Patient : The family member has been suffering from brainstem infarction for 13 days now, relying on oxygen infusion all day long. nasal feeding. 1.Is this brainstem infarction causing atresia syndrome? 2, please suggest medical treatment plan Doctor: brainstem infarction prognosis is poor, from your description can not determine whether the atresia syndrome or shallow coma, treatment to improve the brain circulation antiplatelet neurotrophic and symptomatic support, the specific plan needs to be tailored according to the patient’s condition, can not be developed from your simple description. The patient: the whole process is like this: the patient onset of the day is 8:30 am, at first felt dizzy, slurred speech, limb weakness, went to the Enping City Hospital of Traditional Chinese Medicine on the road back to normal. The patient could walk up to the fourth floor to see the symptoms (see the symptoms at about 9 o’clock), the doctor said his blood pressure was very high, and immediately prescribed a medication list and told the family to go to the pharmacy to get the medicine first. However, before the medicine was available, the family began to slur their speech and limb weakness. The doctor immediately called the emergency room doctor, and the family began to vomit white bubbles in the emergency room. After a round of resuscitation, the family was able to wake up and return to normal, and the doctor said they could eat some congee. The diagnosis was: high blood pressure (blood pressure 202 at the onset) caused a stroke, and it was recommended to stay in the hospital. At 14:00 minutes the family again began to slurred speech, limb weakness, vomiting white bubbles. After resuscitation without success coma at 15:30 transferred to the ICU of Enping City People’s Hospital, ICU doctors and family members to understand the situation, the preliminary diagnosis: cerebral thrombosis, but also wait until the next morning to make a clear diagnosis after CT. The next morning at 9:40 am, the family came out of ICU to do CT. The patient was awake and was emotional when he saw his relatives, shouting and crying, but he could not speak or move. The results came out with the diagnosis: brain stem infarction with an area of 70%, and the family was told to be psychologically prepared. So it formed like this today. There is no condition in Enping People’s Hospital to use interventional methods to thrombolize and do MRI. May I ask: 1. Does this diagnosis miss the best time for thrombolysis? 2. Is there any technical problem in this process? Doctor: Acute cerebral infarction can be treated with thrombolysis within the early time window, but in this case, the patient has already exceeded the time window for intravenous thrombolysis, and you have also explained that the local hospital does not have the objective conditions for arterial interventional thrombolysis. Patient: This is the CT film on the day of onset and the next day. Doctor: The image is not very clear, but it can be determined that the infarction occurred in the cerebral bridge, and combined with some of the clinical information you gave, the current state of the patient is likely to be atresia syndrome. The main threats to the patient’s life now are various infections, malnutrition, electrolyte disorders, bleeding from stress ulcers in the digestive tract and other complications, in addition, the risk of another stroke may occur. Please pay attention to give the patient rehabilitation training for limb function to prevent disuse atrophy and joint stiffness of the limbs, and treatment requires measures such as antiplatelet, improvement of microcirculation and neurotrophy.