Is a high fever serious with brainstem hemorrhage?

Written by Chen Yu Fei
Neurosurgery
Updated on March 27, 2025
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For patients with brainstem hemorrhage who develop a high fever, it is first necessary to consider that the hemorrhage has affected vital central nervous system functions, leading to central fever. In such cases, the fever typically exceeds 38.5 degrees Celsius, and may even reach high fevers of 39 to 40 degrees Celsius, which are difficult to reduce with ordinary antipyretic drugs. Additionally, some patients with brainstem hemorrhage may also have concurrent lung infections, which can lead to recurrent high fevers exceeding 38.5 degrees Celsius. In such situations, it is advisable to perform a blood test for routine blood work. Furthermore, it is also important to monitor for any local inflammation, auscultate the lungs, and determine if the lung sounds are coarser or if there are any dry or wet rales in both lungs.

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Written by Zhang Hui
Neurology
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Is brainstem hemorrhage prone to recurrence?

Brainstem hemorrhage is perilous, and its recurrence largely depends on the cause and the management of risk factors. For instance, one significant cause of brainstem hemorrhage is the presence of certain arterial-venous malformations and sponge-like angiomas. Such conditions tend to recur if not surgically addressed promptly by removing these abnormal vessels, thereby reducing the likelihood of recurrence. Additionally, hypertension is the most common cause of brainstem hemorrhage. Long-term high blood pressure can damage arterial walls and lead to ruptures and bleeding. Stable control of blood pressure, alongside a low-salt, low-fat diet, can prevent recurrence of brainstem hemorrhage. However, poorly controlled blood pressure, resulting in severe fluctuations, can significantly increase the risk of recurrence.

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Written by Chen Yu Fei
Neurosurgery
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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.

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Written by Huang Lei
Physical Medicine and Rehabilitation
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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.

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Written by Chen Yu Fei
Neurosurgery
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How to rehabilitate from brainstem hemorrhage?

For patients with brainstem hemorrhage, it is often recommended during the acute phase to treat them with medications for hemostasis, brain enhancement, nerve nutrition, dehydration to reduce intracranial pressure, and inhibition of gastric acid. It is also important to actively treat complications and comorbidities caused by the brainstem hemorrhage. For these patients, when the condition is stable, appropriate rehabilitation exercises should be carried out. For patients with hemiplegia or aphasia, rehabilitation exercises can be done on the affected limbs, and speech rehabilitation training can help improve current conditions of hemiplegia and aphasia. Additionally, for these patients, active and passive massage of the limbs should be initiated early to prevent muscle atrophy and joint stiffness.

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Written by Chen Yu Fei
Neurosurgery
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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.