Symptoms of brainstem hemorrhage

Written by Gao Yi Shen
Neurosurgery
Updated on February 13, 2025
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The symptoms of brainstem hemorrhage can vary from mild to severe, depending on the specific presentation of the patient. For instance, in milder cases, symptoms may include simple headaches, dizziness, nausea, and vomiting without other clinical symptoms, which can often be easily distinguished from cervical spondylosis. Therefore, timely clinical examinations are necessary to confirm these conditions, which are generally mild and usually do not threaten life. However, symptoms might gradually worsen, manifesting as numbness in the limbs and speech impairments, among others. Some individuals may experience seizures, characterized by convulsions of the limbs, frothing at the mouth, etc. If the hemorrhage becomes more severe, it can compress more brainstem neurons, leading to coma, lethargy, and potentially severe outcomes like dilated pupils, and sudden cessation of breathing and circulation.

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Pre-symptoms of brainstem hemorrhage

Brainstem hemorrhage is extremely dangerous, and once a massive hemorrhage occurs, the patient can quickly lose consciousness and generally there are no effective emergency measures available. The patient will quickly die due to the involvement of the centers controlling heartbeat and breathing. The early symptoms of brainstem hemorrhage are not particularly obvious, but a careful medical history may reveal that patients often experience excessive fatigue, stress, emotional agitation, and poor sleep before the hemorrhage. Patients may show early signs such as dizziness, blurred vision, double vision, limb weakness, and slurred speech. If a patient has very high blood pressure and exhibits these early symptoms, especially if there is discomfort in the neck and upper back area, it is crucial to be highly vigilant and seek immediate medical attention. The prognosis for brainstem hemorrhage is very poor, thus it is essential to focus on preventive measures and properly control blood pressure.

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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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Why would there be bleeding in the brainstem?

Firstly, hemorrhaging can occur anywhere there are blood vessels. The brainstem is an important functional area of the human brain, connecting the cerebrum above and the spinal cord below, with the cerebellum closely positioned behind it. It serves as a crucial relay station for neural connections. This area is the control center of human life, managing vital functions such as breathing and heartbeat. Additionally, this area is densely packed with blood vessels. For patients with chronic hypertension, unstable blood pressure control can lead to degeneration and necrosis of the vessels, and even the formation of dissecting aneurysms or microaneurysms, which can cause the vessels to rupture and bleed under certain conditions. Like the vessels in other parts of the intracranial space, the blood vessels in the brainstem can also bleed. This is referred to as brainstem hemorrhage.

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Can brainstem hemorrhage be cured?

Cerebral hemorrhage is divided into lobar hemorrhage, ventricular hemorrhage, subarachnoid hemorrhage, and brainstem hemorrhage. Brainstem hemorrhage is the most severe type of brain injury. Generally, the volume of hemorrhage is determined in three categories: about five milliliters, ten milliliters, and more than ten milliliters. If it is less than five milliliters, then the volume of hemorrhage is relatively small, and recovery is relatively good, usually without leaving residual symptoms. If it is between five to ten milliliters, life may be preserved, but severe residual symptoms such as hemiplegia, sensory disorders, and motor disorders may occur. However, if it exceeds ten milliliters, the mortality rate is generally very high, making it very difficult to salvage.

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Is brainstem hemorrhage prone to recurrence?

Bleeding in the brainstem area, if not well controlled and treated, is very prone to recurrence. In most cases, considering that patients have underlying diseases such as hypertension and diabetes, and do not control their blood pressure and blood sugar well, resulting in prolonged high levels of blood pressure and blood sugar, such conditions can easily lead to the recurrence of brainstem hemorrhage. Therefore, it is recommended to monitor blood pressure in the morning and evening, take antihypertensive medications on time, and keep the patient's blood pressure within a relatively stable range. Additionally, it is suggested to follow a light diet, low in salt and fat, and to regularly revisit the local hospital for a thorough monitoring of the patient’s vital signs.