What Is a Brainstem Hemorrhage?

Brainstem hemorrhage accounts for about 10% of clinical cerebral hemorrhage cases. Although the incidence is not high, brainstem hemorrhage has an acute onset, a dangerous condition, and a poor prognosis. It is the disease with the highest mortality and the worst prognosis of all strokes. Cerebral stem hemorrhage accounts for 5.0% to 13.4% of cerebral hemorrhage. It occurs more frequently in the pontine and is often caused by rupture of the penetrating artery supplying the basal artery.

Brainstem hemorrhage accounts for about 10% of clinical cerebral hemorrhage cases. Although the incidence is not high, brainstem hemorrhage has an acute onset, a dangerous condition, and a poor prognosis. It is the disease with the highest mortality and the worst prognosis of all strokes. Cerebral stem hemorrhage accounts for 5.0% to 13.4% of cerebral hemorrhage. It occurs more frequently in the pontine and is often caused by rupture of the penetrating artery supplying the basal artery.

English name

brainstem hemorrhage

Common locations

Pontine

Causes of brain stem hemorrhage and common diseases

Primary brain stem hemorrhage is mostly caused by hypertension atherosclerosis.

Secondary brain stem hemorrhage The occurrence of secondary brain stem hemorrhage is related to the speed of brain stem compression on the brain stem and the location, size, and nature of the surrounding tissue lesions. Secondary cerebral hemorrhage mostly occurs in the midbrain and upper pontine. About half of patients have secondary bleeding from deep cerebral hemispheres. Cerebral infarction secondary to brain stem hemorrhage: After cerebral infarction, the brain stem is compressed, deformed, and displaced due to cerebral edema, which causes the small stem arteries, veins, and capillaries in the brain stem to be pulled, ruptured, and bleeding.

Differential diagnosis of brain stem hemorrhage

(1) Sudden onset, rapid progress, severe performance, and often coma;

(2) Irregular breathing: it can manifest as respiratory failure such as blowing, sighing, and tidal breathing;

(3) Pupil needle-like reduction: Approximately 70% of cases show a reduction in pupil needle-like appearance and reflection of light, because when the pontine and medulla are damaged, the parasympathetic nerves are paralyzed, and the parasympathetic nerves have not been damaged or the damage is minor, showing a pupil reduction , But there is reflection of light;

(4) Gastrointestinal bleeding: The more severe the condition, the more severe the disturbance of consciousness, and the higher the incidence of gastrointestinal bleeding. It is related to factors such as damage to the gastroduodenal mucosa, decreased gastric mucosal barrier function, and increased intracranial pressure. ;

(5) Cross paralysis: after brainstem hemorrhage, the ascending or descending conduction beam impulse is blocked or damaged, and after some nerve nucleus is damaged or destroyed, different degrees of lesions appear on the ipsilateral peripheral cerebral nerve palsy and the disease Lateral central colloid hemiplegia;

(6) Poor brain CT scan or craniocerebral MRI examination: can make accurate localization diagnosis, provide reliable diagnosis and judge the prognosis basis for clinical.

Brain stem hemorrhage examination

Cranial brain CT scan and MRI diagnostic value for brainstem hemorrhage: Most scholars now believe that craniocerebral CT scan is still the first choice for diagnosing brainstem hemorrhage, can clarify the location and amount of bleeding, and can make more accurate prognosis. evaluation of. If necessary, do a thin-slice CT scan of the brainstem.

Brain stem hemorrhage treatment principles

The treatment of brainstem hemorrhage should be timely, race against time, and control of blood pressure is the most important part. Rapidly reducing blood pressure to normal or slightly higher levels can effectively prevent rebleeding and prevent further development of the condition. Hibernation is also an important treatment. Hibernation can effectively reduce metabolism, reduce oxygen and energy consumption of brain cells, and protect brain cells. At the same time, the patient is sedated, the energy consumption of the entire body is reduced, and the body reserve is enhanced. For patients with heavy bleeding and coma, timely lateral ventricular drainage should be performed to reduce intracranial pressure and prevent secondary damage to brain cells and formation of cerebral hernia. If you have a lung infection, perform a tracheotomy immediately. Do not hesitate to correct lung function. The treatment of complications should be proactive and not tolerated, otherwise serious consequences will occur. At the same time, intensive care, oxygen inhalation, lowering of intracranial pressure, hemostasis, prevention and treatment of gastric ulcer, protection of brain tissue and other auxiliary treatments will definitely save the lives of most patients with brain stem hemorrhage. Once the patient's vital signs are stable, early functional exercise is required to promote the recovery of various functions of the body. After leaving the hospital, life counselling should also be given to develop a good and positive lifestyle to prevent recurrence of the disease.