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

## TL;DR

A rare case of survival after a large brainstem hemorrhage is reported, using a combination of drainage, infection control, and rehabilitation.

## Contribution

This case report presents a novel multimodal treatment approach for large-volume brainstem hemorrhage resulting in survival and partial recovery.

## Key findings

- A 47-year-old male survived a 10.3 mL brainstem hemorrhage with comprehensive treatment.
- The patient regained consciousness and improved muscle strength after two months of treatment.
- Multidrug-resistant infections were managed successfully during the treatment period.

## Abstract

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, as a single-case report, this study has limited sample size, necessitating further large-scale randomized controlled trials to validate these findings.