Brainstem hemorrhage accounts for about 5-13.4% of brain hemorrhage, with pontocerebral hemorrhage accounting for 80%, midbrain hemorrhage for 15%, and medulla hemorrhage for 5% of brainstem hemorrhage. Although the brainstem is small in size, it is the center of life and the place where all kinds of nerve conduction bundles must pass through, and it is involved in almost all important functions of the central nervous system. Therefore, brainstem hemorrhage is more likely to cause brain function damage than hemorrhage in other parts of the skull, causing more serious consequences. Therefore, we should be highly alert to this problem and treat it early to minimize the damage. Clinical anatomical studies have shown that the paracentral branch is the shortest of the basilar artery branches and has the largest angle with the basilar artery; the short spiral branch is the second; the long spiral branch is the longest and has the smallest angle. Therefore, the paracentral branch is most likely to be involved in bleeding, so the incidence of pontocerebral hemorrhage is higher, mostly due to rupture of the paracentral artery or its branches, followed by mixed hemorrhage and midbrain hemorrhage. The main causes of primary brainstem hemorrhage are hypertension and atherosclerosis, followed by cerebrovascular malformations, and aneurysms and hematologic diseases are also common causes of this disease. In patients with pre-morbid risk factors for brainstem hemorrhage, smoking, hypertension, coronary heart disease, and alcohol consumption have been reported to have a higher mortality rate, and the triggers for the onset of the disease are mostly emotional or activity onset, but less in the quiet state. The clinical characteristics of brainstem hemorrhage are rapid onset, severe disease, rapid progression, and death within 1 to 2 d. The prognosis is poor. The clinical manifestations of brainstem hemorrhage are diverse. The common signs and symptoms of brainstem hemorrhage include: impaired consciousness, headache, vomiting, high fever, irregular breathing, tetraplegia, speech impairment, eye signs, and cranial nerve disorders. Although the death rate of brain stem out is high, it should be treated actively to maximize the chance of survival. Patients in the acute stage need to actively control blood pressure, control systolic blood pressure below 160 mmHg, and maintain blood pressure stability. Along with conventional treatment such as hemostasis and cranial pressure lowering, it is important to keep the airway open, actively prevent and treat complications, and maintain water-electrolyte and acid-base balance. For patients in coma, tracheotomy should be performed early to keep the airway unobstructed, nebulized inhalation and endotracheal drip should be used to treat pulmonary infections, and fiberoptic bronchoscopic alveolar lavage to thoroughly remove sputum is very effective for severe pulmonary infections. Once the vital signs are stable, hyperbaric oxygen therapy can be performed as soon as conditions permit. With the rapid development of minimally invasive neurosurgery, some scholars began to try the surgical treatment of brainstem hemorrhage. For the indications of brainstem hemorrhage, it is generally believed that the surgical treatment is more effective for symptomatic cerebral hematoma cases with the lesion located above the plane of facial nucleus. If the hematoma is located on the ventral side of the brainstem or mainly in the medulla oblongata, the risk of surgery increases significantly and the postoperative outcome is poor. The prognosis of brainstem hemorrhage is influenced by multiple factors. The size of hemorrhage is the most important indicator of prognosis and is closely related to the morbidity and mortality rate; the site of hemorrhage is also one of the indicators of prognosis, and the morbidity and mortality rate of pontocerebral hemorrhage is relatively high. Active prevention and treatment of pre-morbid risk factors can reduce the morbidity and mortality rate. In addition, perfecting acute treatment, preventing and treating complications can improve the quality of patient survival.