How to rehabilitate through exercise after brainstem hemorrhage

Written by Huang Lei
Physical Medicine and Rehabilitation
Updated on January 08, 2025
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Regarding the specific measures for rehabilitation exercises for brainstem hemorrhage, it is necessary to analyze specific problems based on the different conditions of the patients. Based on our past experience, several common symptoms of brainstem hemorrhage can be addressed with corresponding rehabilitation measures. The first one is swallowing disorder, which is very common in patients with brainstem hemorrhage. We can provide patients with electrical stimulation and ice stimulation, and teach them morning exercises such as cheek puffing, tongue stretching, and dry swallowing practices. The second common issue is articulation disorder, for which we can teach patients some speech training. Usually, we can prepare patients with rhythm, cadence, and deep breathing exercises for speech training. The third is the dysfunction of limb mobility. For specific activities, we need to conduct training, including some balance function training.

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Written by Chen Yu Fei
Neurosurgery
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Brainstem hemorrhage CT imaging findings

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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Written by Chen Yu Fei
Neurosurgery
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Rehabilitation of sequelae of brainstem hemorrhage

For patients with brainstem hemorrhage, there may be certain sequelae, such as obvious motor dysfunction of the limbs, like hemiplegia on one side. Additionally, some patients may also lose speech functions, manifested as motor aphasia or mixed aphasia. Most patients are likely to experience a decline in memory and have difficulty swallowing, often accompanied by coughing when drinking water. For these patients, post-recovery rehabilitation treatment becomes particularly crucial. During the recovery phase, effective rehabilitation exercises should be provided for the sequelae, such as rehabilitation exercises for motor functions of the affected limbs and speech function exercises.

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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 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 Shu Zhi Qiang
Neurosurgery
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Is it right to give up treatment for brainstem hemorrhage?

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.