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How long does it take to wake up from a coma caused by brainstem hemorrhage?

The timing of awakening after a coma caused by a brainstem hemorrhage must be judged based on the situation. As brainstem hemorrhages are relatively severe, there is generally no possibility of awakening if the patient's breathing, heartbeat, and circulation are not stable. If the patient can breathe normally off a ventilator and has a normal heartbeat and other vital signs, and pupil responses are also normal, then typically, they may awaken within one to two weeks. However, recovery times vary from person to person depending on the specifics of the condition, the location of the hemorrhage, and the surrounding tissue involved. Therefore, assessments should be made based on specific clinical signs at the time. Particularly with hemorrhages in the medulla oblongata, once coma ensues, it's often impossible to fully awaken the patient, and many succumb to complications later on. Therefore, adequate psychological preparation is essential in clinical settings.

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Written by Chen Yu Fei
Neurosurgery
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Brainstem hemorrhage CT imaging findings

For patients with brainstem hemorrhage, a head CT generally shows irregular high-density shadows in the brainstem area, which are mostly seen in acute fresh brainstem hemorrhages. When the condition of brainstem hemorrhage is relatively stable, low-density shadows may appear around the high-density shadows, which at this time are considered to be due to the presence of surrounding edema. When the patient's condition is stable, a follow-up CT of the brainstem one to two weeks later often shows a gradual reduction in the density of the original high-density shadows, indicating that the hematoma of the brainstem hemorrhage has entered the hematoma absorption phase. In the later stable condition of the disease, as the hematoma is gradually absorbed, the density will also gradually decrease.

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Written by Zhang Hui
Neurology
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How to nourish the body after a brainstem hemorrhage

Brainstem hemorrhage is a very dangerous condition. If the bleeding is substantial, the patient may quickly fall into a coma or even die. If the bleeding is less severe, the prognosis might be relatively better. Patients with brainstem hemorrhage typically experience impaired swallowing functions, showing symptoms like inability to swallow food, difficulty in consuming water, and coughing while drinking. Therefore, it is crucial to supplement nutrition. Primarily, a feeding tube can be inserted for hydration and feeding, with the intake mainly consisting of easily digestible foods such as millet porridge, rice porridge, soybean juice, milk, etc. Additionally, it is important to supplement the patient with fresh vegetables and fruits to ensure an adequate supply of vitamin C. Furthermore, high-quality proteins like lean meat and beef should be provided to ensure adequate protein intake for patients with brainstem hemorrhage.

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Written by Chen Yu Fei
Neurosurgery
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What fruits to eat for brainstem hemorrhage

For patients experiencing brainstem hemorrhage, during the acute phase, if the patient shows significant swallowing dysfunction, it is not appropriate to eat fruits. Instead, you can wait until the patient's condition is stable. At that point, fruits can be juiced, and most of the pulp can be filtered out using a sieve. The fresh juice can be given to the patient to drink. However, it is important to note that if the patient has significant difficulty swallowing and coughs while drinking, this method is not suitable. Once the patient's condition stabilizes, it may be appropriate to gradually introduce some fresh fruits. Common fruits available in the market, such as apples, bananas, and oranges, are usually suitable. It's best to avoid or limit consumption of certain special fruits like durian or mango.

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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.