What should the blood pressure control be for brainstem hemorrhage?

Written by Chen Yu Fei
Neurosurgery
Updated on September 27, 2024
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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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Written by Chen Yu Fei
Neurosurgery
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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.

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Written by Li Qiang
Intensive Care Unit
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Why does gastric bleeding also occur when there is bleeding in the brainstem?

This brainstem hemorrhage, as well as other severe cranial traumas or cerebral hemorrhages, if they cause a severe intracranial hypertension, will lead to a condition called stress ulcer, commonly known as Cushing's ulcer. This occurs because the increased intracranial pressure causes ischemia and hypoxia in the gastric mucosa, which then leads to localized, extensive necrosis of the gastric mucosa, resulting in upper gastrointestinal bleeding. This includes brainstem hemorrhages and many other cranial injuries and cerebral hemorrhages with intracranial hypertension as a very common complication. Therefore, it is due to the local ischemia of the gastric mucosa caused by increased intracranial pressure, leading to bleeding caused by gastric acid corrosion.

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Written by Jiang Fang Shuai
Neurosurgery
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Is brainstem hemorrhage dangerous?

The brainstem is the central hub of life in the human body, controlling vital functions such as blood pressure, pulse, respiration, body temperature, and consciousness. Bleeding in this area is extremely dangerous and is a life-threatening condition. Clinically, it has a high mortality and disability rate. For hemorrhages larger than 5 mL, most patients will succumb to central respiratory and circulatory failure within 48 hours. Even if the bleeding is less than 5 mL, although aggressive resuscitation may save the patient's life, most will suffer from severe brain dysfunction such as hemiplegia, aphasia, or a vegetative state. Therefore, brainstem hemorrhage is very dangerous.

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Written by Chen Yu Fei
Neurosurgery
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How long can someone with brainstem hemorrhage and hemiplegia survive?

Patients with brainstem hemorrhage presenting with hemiplegia have varying life expectancies, which depend on their primary diseases. In cases of severe brainstem hemorrhage, extensive bleeding typically causes significant damage to brainstem functions. Patients often remain in a prolonged comatose state, which can even threaten their lives. However, if the brainstem hemorrhage is minor and accompanied by mild limb hemiplegia, it generally does not pose a significant threat to the patient's life. It is crucial to administer medication treatment promptly after the hemorrhage and to start early rehabilitation exercises for the affected limbs. If patients persistently continue these exercises, they often achieve good treatment outcomes and can enjoy a long-term, high-quality life.

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Written by Tang Li Li
Neurology
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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.