What causes brainstem hemorrhage?

Written by Gao Yi Shen
Neurosurgery
Updated on March 14, 2025
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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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Written by Jiang Fang Shuai
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How long is the period of brainstem hemorrhagic edema?

Brainstem hemorrhage, like hemorrhages in other parts of the brain, also has a period of cerebral edema. Cerebral edema is primarily caused by direct injury to brain tissue following hemorrhage, local ischemic and hypoxic changes, local metabolic products, and some damage to the vascular endothelium. Generally, the edema becomes apparent three days after the hemorrhage, peaks between three to seven days, begins to subside after ten days, and completely resolves around fourteen to fifteen days. However, there are exceptions, such as cases where edema occurs shortly after injury or within a few hours, and the peak period of edema lasts for several weeks, or even up to a month without complete resolution.

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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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Written by Gao Yi Shen
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Can brainstem hemorrhage be cured?

Whether brainstem hemorrhage can be cured must be determined based on clinical symptoms, laboratory tests, and patient examination. Generally speaking, if the symptoms of brainstem hemorrhage are relatively mild, such as headache, dizziness, without the occurrence of limb weakness, hemiplegia, epilepsy, etc., it is generally curable in the later stages without significant residual effects. However, in actual life, some cases of brainstem hemorrhage can be severe, even causing disturbances in consciousness, coma; or leading to abnormal breathing and heart rate, causing death. Therefore, it must be judged based on the situation at the time.

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Written by Gao Yi Shen
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How long does it take to wake up from a coma caused by brainstem hemorrhage?

The timing of awakening after a coma caused by a brainstem hemorrhage must be judged based on the situation. As brainstem hemorrhages are relatively severe, there is generally no possibility of awakening if the patient's breathing, heartbeat, and circulation are not stable. If the patient can breathe normally off a ventilator and has a normal heartbeat and other vital signs, and pupil responses are also normal, then typically, they may awaken within one to two weeks. However, recovery times vary from person to person depending on the specifics of the condition, the location of the hemorrhage, and the surrounding tissue involved. Therefore, assessments should be made based on specific clinical signs at the time. Particularly with hemorrhages in the medulla oblongata, once coma ensues, it's often impossible to fully awaken the patient, and many succumb to complications later on. Therefore, adequate psychological preparation is essential in clinical settings.

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How long is the edema period for brainstem hemorrhage?

The edema phase of the brain stem generally lasts for two to three weeks, with the peak of swelling occurring around seven to ten days. For some patients, the swelling completely subsides nearly a month later. Only after the peak of the swelling has passed can patients be out of life-threatening danger. As the swelling gradually subsides, the patient's consciousness, vital signs, limb movements, eating, and other symptoms will also gradually improve. Once patients get through the swelling phase, we can start early bedside rehabilitation as soon as possible. In addition to using some drugs that nourish brain nerves, passive limb movements, proper limb positioning, early exercise, and acupuncture can all be started early to accelerate the patient's early rehabilitation and prevent complications such as muscle atrophy, relaxation, and dependent pneumonia, which can be improved early on.