Is it right to give up treatment for brainstem hemorrhage?

Written by Shu Zhi Qiang
Neurosurgery
Updated on December 24, 2024
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Brainstem hemorrhage discontinuing treatment could be appropriate in some cases. If the patient has extensive brainstem hemorrhage, particularly at the lower end of the brainstem, and has resulted in deep coma without response to any stimuli, with a Glasgow Coma Scale score of only 3, dilated pupils on both sides without any pupillary light reflex, and possibly no spontaneous breathing, the patient could be considered brain dead. According to international practice, treatment should not be pursued for patients who are brain dead, hence discontinuing treatment is appropriate for such patients. If the patient still has spontaneous breathing, then active resuscitation should be pursued, otherwise, it might be considered inhumane.

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Written by Tang Li Li
Neurology
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Is there any sensation before brainstem hemorrhage?

The most common cause of brainstem hemorrhage is generally hypertension. The mechanism by which hypertension causes bleeding is chronic long-term hypertension, leading to hyaline degeneration of the small arterial walls. Under the force of blood flow, these walls are prone to bulging, leading to the formation of microaneurysms. When blood pressure fluctuates sharply, especially when there is a significant increase, it can cause these microaneurysms to rupture, leading to bleeding. Thus, if there are noticeable symptoms before the hemorrhage, they are mostly due to a sudden increase in blood pressure. Patients often experience dizziness or headaches, sometimes along with blurred vision, and may be accompanied by nausea and vomiting, but most patients may not feel any abnormalities before the bleeding occurs.

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Written by Gao Yi Shen
Neurosurgery
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Brainstem hemorrhage blood pressure control range

The range of blood pressure control for brainstem hemorrhage must be specifically judged based on the current medical condition at the time. Generally speaking, it is optimal to maintain the systolic blood pressure between 110-120 mmHg. This can both ensure normal cerebral blood supply and reduce the risk of recurrent cerebral hemorrhage due to high blood pressure. However, each patient's baseline blood pressure is different, and many patients have a baseline systolic pressure higher than 180 mmHg. In such cases, it might be appropriate to adjust the target slightly higher, for instance around 130 mmHg. It is recognized that no one’s blood pressure can be perfectly consistent, so a certain degree of fluctuation is acceptable. Unless there are long-lasting high values, in which case, control within a certain range might be needed.

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Written by Chen Yu Fei
Neurosurgery
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How long does it take for the fever to subside after a brainstem hemorrhage?

For patients with brainstem hemorrhage, it is common to develop high fever after the bleeding, where the body temperature often exceeds 38.5℃. There are many reasons for the occurrence of high fever. It can be considered that the presence of an intracerebral hematoma compresses the hypothalamic temperature set point, causing abnormalities in the set point function and leading to central fever, with temperatures often reaching 39℃ or even higher than 40℃. At this time, the use of antipyretic drugs alone generally has poor therapeutic effect. It often requires the effective absorption of the intracerebral hematoma for the body temperature to gradually return to normal. Another situation, considering the occurrence of pulmonary infection, it is necessary to promptly provide patients with antibiotics for effective treatment. When the pulmonary infection is effectively controlled, the body temperature will also gradually decrease.

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Written by Gao Yi Shen
Neurosurgery
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The chances of regaining consciousness after brainstem hemorrhage

The probability of awakening from brainstem hemorrhage is generally only about 30%-45%, which is relatively low. This is because the brainstem is the most important center for circulation and respiration in the human body, as well as the awakening center. Awakening can be divided into two stages: the first stage is being able to eat, drink, and defecate independently; the second stage is being able to communicate normally with others. However, patients with brainstem hemorrhage, due to severe damage, may not even reach the first stage, meaning they may not even survive, and reaching the second stage is even more difficult. Therefore, it is essential to clearly understand the specific circumstances at the time, as awakening is generally a very unlikely event.

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Written by Gao Yi Shen
Neurosurgery
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The acute phase of brainstem hemorrhage lasts for several days.

The acute phase of brainstem hemorrhage generally lasts about two to three weeks, or 14 to 21 days, but it also needs to be specifically assessed based on the different conditions of the patient. If the hemorrhage in the brainstem is relatively severe and located in an important functional area, then the critical period may be appropriately extended. For example, if the hemorrhage is in the medulla oblongata and has already caused respiratory and circulatory failure, as well as unstable vital signs and a comatose state, then the critical period could even reach about one to two months, because it is often necessary to use a ventilator to assist breathing, and the patient's comatose state does not allow for full consciousness. However, for some brainstem hemorrhages, such as a small hemorrhage in the pons that only causes the clinical symptom of headache in the patient, the critical period is generally no more than two weeks. Thus, each patient's condition is different.