The acute phase of brainstem hemorrhage lasts for several days.

Written by Gao Yi Shen
Neurosurgery
Updated on November 25, 2024
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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.

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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.

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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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Is it right to give up treatment for brainstem hemorrhage?

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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Can I drink fish soup with brainstem hemorrhage?

The patient experienced a brainstem hemorrhage, and if the bleeding is extensive, it's possible that the patient could be in a deep coma. In more severe cases, brain death could occur, where the patient would not be able to breathe on their own. Since the pathology mainly occurs in the brain, when the patient is in a coma, they are certainly not able to eat by themselves. At this time, feeding usually involves the insertion of a tube through the nose down to the stomach, called a nasogastric tube. Through this tube, food is delivered directly to the stomach, allowing for gastrointestinal nutrition. Commonly, the gastrointestinal function of such patients remains normal, so it is possible to administer liquid nutrition through the nasogastric tube, such as nutrient solutions or fish soup, without any issues.

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How to exercise balance after brainstem hemorrhage?

For patients with brainstem hemorrhage who exhibit significant limb motor dysfunction and reduced sense of balance, it is recommended to seek treatment at a well-known local tertiary hospital. Experienced rehabilitation therapists should assess the current condition and develop an individualized rehabilitation exercise plan based on the patient's condition. Gradually, they should begin exercise training, including training for limb balance capabilities. Patients who actively and effectively engage in exercise therapy often achieve good therapeutic effects, with gradual restoration of balance and strengthening of limb motor function, achieving relatively satisfactory treatment outcomes.