Causes of brainstem hemorrhage

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 23, 2024
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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.

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Written by Jiang Fang Shuai
Neurosurgery
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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.

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Written by Gao Yi Shen
Neurosurgery
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Can bleeding in the brainstem be saved?

The causes of brainstem hemorrhage can mainly be divided into three categories, The first category is caused by hypertensive factors, which are often the most common cause. The second category is caused by vascular diseases, among which cavernous hemangiomas and arteriovenous fistulas are most common. The third category includes relatively rare diseases, which should not be overlooked in clinical practice, such as tumoral factors. For these, specific examinations must be conducted to accurately determine the cause of the bleeding. Whether treatment is possible depends on the specific circumstances at the time. If the amount of bleeding is relatively small and the area affected is not a critical functional zone, such as the medulla, there is still a possibility of treatment later on. Active surgical and medical treatments can lead to healing later on. However, if the brainstem hemorrhage has already caused cessation of breathing and circulation, generally, there is no need for treatment as such conditions often lead to respiratory and circulatory failure, resulting in death.

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Written by Gao Yi Shen
Neurosurgery
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How many milliliters of brainstem hemorrhage are fatal?

Brainstem hemorrhage does not have a specific volume that can be fatal; the brainstem is the central hub for respiration and circulation in the human body, including the medulla, midbrain, and pons. For the pons and midbrain, a hemorrhage of five milliliters can be fatal. For the medulla, which is very narrow and densely packed with neural tissue, even one milliliter of bleeding can suddenly cause the patient's respiration and circulation to stop. Therefore, even one milliliter of brainstem hemorrhage is an immeasurable loss, and brainstem hemorrhages should be classified as critically severe. Immediate hospitalization and treatment are crucial to achieve a relatively better prognosis.

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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 Gao Yi Shen
Neurosurgery
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How long does it take for a brainstem hemorrhage clot to be absorbed?

In general, the absorption time for a brainstem hemorrhage clot is around two to three weeks. During this period, several phases must be passed, with the two main ones being the rebleeding phase and the brain swelling phase. Rebleeding often occurs within three days after the initial bleeding. If not treated promptly during this time, it can easily lead to further brainstem hemorrhage, increasing the size of the clot and hindering the later absorption process. The second phase is the peak of brain swelling and vasospasm. During this phase, certain substances released during the absorption of blood vessels and clots can cause swelling and spasms of the surrounding tissues. If this phase is also safely navigated, then subsequent absorption tends to be relatively quicker. However, complete absorption generally requires at least two to three weeks.