Up to 50% of patients die after experiencing the type of brain hemorrhage Michaels did, says neurosurgeon Michael Lawton, MD.

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By Anne Harding

TUESDAY, APRIL 27, 2010 (Health.com) —­ On April 22, hair-band front man turned reality TV star Bret Michaels was rushed to the hospital with an excruciating headache. Doctors discovered that Michaels had suffered a brain hemorrhage—a type of stroke—but they haven’t yet pinpointed the source of the bleeding. The Celebrity Apprentice contestant remains in the intensive care unit under 24-hour surveillance, according to a statement posted Monday on Michaels’s website.

Michaels, 47, who led the band Poison in the ‘80s and ‘90s, has had diabetes since he was 6 years old, and had undergone an emergency appendectomy less than two weeks before his current hospitalization. It’s unclear whether either condition was related to the hemorrhage.

To learn more about the type of hemorrhage Michaels experienced, Health.com spoke with Michael Lawton, MD, the chief of vascular neurosurgery at the University of California, San Francisco Medical Center. Dr. Lawton has never treated Michaels and does not have access to his medical records, but he has treated hundreds of similar cases.

Q: What type of brain hemorrhage did Bret Michaels have?
A: Mr. Michaels had what’s called a subarachnoid hemorrhage, or bleeding into the space between the brain and the membranes surrounding it.

Q: Is that the same thing as a stroke?
A: Yes. Most strokes—about 85%—occur when a clot or some other obstruction blocks blood flow to (or within) the brain; these are known as ischemic strokes. Hemorrhagic strokes represent 15% of strokes, and are caused by bleeding within the brain. Subarachnoid hemorrhage is one type of hemorrhagic stroke.

Q: What causes this type of bleeding?
A: Nine out of 10 subarachnoid hemorrhages are due to a ruptured aneurysm. Aneurysms are bulges or weak areas in an artery, and people may have them for years with no symptoms. Typically, once a subarachnoid hemorrhage is diagnosed, a patient will have a test called an angiogram to look for an aneurysm. When doctors can’t find the source of the bleeding, it usually means that it’s not an aneurysm, or it’s a very small one that’s difficult to see.

In the remaining 10% of cases, the cause may be a leaky vein or small artery.

Q: What are the symptoms of a brain hemorrhage?
A: Typically, patients will have a very severe headache—what they describe as the worst headache of their life. Mr. Michaels’s presentation is fairly typical for subarachnoid hemorrhage. Some people will fall into a coma.

Next page: How are subarachnoid hemorrhages treated?

Q: How are subarachnoid hemorrhages treated?
A: First, doctors will search for the source of the bleeding and, once it’s found, perform surgery to close off the ruptured aneurysm and prevent it from starting to bleed again.

If we can’t find an aneurysm, we wait five to seven days, and then we repeat the angiogram again. Sometimes if you wait a while you see a small aneurysm that might have been hidden before. If the angiogram still doesn’t find an aneurysm on the second try, we typically just chalk it up to a vein.

In the meantime, patients have to get through the aftereffects of bleeding in the brain. It generally takes a while to recover from this, and Mr. Michaels will have to go through all of it.

Q: What is the prognosis for this type of brain hemorrhage?
A: Thirty-five to 50% of patients will die after a subarachnoid hemorrhage, while about a quarter will end up with some kind of neurological deficit. This can range from a type of nerve damage that interferes with normal eye movement (oculomotor nerve palsy) to paralysis, and anything in between.

It really depends on how bad the bleeding was and where the aneurysm was located. Twenty-five to 40% of patients will recover completely with no neurological problems.

Q: What are some risk factors for hemorrhagic stroke?
A: High blood pressure, cigarette smoking, and having a close relative with a brain aneurysm are the main risk factors. The fact that Mr. Michaels has diabetes wouldn’t directly increase his risk, although people with diabetes are more likely to have hypertension.

Q: Is subarachnoid hemorrhage rare?
A: About 3% of the general population has an aneurysm. At our hospital, we probably see more than 500 aneurysm patients annually. It’s not rare, but having said that, only about 10% of those end up like Mr. Michaels, where we don’t find their aneurysm.

Q: Is there anything people can do to reduce their risk of brain hemorrhage?
A: People should keep their blood pressure and cholesterol levels under control and take antihypertensive medications if necessary, as well as cholesterol-lowering drugs if needed. If you smoke, quit.

If you have a family history of aneurysm, you can undergo a screening test to see if you have one as well; if you do, you and your doctor can decide whether you need surgery to repair it. A ruptured aneurysm must be treated within 24 hours. An aneurysm that isn’t ruptured isn’t an emergency, but should be addressed promptly.