History, present and future of diagnosis and treatment of primary brainstem hemorrhage

Abstract

Primary brainstem hemorrhage (PBSH) has the worst outcome among all types of spontaneous intracerebral hemorrhage (SICH). There is no standardized criteria to diagnose PBSH. Generally, the diagnosis of PBSH is based on the history of hypertension, the clinical and radiological features after excluding other bleeding etiologies such as aneurysm, arteriovenous malformation, cavernomas and tumor apoplexy within brainstem. The management of PBSH remains controversial. Conservative and supportive treatment is given in most western countries where surgery is considered not to improve consciousness and other neurological functions. However, Asian countries such as China, Korea and Japan make a great contribution in surgical management of PBSH, emphasizing the lifesaving role of surgery. The current study of PBSH progresses very slow due to the lack of high ⁃ level clinical trial. In the future, multicenter cohort or randomized clinical study may guide the best way to deal with PBSH.

doi：10.3969/j.issn.1672⁃6731.2021.02.002