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Gao Yi Shen
Neurosurgery
About me
Graduated from Tianjin Medical University with a master's degree in Neurosurgery. Previously worked and studied at large tertiary hospitals in Beijing and Tianjin. Have a deep understanding and awareness of common and prevalent cerebral diseases, particularly skilled in understanding and formulating treatment plans for cerebrovascular diseases.
Proficient in diseases
There is a deep understanding and awareness of common and prevalent cranial diseases, especially skilled in understanding and developing treatment plans for cerebrovascular diseases.
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The chances of regaining consciousness after brainstem hemorrhage
The probability of awakening from brainstem hemorrhage is generally only about 30%-45%, which is relatively low. This is because the brainstem is the most important center for circulation and respiration in the human body, as well as the awakening center. Awakening can be divided into two stages: the first stage is being able to eat, drink, and defecate independently; the second stage is being able to communicate normally with others. However, patients with brainstem hemorrhage, due to severe damage, may not even reach the first stage, meaning they may not even survive, and reaching the second stage is even more difficult. Therefore, it is essential to clearly understand the specific circumstances at the time, as awakening is generally a very unlikely event.
How long do you have to stay in the ICU for a brainstem hemorrhage?
The length of stay in the ICU for brainstem hemorrhage depends entirely on the patient's specific condition. Generally, as long as the patient's breathing is stable and they can breathe on their own, and all other vital signs are relatively stable, they can be transferred out of the ICU. However, this depends on the patient's condition at the time. Many patients are admitted to the ICU typically due to poor breathing and lack of autonomous respiration. If a ventilator is used and the results improve, they may then be transferred out. Some may be out in a week, while others may need one to two months. It is also crucial to determine whether they have developed ventilator-associated pneumonia, lower limb venous thrombosis, or other more severe clinical manifestations, so decisions should be made based on these conditions for accuracy.
Brainstem hemorrhage blood pressure control range
The range of blood pressure control for brainstem hemorrhage must be specifically judged based on the current medical condition at the time. Generally speaking, it is optimal to maintain the systolic blood pressure between 110-120 mmHg. This can both ensure normal cerebral blood supply and reduce the risk of recurrent cerebral hemorrhage due to high blood pressure. However, each patient's baseline blood pressure is different, and many patients have a baseline systolic pressure higher than 180 mmHg. In such cases, it might be appropriate to adjust the target slightly higher, for instance around 130 mmHg. It is recognized that no one’s blood pressure can be perfectly consistent, so a certain degree of fluctuation is acceptable. Unless there are long-lasting high values, in which case, control within a certain range might be needed.
The acute phase of brainstem hemorrhage lasts for several days.
The acute phase of brainstem hemorrhage generally lasts about two to three weeks, or 14 to 21 days, but it also needs to be specifically assessed based on the different conditions of the patient. If the hemorrhage in the brainstem is relatively severe and located in an important functional area, then the critical period may be appropriately extended. For example, if the hemorrhage is in the medulla oblongata and has already caused respiratory and circulatory failure, as well as unstable vital signs and a comatose state, then the critical period could even reach about one to two months, because it is often necessary to use a ventilator to assist breathing, and the patient's comatose state does not allow for full consciousness. However, for some brainstem hemorrhages, such as a small hemorrhage in the pons that only causes the clinical symptom of headache in the patient, the critical period is generally no more than two weeks. Thus, each patient's condition is different.
Causes of cerebral infarction
There are many causes of cerebral infarction, but the most common in clinical practice is the narrowing or occlusion of the carotid artery. Since the brain is supplied by four blood vessels, any issues with any of these vessels can potentially lead to a cerebral infarction. Conditions commonly known as the "three highs"—high blood pressure, high blood sugar, and high cholesterol—can easily lead to narrowing or even blockage of the blood vessels. Thus, these factors are fundamentally the cause. Additionally, smoking and drinking can also lead to vascular narrowing and cause cerebral infarction. In some special cases, autoimmune diseases can cause inflammation inside the vessels, leading to narrowing. Other causes include arterial tears due to trauma, which can lead to ischemia and infarction, or abnormal blood supply due to arrhythmias causing cerebral infarction.
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.
Trigeminal neuralgia prodrome
Trigeminal neuralgia does not have very obvious precursors. This is because trigeminal neuralgia often occurs suddenly, especially with the concept of trigger points. That is to say, once the trigger point is activated, it immediately induces pain without any warning signs. Trigger points vary from person to person, usually located primarily on the cheek. Patients who frequently suffer from trigeminal neuralgia often know these areas. Typically, the pain occurs during activities like brushing teeth with cold water or chewing hard foods such as peanuts or walnuts, triggering severe pain instantly. Thus, in the case of trigeminal neuralgia, there are no precursors, only immediate triggers and immediate pain.
What are the dangers of a concussion?
In general, as long as one follows medical advice, recovery from a concussion is usually quite satisfactory, and it rarely leaves any long-term harm. Short-term harm can result in the patient experiencing some very painful symptoms such as headaches, dizziness, nausea, vomiting, etc. Such subjective experiences can comparatively make the patient suffer. For those who are emotionally excited or fragile, it may even lead to anxiety and depression, which are some of the recent damages. In the long term, some patients might experience a loss of memory, particularly short-term memory, which can also cause some inconvenience in their lives. However, overall, the damage from a concussion is very minimal, and as long as it is treated properly, there is generally no harm in the later stages.
Methods of Cerebral Infarction
There are many methods for treating cerebral infarction, but it is essential to make judgments based on the situation, as each patient's condition is different and requires different treatment approaches. For patients with acute cerebral infarction, treatments such as emergency thrombolysis or thrombectomy can be undertaken. For chronic cerebral infarction, initially, medical treatment is applied, including managing blood pressure, lowering blood lipids, stabilizing blood sugar levels, quitting smoking and alcohol, etc. Subsequently, this includes the oral administration of antiplatelet aggregation medications, which can effectively reduce the recurrence of cerebral infarction. Finally, corresponding surgical treatments are considered, including endarterectomy, superficial temporal artery to middle cerebral artery anastomosis, and appropriate stent implantation surgeries, depending on the specific characteristics. (Specific medications should be administered under the guidance of a physician.)
What should be paid attention to in the diet for cerebral infarction?
There are many dietary considerations for patients with cerebral infarction: The first point is to definitely eliminate some unhealthy eating habits, including smoking, drinking alcohol, consuming large amounts of meat, binge eating, sitting for long periods, and not exercising, among other things. Improving these bad habits can greatly help in reducing the recurrence of cerebral infarction. The second point is to adopt a diet low in salt and fat and high in protein. It is essential to avoid greasy and pickled foods on a regular basis to also reduce the recurrence of cerebral infarction. The third point is to eat more green leafy vegetables on a daily basis, especially those that are local and seasonal. If blood sugar levels are stable, increasing the consumption of fruits can also enhance the body's resistance and reduce the recurrence of cerebral infarction.