What will happen with brainstem hemorrhage?

Written by Zhang Hui
Neurology
Updated on December 16, 2024
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Brainstem hemorrhage is a very dangerous disease because the structure of the brainstem is so crucial. It contains the life centers responsible for breathing and heartbeat, as well as sensory and motor nerve fibers passing through it. If the brainstem hemorrhage is severe and the amount of bleeding is large, the patient may experience paralysis of the limbs, swallowing dysfunction, and choking on water, among other symptoms. If the condition worsens, it can lead to coma, persistent high fever, and even death. Patients with minor brainstem hemorrhages may exhibit symptoms such as dizziness, nausea, vomiting, numbness in the limbs, and paralysis. Generally, brainstem hemorrhages are caused by hypertension, which must be well controlled.

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Written by Chen Yu Fei
Neurosurgery
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The critical period for brainstem hemorrhage is several days.

For patients with brainstem hemorrhage, the first week after the onset is a critical period. During this time, the bleeding may gradually increase, and secondary cerebral edema may occur, leading to dysfunction of the brainstem and even respiratory and circulatory failure, which can endanger the patient's life. Therefore, for these patients, it is crucial to closely monitor any changes in their condition, transfer them to the intensive care unit, and closely monitor their vital signs. Special attention should be paid to the patient's blood pressure, respiration, heart rate, pupil reactions, consciousness, and limb activity. Dynamic follow-up head CT scans should be performed to observe any changes in the condition.

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Written by Li Qiang
Intensive Care Unit
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Why does gastric bleeding also occur when there is bleeding in the brainstem?

This brainstem hemorrhage, as well as other severe cranial traumas or cerebral hemorrhages, if they cause a severe intracranial hypertension, will lead to a condition called stress ulcer, commonly known as Cushing's ulcer. This occurs because the increased intracranial pressure causes ischemia and hypoxia in the gastric mucosa, which then leads to localized, extensive necrosis of the gastric mucosa, resulting in upper gastrointestinal bleeding. This includes brainstem hemorrhages and many other cranial injuries and cerebral hemorrhages with intracranial hypertension as a very common complication. Therefore, it is due to the local ischemia of the gastric mucosa caused by increased intracranial pressure, leading to bleeding caused by gastric acid corrosion.

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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 Chen Yu Fei
Neurosurgery
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Can you survive with 10 milliliters of bleeding in the brainstem?

A brainstem hemorrhage of 10 milliliters is relatively significant; whether the patient can survive depends on specific circumstances. First, it must be determined if the hemorrhage has compressed important neural nuclei, causing apparent respiratory and circulatory dysfunction. If such dysfunction occurs, it could severely threaten the patient's life. Additionally, the patient's level of consciousness and the availability of timely and effective treatment, along with necessary life support, must be considered. For example, if respiratory and circulatory dysfunction arises, it might be appropriate to use vasopressors to maintain blood pressure and ventilators to assist breathing. If effective life support is available, it is often possible to survive the peak period of swelling and preserve life.

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Written by Gao Yi Shen
Neurosurgery
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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.