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Abstract: The brainstem is the life center of the human body, and hypertensive atherosclerosis is the main cause of brainstem hemorrhage, with a very high morbidity and mortality rate after hemorrhage, which requires immediate treatment once it develops. The patient suddenly became unconscious during the work process and sought medical attention by calling for help, perfected cranial CT suggesting brainstem hemorrhage, considered as acute and critical neurology, given dehydration, lowering cranial pressure, hemostasis and other drug treatment after the condition was controlled and stabilized, hospitalized for about 20 days for review, most of the hemorrhage was absorbed and discharged successfully.
Basic information】Male, 47 years old
Type of disease】Brain stem hemorrhage
Hospital】Shandong Provincial Third Hospital
Date of consultation】December 2020
Treatment plan】Medication (injectable spearhead viper hemagglutinase, mannitol injection, glycerol fructose injection)
Treatment Period】Hospitalization 20 days, outpatient follow-up after 1 month
Treatment effect】Stable condition
I. Initial consultation
The patient was fat, had an attack during work, and was sent to the emergency room by a colleague. The patient was the leader of the unit and the pillar of the family, and was usually very busy at work, socializing a lot, and staying up late and working overtime were the norm. Neurological examination suggested: impaired consciousness, no response to call, limb floppy state, positive pathological signs. Urgent improvement of cranial CT examination suggested: brainstem hemorrhage. The blood pressure was as high as 220/110 mmHg, the electrocardiogram showed normal, and the emergency blood routine, blood gas analysis, and cardiac enzymes did not show any obvious abnormality. The family communicated with the family that the condition was critical and life-threatening at any time, so the patient was immediately sent to the intensive care unit and needed immediate hospitalization with poor prognosis.
II. Treatment history
Brainstem hemorrhage is usually caused by intracerebral hemorrhage due to blood vessel rupture caused by hypertension, which has an acute onset and can lead to immediate coma, tetraplegia, impaired consciousness and other neurological symptoms, positive pathological signs, rapid disease progression, and easy secondary cardiopulmonary failure leading to death. After admission, the patient was given injectable spearhead pit viper hemagglutinase, mannitol injection, and glycerol fructose injection for blood pressure stabilization, dehydration, cranial pressure reduction, and hemostasis. Since the patient’s bleeding site was the vital center, although the bleeding volume was small, the symptoms were heavy. We communicated with the family that the peak edema period of 5-7 days after brainstem hemorrhage might trigger an aggravation of the condition and even a risk of life. After active treatment, the patient’s condition was stable, but symptoms of impaired consciousness and lack of limb movement still existed. Blood pressure gradually decreased to normal. Acupuncture and physiotherapy were given at an early stage to promote neurological rehabilitation. The patient was discharged after 20 days of hospitalization in stable condition, and was instructed to return to the hospital for rehabilitation training after half a month.
Treatment effect
The brainstem has many important nuclei and is clinically known as the center of life; hemorrhage in this area can cause serious neurological dysfunction and even lead to risk of life. In about 20 days, the cranial CT was rechecked and most of the hemorrhage was absorbed, and the patient was discharged with stable condition.
IV. Notes
The patient’s life was saved after treatment, and we are happy for the patient. During the treatment period, attention should be paid to monitoring blood pressure, actively controlling it to the normal range, and adjusting antihypertensive drugs if necessary. At home, pay attention to turning and patting the back regularly to avoid the formation of decubitus ulcers. Massage the limbs regularly to promote blood return and avoid the formation of venous thrombosis in the lower limbs. Encourage coughing and sputum, and take good care of the respiratory tract to avoid the occurrence of crushing pneumonia. Pay attention to the patient’s state of consciousness and the muscle tone of the limbs, and actively give rehabilitation interventions. Pay attention to giving nutritional support to avoid secondary diseases of other systems. After discharge from the hospital, regularly visit the neurology department for follow-up cranial MRI to assess the intracerebral situation and adhere to rehabilitation training to avoid loss of limb muscle strength and muscle atrophy. Family members should be psychologically prepared for long-term rehabilitation and assist the patient to adhere to it.
V. Personal insight
This patient had brainstem hemorrhage at a young age, which caused serious sequelae and seriously affected the patient’s daily life and directly led to severe disability, related to the usual work status and negligent management of the body, and should avoid staying up late and working at high intensity for a long time. Carelessness. You should ensure good sleep, monitor blood pressure, and pay attention to the combination of work and rest. The body is the capital of the revolution, so you should pay attention to ensure that your body is healthy.