Brainstem hemorrhage CT imaging findings

Written by Chen Yu Fei
Neurosurgery
Updated on September 28, 2024
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For patients with brainstem hemorrhage, a head CT generally shows irregular high-density shadows in the brainstem area, which are mostly seen in acute fresh brainstem hemorrhages. When the condition of brainstem hemorrhage is relatively stable, low-density shadows may appear around the high-density shadows, which at this time are considered to be due to the presence of surrounding edema. When the patient's condition is stable, a follow-up CT of the brainstem one to two weeks later often shows a gradual reduction in the density of the original high-density shadows, indicating that the hematoma of the brainstem hemorrhage has entered the hematoma absorption phase. In the later stable condition of the disease, as the hematoma is gradually absorbed, the density will also gradually decrease.

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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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How long does it take to wake up from a brainstem hemorrhage?

Brainstem hemorrhage is a very serious condition. If the amount of bleeding in the brainstem increases, the patient will rapidly become comatose and exhibit symptoms such as paralysis of the limbs, inability to swallow, and inability to speak. Generally, if a patient with brainstem hemorrhage falls into a coma and cranial CT confirms a large amount of bleeding in the brainstem, the chances of the patient waking up are very, very slim. If the amount of brainstem hemorrhage is not particularly large and the patient's level of coma is not very deep, treatment may lead to the patient waking up, which could take about two to four weeks. However, the prognosis for brainstem hemorrhage is generally poor, and if the patient falls into a coma, they are usually unlikely to wake up. The treatment for brainstem hemorrhage mainly involves controlling blood pressure and preventing complications. If respiratory failure occurs, timely treatment with a ventilator is necessary. Overall, brainstem hemorrhage has a poor prognosis and high costs.

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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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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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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.