How to exercise swallowing after a brainstem hemorrhage

Written by Tang Ying
Physical Medicine and Rehabilitation
Updated on September 28, 2024
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Patients with brainstem hemorrhage often have critical conditions. Therefore, after stabilizing their condition, their swallowing function is usually severely impaired. During swallowing training, besides the common use of medications and acupuncture treatment, professional swallowing therapists in a formal rehabilitation medicine department conduct training on swallowing functions. Before starting swallowing training, an accurate assessment of swallowing function is typically conducted first. Swallowing disorders are divided into four stages: the preparatory stage, the oral stage, the pharyngeal stage, and the esophageal stage. In the preparatory stage, coordinating the consistency of the food can aid the patient's swallowing. Proper stimulation of the oral and pharyngeal muscles, including stimulation of the tongue and pharyngeal wall muscles, cold therapy, tongue pressure training, and training of the muscles around the mouth, are used to help restore swallowing function. During the esophageal stage, when the patient's condition has stabilized, videofluoroscopic swallow study can be carried out to assess specific issues in the esophageal stage, which are often related to cricopharyngeal dysfunction. Esophageal dilation with a balloon may also be used. With these accurate assessments and appropriate training, the swallowing function of patients generally shows significant improvement. Therefore, when patients experience these swallowing dysfunctions, it is best to seek treatment from a formal rehabilitation medicine department for better care.

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Written by Chen Yu Fei
Neurosurgery
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What fruits to eat for brainstem hemorrhage

For patients experiencing brainstem hemorrhage, during the acute phase, if the patient shows significant swallowing dysfunction, it is not appropriate to eat fruits. Instead, you can wait until the patient's condition is stable. At that point, fruits can be juiced, and most of the pulp can be filtered out using a sieve. The fresh juice can be given to the patient to drink. However, it is important to note that if the patient has significant difficulty swallowing and coughs while drinking, this method is not suitable. Once the patient's condition stabilizes, it may be appropriate to gradually introduce some fresh fruits. Common fruits available in the market, such as apples, bananas, and oranges, are usually suitable. It's best to avoid or limit consumption of certain special fruits like durian or mango.

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Written by Gao Yi Shen
Neurosurgery
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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.

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Written by Jiang Fang Shuai
Neurosurgery
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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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Written by Jiang Fang Shuai
Neurosurgery
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Can brainstem hemorrhage be operated on?

The brainstem is the center of human life, controlling vital functions such as breathing, circulation, heart rate, and blood pressure. Once bleeding occurs, patients often experience unstable vital signs, deep coma, and can die from brain function failure within a short period. Previously, it was believed that the brainstem was a no-go zone for surgery, and treatment for brainstem hemorrhage was primarily conservative medical therapy. However, with the continuous improvement of medical technology, neurosurgery departments in many top-tier hospitals have made significant achievements in minimally invasive or open surgeries for brainstem hemorrhages. Therefore, surgery for brainstem hemorrhage is not impossible and can be considered under specific circumstances.

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Written by Jiang Fang Shuai
Neurosurgery
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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.