Is it right to give up treatment for brainstem hemorrhage?

Written by Shu Zhi Qiang
Neurosurgery
Updated on December 24, 2024
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Brainstem hemorrhage discontinuing treatment could be appropriate in some cases. If the patient has extensive brainstem hemorrhage, particularly at the lower end of the brainstem, and has resulted in deep coma without response to any stimuli, with a Glasgow Coma Scale score of only 3, dilated pupils on both sides without any pupillary light reflex, and possibly no spontaneous breathing, the patient could be considered brain dead. According to international practice, treatment should not be pursued for patients who are brain dead, hence discontinuing treatment is appropriate for such patients. If the patient still has spontaneous breathing, then active resuscitation should be pursued, otherwise, it might be considered inhumane.

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Written by Jiang Fang Shuai
Neurosurgery
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The difference between brainstem hemorrhage and cerebral hemorrhage.

Cerebral hemorrhage refers to any bleeding caused by the rupture of cerebral blood vessels. Based on the location of the bleeding, there is hemorrhage in the cerebral lobes, thalamic hemorrhage, cerebellar hemorrhage, brainstem hemorrhage, and so on. Consequently, brainstem hemorrhage is a type of cerebral hemorrhage. Because the brainstem is the life center of humans, even a small amount of bleeding can lead to severe consequences, and may even cause death. Therefore, brainstem hemorrhage is one of the most dangerous types of cerebral hemorrhage and has a very high rate of mortality and disability in clinical settings.

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Written by Gao Yi Shen
Neurosurgery
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How long does it take for a brainstem hemorrhage clot to be absorbed?

In general, the absorption time for a brainstem hemorrhage clot is around two to three weeks. During this period, several phases must be passed, with the two main ones being the rebleeding phase and the brain swelling phase. Rebleeding often occurs within three days after the initial bleeding. If not treated promptly during this time, it can easily lead to further brainstem hemorrhage, increasing the size of the clot and hindering the later absorption process. The second phase is the peak of brain swelling and vasospasm. During this phase, certain substances released during the absorption of blood vessels and clots can cause swelling and spasms of the surrounding tissues. If this phase is also safely navigated, then subsequent absorption tends to be relatively quicker. However, complete absorption generally requires at least two to three weeks.

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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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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 Gao Yi Shen
Neurosurgery
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How many milliliters of brainstem hemorrhage are fatal?

Brainstem hemorrhage does not have a specific volume that can be fatal; the brainstem is the central hub for respiration and circulation in the human body, including the medulla, midbrain, and pons. For the pons and midbrain, a hemorrhage of five milliliters can be fatal. For the medulla, which is very narrow and densely packed with neural tissue, even one milliliter of bleeding can suddenly cause the patient's respiration and circulation to stop. Therefore, even one milliliter of brainstem hemorrhage is an immeasurable loss, and brainstem hemorrhages should be classified as critically severe. Immediate hospitalization and treatment are crucial to achieve a relatively better prognosis.