Brainstem hemorrhage CT imaging findings

Written by Chen Yu Fei
Neurosurgery
Updated on September 28, 2024
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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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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.

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Precursor warnings of brainstem hemorrhage

The warning signs of brainstem hemorrhage must be analyzed according to the situation. Clinically, many people have induced brainstem hemorrhage due to straining during defecation or becoming emotionally agitated during arguments. It is quite common for someone to suddenly collapse and become unconscious after an argument, which is likely indicative of a brainstem hemorrhage. Additionally, one may experience severe headaches without any obvious triggers, along with numbness or weakness in the limbs and speech impairments. Furthermore, signs of coma often appear. If a patient's coma is accompanied by pinpoint pupils, it is crucial to get them to a hospital for appropriate examinations immediately, as this is very likely a precursor to brainstem hemorrhage.

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Brainstem hemorrhage is what?

There are many causes of brainstem hemorrhage, and clinically, it is mostly considered to be caused by hypertensive cerebral hemorrhage. Patients have a history of hypertension and have not received regular and effective antihypertensive treatment, leading to suboptimal blood pressure control. Excessively high blood pressure often results in the weakening or even disappearance of the patient's own vascular regulatory functions. Under certain triggering factors, such as fatigue, exhaustion, mental stress, or overly intense emotions, the blood pressure within the vessels may exceed their own regulatory capabilities, making bleeding more likely. If the bleeding occurs in the brainstem, it manifests as a brainstem hemorrhage. In some patients, brainstem hemorrhages are caused by conditions like cavernous angiomas, aneurysms, or arteriovenous malformations.

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How is brainstem hemorrhage treated?

Brainstem hemorrhage is extremely dangerous and must be treated as soon as possible. The treatment plan mainly includes: the patient must rest in bed, avoid emotional stimulation, ensure smooth bowel movements, and must strengthen turning over and patting the back to prevent serious complications such as bedsores and pulmonary infections. In terms of medication, it mainly involves providing drugs that protect brain cells and nourish brain nerves. Additionally, because patients with brainstem hemorrhage have high intracranial pressure, it is necessary to administer dehydrating drugs to reduce intracranial pressure. Moreover, once the patient's vital signs stabilize, treatments such as acupuncture and rehabilitation training are needed to promote the recovery of neural functions. If the patient experiences respiratory failure, it is necessary to promptly use a ventilator for treatment. Furthermore, patients with brainstem hemorrhage who are bedridden for a long period can develop complications such as pulmonary infections and urinary system infections. If these complications occur, timely use of antibiotics is necessary to control the complications.

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How long do you have to stay in the ICU for a brainstem hemorrhage?

The length of stay in the ICU for brainstem hemorrhage depends entirely on the patient's specific condition. Generally, as long as the patient's breathing is stable and they can breathe on their own, and all other vital signs are relatively stable, they can be transferred out of the ICU. However, this depends on the patient's condition at the time. Many patients are admitted to the ICU typically due to poor breathing and lack of autonomous respiration. If a ventilator is used and the results improve, they may then be transferred out. Some may be out in a week, while others may need one to two months. It is also crucial to determine whether they have developed ventilator-associated pneumonia, lower limb venous thrombosis, or other more severe clinical manifestations, so decisions should be made based on these conditions for accuracy.