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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 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 \nHongjian Pu,  \nUniversity of Pittsburgh, United States  \nREVIEWED BY  \nNenad Koruga,  \nOsijek Clinical Hospital Center, Croatia Shahnawaz Ahmad,  \nBanaras Hindu University, India Xinghua Xu,  \nPeople’s Liberation Army General Hospital, China  \n*CORRESPONDENCE  \nWenhui Shang  \n [1158487937@qq.com](1158487937@qq.com)  \nRECEIVED 07 October 2025  \nREVISED 09 November 2025  \nACCEPTED 17 November 2025  \nPUBLISHED 18 December 2025  \nCITATION  \nHan 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.  \nFront. Neurosci. 19:1719867 .  \ndoi: 10.3389/fnins.2025.1719867  \nCOPYRIGHT  \n© 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.  \nMultimodal management of a large-volume brainstem hemorrhage with stereotactic drainage, targeted antimicrobial therapy, and early neurorehabilitation: a case report  \nXinyuan Han, Zhijun Huang, Jing Ning and Wenhui Shang* Department of Neurological Rehabilitation, Shaanxi Provincial Rehabilitation Hospital, Xi’an, China  \nModerate-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.  \nKEYWORDS  \nbrainstem hemorrhage, case report, hematoma puncture drainage, multidrug-resistant organisms infection, neurorehabilitation  \nIntroduction  \nPrimary 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) .  \nFrontiers in Neuroscience 01 [frontiersin.org](frontiersin.org)  \nWe present a rare case of a hypertensive patient with a 10.3 mL brainstem hemorrhage who achieved survival and consciousness recovery followi","cbCaimKFeYj96JUI","https://ap.wps.com/l/cbCaimKFeYj96JUI","pdf",1199487,"English","# Introduction\n## Case description","[{\"question\":\"What type of condition is described in this case report?\",\"answer\":\"The case report focuses on a large-volume brainstem hemorrhage, presenting an extremely poor prognosis profile due to hematoma volume.\"},{\"question\":\"What interventions were used for treatment?\",\"answer\":\"Treatment included stereotactic-guided hematoma puncture drainage and tracheostomy, plus hemostatic therapy, intracranial pressure reduction, targeted anti-infection therapy, and early neurorehabilitation.\"},{\"question\":\"What complication occurred during treatment and what was the outcome?\",\"answer\":\"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.\"}]","Multimodal management of a large-volume brainstem hemorrhage with stereotactic drainage, targeted antimicrobial therapy, and early neurorehabilitation - a case report | PDF",1790587839,13]