Symptoms and signs of brainstem hemorrhage

Written by Gao Yi Shen
Neurosurgery
Updated on May 03, 2025
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The symptoms and signs of brainstem hemorrhage must be judged based on the situation. There are many nerve fibers in the brainstem, and bleeding in any area could lead to different clinical manifestations. The most common general symptoms include headache, nausea, dizziness, vomiting, and numbness and weakness in the limbs, and even conditions such as drowsiness, stupor, and even coma may occur. If more severe, it could cause abnormal rhythms in heart and respiratory functions, and some special symptoms might appear. For example, hemorrhage in the midbrain might cause bilateral pupil constriction, especially pinpoint constriction; if the hemorrhage occurs in the medulla, it could cause respiratory and circulatory arrest early on.

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What should the blood pressure control be for brainstem hemorrhage?

For patients with brainstem hemorrhage, it is important to maintain stable blood pressure after the bleeding. The ideal blood pressure should be controlled between 130/80 and 140/90. This is because the blood pressure should not be controlled too low. If the blood pressure is too low, it can lead to insufficient perfusion pressure in the brain tissue or brainstem, thus exacerbating the state of brain tissue ischemia and hypoxia, which may aggravate the local brainstem ischemia and cause new brainstem infarcts. Additionally, blood pressure should not be too high, as excessively high blood pressure can lead to primary brainstem hemorrhage, coagulation dysfunction, and situations where bleeding is difficult to stop. Moreover, it can cause rebleeding of the brainstem, also known as secondary hemorrhage, which, once it occurs, can be life-threatening for the patient.

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Recovery of consciousness from brainstem hemorrhage takes several days.

For patients with brainstem hemorrhage, how many days it takes to regain consciousness depends on the location of the bleeding and the amount of bleeding. If the amount of bleeding is small, the patient's consciousness often gradually awakens within 24 to 48 hours. There may be short-term language impairments, manifesting as unclear speech, difficulty speaking, articulation disorders, and accompanied by significant swallowing difficulties, indicated by choking on water, but this will gradually improve over time. If the bleeding is substantial, it often leads to the patient being in a coma for a long time, and may even enter a vegetative state for an extended period, unable to regain autonomous consciousness.

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Is it normal to have a high fever with brainstem hemorrhage?

Patients with brainstem hemorrhage who develop a high fever may have several possible causes. Firstly, it might be due to absorption heat, but in such cases, the body temperature generally does not exceed 38.5 degrees Celsius. If there is recurrent fever, accompanied by coughing, expectoration, yellow and sticky sputum that is difficult to expel, it is mostly considered likely to be a pulmonary infection, in which case the body temperature generally exceeds 38.5 degrees Celsius, and high fever occurs. Additionally, it is important to note that once fever occurs, antipyretic medications should be administered to the patient to help lower the body temperature. Physical methods such as using warm water or rubbing alcohol for baths can also be used to reduce the temperature.

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Can brainstem hemorrhage be cured?

Brainstem hemorrhage is a very dangerous disease with poor prognosis and high mortality rate. Although the brainstem is very small, it contains almost all vital neurological functions. Once hemorrhage occurs, it can cause severe neurological dysfunction, and even lead to the patient's death due to cessation of heartbeat and breathing in a short period. So, can brainstem hemorrhage be cured? It mainly depends on the location of the hemorrhage, the amount of bleeding, and the clinical symptoms. Patients with less bleeding, hemorrhages closer to the upper end of the brainstem, and milder clinical symptoms have a better chance of recovery. However, those with more extensive bleeding, hemorrhages closer to the lower end of the brainstem, and more severe clinical symptoms have a lesser likelihood of recovery.

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Is brainstem hemorrhage serious?

Brainstem hemorrhage is caused by the rupture of small blood vessels in the brainstem, with common causes including hypertension, cerebral arteriosclerosis, vascular degeneration, and microaneurysms of vessels. Clinically, it manifests as sudden onset of consciousness impairment, confusion, coma or deep coma, accompanied by disorders of limb sensory and motor functions, eye movement disorders, and unstable vital signs, among others. If the hemorrhage occurs in the medulla, it can cause death by stopping the patient's heartbeat and breathing within a short period. Brainstem hemorrhage is a severe condition in neurology, and treatment focuses on bed rest to stop bleeding, reducing intracranial pressure, and treating complications. Despite advances in modern medicine, medical professionals often find themselves powerless in the face of many patients with brainstem hemorrhage. For brainstem hemorrhages with more than three milliliters of blood, most patients ultimately succumb to the condition. Therefore, brainstem hemorrhage is a very serious disease with a very high mortality rate in clinical settings.