Brainstem injury refers to damage to the midbrain, pons and medulla oblongata. This includes primary and secondary brainstem injuries. Primary brainstem injury refers to the brainstem injury that occurred directly at the time of injury. (A) injury mechanism: 1, lateral head force, brainstem for the ipsilateral cerebellar curtain free edge contusion; forehead force, and slope impact injury; posterior occipital force, and occipital foramen impact injury. 2, rotational injury, the brainstem suffered pulling and twisting and injury. 3.In a whip-like injury, the medulla oblongata is injured at the junction with the cervical medulla. 4, bipedal or hip landing caused by medulla oblongata injury. (B) pathology: the pathological changes of brainstem injury vary in severity. The milder ones only have microscopically visible punctate hemorrhage and limited edema. In severe cases, neural structures in the brainstem are fractured, focal or large hemorrhage, edema and softening. (iii) Clinical manifestations: 1. Impaired consciousness, which appears immediately after injury, is more severe and lasts longer. Mild to moderate coma, or drowsiness in mild cases, or deep coma in severe cases. 2, the emergence of the cone bundle sign and decerebrate tonicity: brainstem injury early manifested as flaccid paralysis, loss of reflexes, later appear cone bundle sign, severe cases appear decerebrate tonicity. 3, high fever. 4, other manifestations: pupil changes, double pupil unequal size, variable size; strabismus, diplopia, ocular motility disorders; changes in vital signs, such as irregular breathing, decreased blood pressure, weak pulse, etc. (D) Diagnosis: In a few patients seen early after injury, most of them rely on CT, MRI and brainstem evoked auditory potential (BEAP) for diagnosis, except for those who present with typical brainstem symptoms. focal hemorrhage in the brainstem in CT, manifested as punctate high-density shadow with narrowing or disappearance of the surrounding brain pool. MRI is more obvious than CT, in addition, lumbar puncture of hemorrhagic cerebrospinal fluid also helps in diagnosis. (E) Treatment: severe primary brainstem injury with a long duration of coma should be treated with tracheotomy, ventilator-assisted respiration and sub-cold temperature as early as possible. For patients with mild brainstem injury, can be treated according to brain contusion, some patients can get good results, while for the heavy, the mortality rate is very high, so the rescue work should be carefully and carefully, to have a long-term plan, and care work is particularly important, at the same time, pay close attention to the prevention and treatment of various complications. 1, protection of the central nervous system, hibernation therapy, as appropriate, to reduce brain metabolism; active anti-brain edema; the use of hormones and neurotrophic drugs. 2.Systemic support therapy, maintain nutrition, prevent and correct water and electrolyte disorders. 3.Actively prevent and manage complications, the most common ones are pulmonary infection, urinary tract infection and decubitus ulcer. Strengthen nursing care, close observation, early detection and timely treatment. For patients with severe consciousness impairment and respiratory dysfunction, early implementation of tracheotomy is necessary, but care should be strengthened after tracheotomy to reduce the chance of infection. 4, the recovery period should focus on the improvement of brainstem function, available sudorific drugs, hyperbaric oxygen chamber treatment, enhance body resistance and prevention of complications. (F) Prognosis: severe brainstem injury has a high mortality rate, accounting for almost 1/3 of the craniocerebral injury mortality rate, and if the medulla oblongata is traumatized, there is little hope for salvation.