Multimodal management of a large-volume brainstem hemorrhage with stereotactic drainage, targeted antimicrobial therapy, and early neurorehabilitation - a case report

Sep 28, 2026

Uploaded by Terk

Moderate-volume brainstem hemorrhage (>5 mL) is associated with extremely poor outcomes, yet this case report documents rare survival after a large-volume brainstem hemorrhage with multimodal therapeutic intervention. A 47-year-old man with hypertension and sudden coma underwent stereotactic-guided hematoma puncture drainage and tracheostomy, alongside hemostatic care, intracranial pressure reduction, anti-infection management, and structured early neurorehabilitation. During treatment, recurrent multidrug-resistant bacterial infections emerged, but after two months the patient regained consciousness with improved limb strength, despite persistent motor aphasia, dysphagia, and urinary/fecal incontinence. The report emphasizes early comprehensive management, while noting limited generalizability as a single case.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Case description

TYPE Case Report PUBLISHED 18 December 2025 DOI 10.3389/fnins.2025.1719867 OPEN ACCESS EDITED BY Hongjian Pu, University of Pittsburgh, United States REVIEWED BY Nenad Koruga, Osijek Clinical Hospital Center, Croatia Shahnawaz Ahmad, Banaras Hindu University, India Xinghua Xu, People’s Liberation Army General Hospital, China *CORRESPONDENCE Wenhui Shang [1158487937@qq.com](1158487937@qq.com) RECEIVED 07 October 2025 REVISED 09 November 2025 ACCEPTED 17 November 2025 PUBLISHED 18 December 2025 CITATION Han X, Huang Z, Ning J and Shang W (2025) Multimodal management of a large-volume brainstem hemorrhage with stereotactic drainage, targeted antimicrobial therapy, and early neurorehabilitation: a case report. Front. Neurosci. 19:1719867 . doi: 10.3389/fnins.2025.1719867 COPYRIGHT © 2025 Han, Huang, Ning and Shang. This isan open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Multimodal management of a large-volume brainstem hemorrhage with stereotactic drainage, targeted antimicrobial therapy, and early neurorehabilitation: a case report Xinyuan Han, Zhijun Huang, Jing Ning and Wenhui Shang* Department of Neurological Rehabilitation, Shaanxi Provincial Rehabilitation Hospital, Xi’an, China Moderate-volume brainstem hemorrhage (>5 mL) typically carries an extremely poor prognosis. This article presents a rare case of survival following a large-volume brainstem hemorrhage with therapeutic intervention. A 47-year-old male with hypertension presented with sudden-onset coma. CT imaging revealed a 10 .3 mL brainstem hemorrhage. The patient underwent hematoma puncture drainage and tracheostomy, accompanied by hemostatic therapy, intracranial pressure reduction, anti-infection treatment, and neurorehabilitation. During treatment, the patient developed recurrent multidrug-resistant bacterial infections. After 2 months, the patient gradually regained consciousness with improved limb muscle strength, though exhibiting motor aphasia, dysphagia, and urinary/fecal incontinence. Rehabilitation therapy was continued. This case demonstrates that even with large-volume brainstem hemorrhage, comprehensive management including timely drainage, intracranial pressure control, tracheostomy, infection management, and early rehabilitation may achieve survival and consciousness recovery. However, asa single-case report, this study has limited sample size, necessitating further large-scale randomized controlled trials to validate these ﬁndings. KEYWORDS brainstem hemorrhage, case report, hematoma puncture drainage, multidrug-resistant organisms infection, neurorehabilitation Introduction Primary brainstem hemorrhage accounts for approximately 5–10% of spontaneous intracerebral hemorrhages, with prognosis strongly correlated to hematoma volume. Even a minimal volume of brainstem hemorrhage can lead to severe consequences (Zheng et al., 2022) . Studies indicate that patients with hemorrhage volumes exceeding 5 mL face mortality rates as high as 60–80%, and survivors often suﬀer severe neurological deﬁcits (AlMohammedi et al., 2020; Wang et al., 2019; Zheng et al., 2022) . The optimal management of moderate-volume (5–10 mL) brainstem hemorrhage remains controversial, though emerging evidence suggests potential beneﬁts from early surgical intervention (Chen et al., 2021; Ding et al., 2024; Pustilnik et al., 2024) . Frontiers in Neuroscience 01 [frontiersin.org](frontiersin.org) We present a rare case of a hypertensive patient with a 10.3 mL brainstem hemorrhage who achieved survival and consciousness recovery followi

FAQs

What type of condition is described in this case report?

The case report focuses on a large-volume brainstem hemorrhage, presenting an extremely poor prognosis profile due to hematoma volume.

What interventions were used for treatment?

Treatment included stereotactic-guided hematoma puncture drainage and tracheostomy, plus hemostatic therapy, intracranial pressure reduction, targeted anti-infection therapy, and early neurorehabilitation.

What complication occurred during treatment and what was the outcome?

The patient developed recurrent multidrug-resistant bacterial infections, and after two months he gradually regained consciousness with improved limb strength, though he still had motor aphasia, dysphagia, and urinary/fecal incontinence.

Sep 28, 2026

Uploaded by Terk