Subscribe
Brainstem hemorrhage
Brainstem hemorrhage is what?
There are many causes of brainstem hemorrhage, and clinically, it is mostly considered to be caused by hypertensive cerebral hemorrhage. Patients have a history of hypertension and have not received regular and effective antihypertensive treatment, leading to suboptimal blood pressure control. Excessively high blood pressure often results in the weakening or even disappearance of the patient's own vascular regulatory functions. Under certain triggering factors, such as fatigue, exhaustion, mental stress, or overly intense emotions, the blood pressure within the vessels may exceed their own regulatory capabilities, making bleeding more likely. If the bleeding occurs in the brainstem, it manifests as a brainstem hemorrhage. In some patients, brainstem hemorrhages are caused by conditions like cavernous angiomas, aneurysms, or arteriovenous malformations.
What causes fever from brainstem hemorrhage?
Patients with brainstem hemorrhage experience fever generally for the following three reasons: First, infection. Patients with brainstem hemorrhage often have disturbances of consciousness and dysfunction of the throat, and are bedridden, which frequently leads to aspiration pneumonia and hypostatic pneumonia. This is due to weakened ability to clear phlegm, as well as choking caused by saliva and feeding. Additionally, infections can easily occur in the gastrointestinal tract, urinary tract, and from skin pressure sores. Second, abnormalities in the temperature set point cause central hyperthermia. In patients with brainstem hemorrhage, the temperature regulation center is damaged. If the temperature regulating center sets the body temperature above 38 degrees Celsius, it often persists and cannot be reduced, and medications are poorly effective in lowering the temperature, necessitating the use of ice packs for physical cooling. Third, patients with brainstem hemorrhage often use large doses of diuretics. Dehydration after diuretic use can put patients in a state of excessive dehydration. If rehydration therapy is not adequately managed, dehydration fever can easily occur.
How long does it take for the fever to subside after a brainstem hemorrhage?
For patients with brainstem hemorrhage, it is common to develop high fever after the bleeding, where the body temperature often exceeds 38.5℃. There are many reasons for the occurrence of high fever. It can be considered that the presence of an intracerebral hematoma compresses the hypothalamic temperature set point, causing abnormalities in the set point function and leading to central fever, with temperatures often reaching 39℃ or even higher than 40℃. At this time, the use of antipyretic drugs alone generally has poor therapeutic effect. It often requires the effective absorption of the intracerebral hematoma for the body temperature to gradually return to normal. Another situation, considering the occurrence of pulmonary infection, it is necessary to promptly provide patients with antibiotics for effective treatment. When the pulmonary infection is effectively controlled, the body temperature will also gradually decrease.
Can I drink fish soup with brainstem hemorrhage?
The patient experienced a brainstem hemorrhage, and if the bleeding is extensive, it's possible that the patient could be in a deep coma. In more severe cases, brain death could occur, where the patient would not be able to breathe on their own. Since the pathology mainly occurs in the brain, when the patient is in a coma, they are certainly not able to eat by themselves. At this time, feeding usually involves the insertion of a tube through the nose down to the stomach, called a nasogastric tube. Through this tube, food is delivered directly to the stomach, allowing for gastrointestinal nutrition. Commonly, the gastrointestinal function of such patients remains normal, so it is possible to administer liquid nutrition through the nasogastric tube, such as nutrient solutions or fish soup, without any issues.
How to rehabilitate through exercise after brainstem hemorrhage
Regarding the specific measures for rehabilitation exercises for brainstem hemorrhage, it is necessary to analyze specific problems based on the different conditions of the patients. Based on our past experience, several common symptoms of brainstem hemorrhage can be addressed with corresponding rehabilitation measures. The first one is swallowing disorder, which is very common in patients with brainstem hemorrhage. We can provide patients with electrical stimulation and ice stimulation, and teach them morning exercises such as cheek puffing, tongue stretching, and dry swallowing practices. The second common issue is articulation disorder, for which we can teach patients some speech training. Usually, we can prepare patients with rhythm, cadence, and deep breathing exercises for speech training. The third is the dysfunction of limb mobility. For specific activities, we need to conduct training, including some balance function training.
How does a brainstem hemorrhage clot get absorbed?
For patients with brainstem hemorrhage, edema generally enters the edema phase within 24 to 48 hours, and then gradually transitions into the absorption phase. During this period, it is first necessary to provide the patient with medications that enhance brain function, promote blood circulation and remove blood stasis, and nourish the nerves for treatment. At the same time, it is important to monitor changes in the patient's condition, and regularly perform a head CT scan to dynamically observe the changes in cerebral hematoma. In most cases, it is necessary to prevent various complications or concurrent diseases. If there is an abnormality in coagulation function, it is advisable to administer hemostatic drugs for treatment during the acute phase. However, once the patient's condition stabilizes, use medications that improve cerebral microcirculation and promote blood circulation and remove blood stasis for treatment.
Is brainstem hemorrhage related to smoking?
Brainstem hemorrhage is somewhat related to smoking. For brainstem hemorrhage, smoking acts as a trigger. During the process of smoking, the nicotine in tobacco may cause constriction of the brain's blood vessels, leading to increased blood pressure. When blood pressure rises beyond the blood vessels' ability to regulate themselves, it often induces the vessels to rupture and bleed, resulting in a brainstem hemorrhage. Of course, for brainstem hemorrhage, smoking is just one triggering factor and not the sole cause. For these patients, the majority of cases are largely related to poor lifestyle habits, poor dietary habits, and the individual's underlying vascular conditions.
Is it right to give up treatment for brainstem hemorrhage?
Brainstem hemorrhage discontinuing treatment could be appropriate in some cases. If the patient has extensive brainstem hemorrhage, particularly at the lower end of the brainstem, and has resulted in deep coma without response to any stimuli, with a Glasgow Coma Scale score of only 3, dilated pupils on both sides without any pupillary light reflex, and possibly no spontaneous breathing, the patient could be considered brain dead. According to international practice, treatment should not be pursued for patients who are brain dead, hence discontinuing treatment is appropriate for such patients. If the patient still has spontaneous breathing, then active resuscitation should be pursued, otherwise, it might be considered inhumane.
Does brainstem hemorrhage easily recur?
The main cause of brainstem hemorrhage is hypertension, which can lead to hyalinization in the arteries that supply the brainstem, and even the formation of small aneurysms. Under the impact of blood flow, these are prone to rupture, leading to hemorrhage in the brainstem. This is the primary mechanism of onset for brainstem hemorrhage. If the brainstem hemorrhage is caused by hypertension, maintaining good control of blood pressure and keeping it below the ideal level of 140-90 mmHg can prevent frequent recurrence, so there is no need for excessive worry, but it is crucial to monitor blood pressure regularly. Additionally, brainstem hemorrhages can also be caused by other reasons, such as cavernous hemangiomas or arteriovenous malformations. If brainstem hemorrhage is caused by these diseases, and the abnormal vessels are not surgically removed, recurrence is likely. Removing these abnormal vessels can greatly reduce the likelihood of recurrent brainstem hemorrhages.
What will happen after waking up from a brainstem hemorrhage?
For patients suffering from brainstem hemorrhage, when they are conscious, they often exhibit symptoms of neurological dysfunction. For instance, many patients may experience mild cognitive impairments, such as a decline in memory, as well as a noticeable decrease in learning and calculation abilities. Some patients might lose language functions or display significant aphasia, including anomia, motor aphasia, or mixed aphasia. Additionally, some patients may concurrently suffer from dysphagia, characterized by frequent coughing episodes when drinking fluids. Furthermore, some patients may exhibit specific symptoms or signs of limb motor dysfunction. Such patients typically require ongoing effective treatment.