eISSN: 1509-572x
ISSN: 1641-4640
Folia Neuropathologica
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vol. 61
Original paper

Development and initial experience of a novel classification system for patients with brain stem haemorrhage

Lu Li
An Ji Wang
Han Bing Zhang
De Shen Wu
Guang Liang Zhuang
Yan Chao Shen
De Shan Gong
Jie Wang

Department of Neurosurgery, Shanghai Deji Hospital, Shanghai, China
Epilepsy Center of Shanghai Deji Hospital, Shanghai, China
Folia Neuropathol 2023; 61 (3): 301-308
Online publish date: 2023/09/11
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There is no uniform classification standard for brain stem haemorrhage. On the basis of previous experience in the treatment of brainstem haemorrhage, this study explored and established a set of criteria for brainstem haemorrhage classification, risk-stratified such patients and guided the selection of treatment options so as to achieve accurate and standardized diagnosis and treatment.

Material and methods:
Thirty patients with brainstem haemorrhage from April 2019 to May 2022 were included. According to the amount and location of the brain stem bleeding, it was divided into the following types: small haemorrhage type (type 1), medium haemorrhage type (lateral type 2a, dorsal type 2b, ventral type 2c), and large haemorrhage type (type 3), and the preoperative condition and postoperative outcome within 3 months were evaluated.

The included 30 patients with brainstem haemorrhage were aged 53.2 ±13.8 years old, and 80% were men. Among them, 5 patients were type 1 (16.7%), 2 patients type 2a (6.7%), 7 patients type 2b (23.3%), 5 patients type 2c (16.7%) and 11 patients type 3 (36.7%). The prognosis among these subtypes was significantly different (p < 0.001). All type 1 patients were cured, with the highest mortality rate in type 2c patients (100%). Compared with type 2b (5.5 ±3.5 days) and type 2c (3.4 ±2.5 days), type 3 patients tend to die within fewer days (2.9 ±2.7 days). The difference in NIHSS scores was significant among surviving patients (p < 0.001). Type 1 is the lowest at 1.8 ±2.2 points; type 3 is the highest at 35.0 ±3.5 points.

Relying on the anatomical basis and treatment plan, we propose a different classification, which is conducive to quickly identifying the haemorrhage type and degree of disease, and putting forward an appropriate treatment plan, which is expected to improve the patient prognosis.


neurosurgery brain stem, brain stem haemorrhage, clinical classification

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