Brainstem Hemorrhage: Symptoms, Risks & How It’s Treated

Among intracerebral haemorrhages, spontaneous brainstem haemorrhage is the most deadly subtype and is always linked to a negative outcome. Hemorrhage in the brainstem that is especially related to chronic hypertension but is not connected to specific or observable lesions such arteriovenous malformations and cavernous malformation. Its clinical features include significant death and disability, fast progression, and sudden start. Brainstem is the deep brain structure that connects the brain to the spinal cord. Brainstem has three parts; midbrain, pons and medulla. Brainstem control body functions such as;

Regulate heart rate, breathing, blood pressure
Swallowing food
Eye movements
Sensations and muscle movements of the body especially facial muscle
Hearing

Brainstem hemorrhage is an uncommon type of intracerebral hemorrhage. Making up 6 to 10% of spontaneous intracerebral hemorrhage, and its death rate varies from 30 to 90% according to the research being conducted.

Symptoms of Brainstem Hemorrhage

Brainstem hemorrhage symptoms immediately after the hemorrhage or stroke or later such as:

Headache: Severe uncontrolled headache like thunderclap.
Dizziness: Spinning sensation and unbalance.
Vision problem: Problem in vision like blurry vision, double vision or loss of vision.
Speech difficulty: Trouble with understanding speech or slurred speech
Confusion: Disorientation and loss of thinking ability.
Weakness or numbness: Tingling sensation on one side of the body on face, arm and leg.
Difficulty in Swallowing: Due to the weakness of the muscle chewing, swallowing food becomes very difficult.
Nausea and vomiting: Too much bleeding in the brain or leads to vomiting. Vomiting occurs at the onset of the stroke.
Abnormal heart rate: Fluctuation in heart rate during stroke.
Loss of balance and coordination: Difficulty in standing and walking which increase risk of fall. Loss control over muscle movement.
Memory Issues: Problem to recall names, places or things.
Depression: After stroke depression anxiety is very common because of not being able to live like before stroke or hemorrhage.
Trouble Walking: After stroke walking patter is changed, patients are not able to walk like before and balance is also lost.
Excessive Sleepiness: Excessive sleep is common in some individuals after brainstem hemorrhage.
Seizure: Seizures are common in hemorrhagic stroke. This can occur within 24 hours of onset of hemorrhage.
Loss of Body Sensation: A person affected by brainstem stroke could find it harder to detect pain or changes in temperature. Only certain bodily parts, such as the face, arms, chest, tongue or other part of the body, may experience this feeling.

Risk Factors of Brainstem Hemorrhage

Chronic Hypertension (High Blood Pressure): Long term high blood pressure is the most common risk factor of the hemorrhage. Due to uncontrolled high blood pressure, blood vessels will rupture and result in sudden intracerebral hemorrhage.
Diabetes: high blood sugar causes tiny ruptures in the blood vessels which leads to the big rupture of the blood vessels of the brain that may lead to the intracerebral hemorrhage.
Arteriovenous Malformation: It is an abnormal cerebral blood vessel mesh. Bleeding into the subarachnoid space may occur if these arteries weaken or burst. Subarachnoid hemorrhage can occasionally result from head trauma or injury.
Cavernous Malformation: An abnormal collection of small capillaries (tiny blood vessels) is known as a cavernous malformation. Cerebral cavernous malformation is often seen in the brain, brainstem, and spinal cord.
Cerebral Amyloid Angiopathy: Amyloid is a protein accumulation that precipitates inside the arterial walls of the brain. This condition is frequently observed in the elderly and is linked to high blood pressure and age-related brain blood vessel deterioration.

Diagnosis of Brainstem Hemorrhage

Computer Tomography (CT) scan
Angiogram
MRI (Magnetic Resonance Imaging)
Blood test
Cerebral angiography
Lumbar puncture
Spinal tap test
Endoscopic hematoma removal

Treatment

Death rate after brainstem hemorrhage is higher than survival rate. To control blood pressure and decrease brain swelling medications may also be used. Some medicines used for the treatment of intracerebral hemorrhage are: