How long is the edema period for brainstem hemorrhage?

Written by Tang Ying
Physical Medicine and Rehabilitation
Updated on September 20, 2024
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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.

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What should the blood pressure control be for brainstem hemorrhage?

For patients with brainstem hemorrhage, it is important to maintain stable blood pressure after the bleeding. The ideal blood pressure should be controlled between 130/80 and 140/90. This is because the blood pressure should not be controlled too low. If the blood pressure is too low, it can lead to insufficient perfusion pressure in the brain tissue or brainstem, thus exacerbating the state of brain tissue ischemia and hypoxia, which may aggravate the local brainstem ischemia and cause new brainstem infarcts. Additionally, blood pressure should not be too high, as excessively high blood pressure can lead to primary brainstem hemorrhage, coagulation dysfunction, and situations where bleeding is difficult to stop. Moreover, it can cause rebleeding of the brainstem, also known as secondary hemorrhage, which, once it occurs, can be life-threatening for the patient.

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Intensive Care Unit
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Is vomiting severe in brainstem hemorrhage?

Vomiting after brainstem hemorrhage is definitely a serious matter because if the vomiting is caused by a brain-related issue, it is due to increased intracranial pressure. This type of vomiting is characterized as projectile vomiting, which is one of the three major signs of increased intracranial pressure. If the brainstem hemorrhage is extensive, it may cause local stimulation leading to cerebral vascular spasm, or issues such as obstructed brain circulation resulting in increased intracranial pressure and hydrocephalus. This increase in intracranial pressure, especially if prolonged, can lead to brain herniation, which is particularly deadly if it compresses the brainstem. Therefore, this is a very urgent and serious condition that requires immediate attention. Of course, if the vomiting is solely due to other reasons such as gastric retention or improper feeding, that would be a different matter. Projectile vomiting caused by increased intracranial pressure is highly severe.

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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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Is it normal to have a high fever with brainstem hemorrhage?

Patients with brainstem hemorrhage who develop a high fever may have several possible causes. Firstly, it might be due to absorption heat, but in such cases, the body temperature generally does not exceed 38.5 degrees Celsius. If there is recurrent fever, accompanied by coughing, expectoration, yellow and sticky sputum that is difficult to expel, it is mostly considered likely to be a pulmonary infection, in which case the body temperature generally exceeds 38.5 degrees Celsius, and high fever occurs. Additionally, it is important to note that once fever occurs, antipyretic medications should be administered to the patient to help lower the body temperature. Physical methods such as using warm water or rubbing alcohol for baths can also be used to reduce the temperature.

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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.