How to rescue brainstem hemorrhage?

Written by Zhang Hui
Neurology
Updated on May 25, 2025
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Brainstem hemorrhage is an extremely dangerous disease. Patients typically have a long history of hypertension, and their blood pressure is not particularly well-controlled. The onset of the condition is sudden, and if the bleeding is extensive, it can quickly lead to unconsciousness and even respiratory and cardiac failure, resulting in death. It is crucial to rush the patient to the nearest hospital for emergency treatment to avoid aggravating the brainstem hemorrhage due to bumps during a long transport. Generally, the patient should be kept in a supine position, and if they are still conscious, it is vital to keep their emotions stable. Additionally, it is necessary to ensure the airway remains clear. If respiratory failure occurs, ventilation can be provided. Medications that reduce intracranial pressure can be administered to alleviate brainstem edema. Furthermore, respiratory stimulant drugs can be given to ensure breathing. Overall, the mortality rate for brainstem hemorrhages is exceedingly high, with a lack of particularly effective emergency measures.

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Written by Li Qiang
Intensive Care Unit
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Is vomiting severe in brainstem hemorrhage?

Vomiting after brainstem hemorrhage is definitely a serious matter because if the vomiting is caused by a brain-related issue, it is due to increased intracranial pressure. This type of vomiting is characterized as projectile vomiting, which is one of the three major signs of increased intracranial pressure. If the brainstem hemorrhage is extensive, it may cause local stimulation leading to cerebral vascular spasm, or issues such as obstructed brain circulation resulting in increased intracranial pressure and hydrocephalus. This increase in intracranial pressure, especially if prolonged, can lead to brain herniation, which is particularly deadly if it compresses the brainstem. Therefore, this is a very urgent and serious condition that requires immediate attention. Of course, if the vomiting is solely due to other reasons such as gastric retention or improper feeding, that would be a different matter. Projectile vomiting caused by increased intracranial pressure is highly severe.

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Written by Gao Yi Shen
Neurosurgery
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What causes brainstem hemorrhage?

In clinical practice, the main factor causing brainstem hemorrhage is hypertension. Some secondary factors include diabetes, hyperlipidemia, smoking, drinking, and other unhealthy lifestyle habits. These factors combined can more easily lead to brainstem hemorrhage. Among them, hypertension has the most significant impact. Continuous rise or fluctuation of blood pressure can easily cause vascular fluctuations, especially damaging the inner lining of the vessels and leading to arteriosclerosis. The brainstem is supplied by the basilar artery, and the pontine arteries branch vertically from the brainstem. When blood pressure rises, it seldom reduces the impact on the vessels and can directly cause the vessels to rupture, resulting in bleeding in the brainstem, which is the primary cause. Therefore, it is crucial to strictly control blood pressure in patients with brainstem hemorrhage to reduce the likelihood of recurrence later.

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Written by Chen Yu Fei
Neurosurgery
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Signs before death from brainstem hemorrhage

For patients with brainstem hemorrhage, if the patient's life is in danger, they often exhibit some special clinical manifestations. For example, the patient may present with apparent consciousness disturbances, characterized by moderate to severe coma states. In this state, the patient is unaware, unable to open their eyes or speak. When subjected to strong painful stimuli on their limbs, there is often no significant response, or it may just cause muscle twitching. Additionally, patients with brainstem hemorrhage may exhibit severe disturbances in vital signs as they approach death, characterized by shallow, rapid, and weakening spontaneous breathing, sometimes even ceasing, often requiring ventilator support. Also, difficulty in maintaining blood pressure may lead to a sudden drop in pressure or even shock.

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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 Chen Yu Fei
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Is a high fever serious with brainstem hemorrhage?

For patients with brainstem hemorrhage who develop a high fever, it is first necessary to consider that the hemorrhage has affected vital central nervous system functions, leading to central fever. In such cases, the fever typically exceeds 38.5 degrees Celsius, and may even reach high fevers of 39 to 40 degrees Celsius, which are difficult to reduce with ordinary antipyretic drugs. Additionally, some patients with brainstem hemorrhage may also have concurrent lung infections, which can lead to recurrent high fevers exceeding 38.5 degrees Celsius. In such situations, it is advisable to perform a blood test for routine blood work. Furthermore, it is also important to monitor for any local inflammation, auscultate the lungs, and determine if the lung sounds are coarser or if there are any dry or wet rales in both lungs.