Strokes vary in their location and severity. A “massive” stroke is one that results in significant disability or even death.
Here’s what to know about the different types of massive strokes and their potential long-term effects.
Stroke Versus Massive Stroke
Any type of stroke can be severe enough to be considered massive, but some are more likely than others to result in significant disabilities or death. The outcome depends on several factors, including the type of stroke, which part of the brain was affected, and how long it takes to get medical help.
Some doctors use the National Institutes of Health Stroke Scale to calculate a stroke “score” based on evaluating a number of functional abilities or deficits in the patient. The higher the score, the more severe the stroke.
Types
There are a few categories of strokes that are more likely to result in significant disability, coma, or death. Some are “sub-types” of an ischemic stroke, which is the most common type, accounting for 87% of all strokes.
Ischemic Strokes
Ischemic strokes occur when a blood clot interrupts blood flow to the brain. Sub-types of ischemic strokes that are considered massive include:
Bilateral watershed stroke: Watershed strokes affect areas of the brain that are referred to as the “watershed areas.” These areas receive their blood supply from the tiniest end branches of blood vessels, and therefore they require adequate blood pressure and blood volume to ensure that enough blood flows through them at all times.
Because of this, watershed areas on both sides of the brain are at high risk of developing ischemia, or lack of blood flow during certain conditions.
Advanced carotid stenosis (clogging of the neck arteries) on both sides of the neck is one of the risk factors for this type of stroke. Watershed strokes produce severe disability because they impact movement on both sides of the body.
Large thrombotic stroke: Thrombotic strokes are caused by large blood clots that form in an artery that feeds blood to the brain.
Middle cerebral artery stroke is an example of a severe thrombotic stroke. The swelling causes a rapid increase in pressure throughout the entire brain. In turn, this high pressure leads to global brain dysfunction, impaired consciousness and, very often, brain herniation (significant pressure and pushing on the brain) and death.
Large embolic stroke: An embolic stroke occurs when a blood clot that forms in another area of the body (such as the heart or large arteries of the upper chest and neck) travels to the brain. The most severe embolic strokes are due to a clot that travels from the heart to the brain.
Hemorrhagic Strokes
Hemorrhagic strokes occur when an artery in the brain bursts, releasing blood into the brain. The blood increases the pressure inside the skull (called intracranial pressure) causing major damage to surrounding tissue. Hemorraghic strokes account for 13% of strokes.
There are three types of hemorrhagic stroke, depending on where the bleeding occurs:
Subarachnoid hemorrhage (also called subdural hemorrhage) involves rupture of a vessel on the surface of the brain. Blood seeps into the space between the brain and an area of tissue called the arachnoid layer, which surrounds the brain. Parenchymal or intracerebral hemorrhage occurs when the bleeding goes directly into the brain tissue. Intraventricular hemorrhage involves bleeding into or around the chambers (ventricles) that contain the cerebrospinal fluid that surrounds the brain and spinal cord.
Hemorrhagic strokes are extremely dangerous because the blood in the brain can sometimes lead to further complications such as hydrocephalus, increased intracranial pressure, and blood vessel spasms.
If not treated aggressively, these conditions can lead to severe brain damage and even death. This is why even minor episodes of bleeding in the brain require emergency evaluation.
Brainstem Stroke
The brainstem connects the brain to the spinal cord, and from there to the body. The brainstem controls many important functions, such as breathing, blood pressure, and heart rate; it also contains the brain’s awareness center, which allows us to stay conscious. Brainstem strokes can be caused by a clot or a hemorrhage.
A brainstem stroke, even a small one, may lead to hemiplegia, paralysis, or changes in vision. Depending on the location of a stroke within the brainstem, a brainstem stroke can result in long-term unconsciousness.
Signs of a Stroke
The key signs of a stroke of any type are:
Sudden numbness or weakness in the face, arm, or leg, especially on one side of the bodySudden confusion, trouble speaking, or difficulty understanding speechSudden trouble seeing in one or both eyesSudden trouble walking, dizziness, loss of balance, or lack of coordinationSudden severe headache with no known cause
Complications
The most severe outcomes of a massive stroke include:
Paralysis
A massive stroke frequently results in complete paralysis on one side of the body, called hemiplegia. Hemiparesis, which is defined by weakness on one side of the body, is a less severe complication. A stroke that affects the left side of the brain will result in paralysis or weakness on the right side of the body, and vice versa.
Coma
Brainstem strokes in particular can cause a patient to end up in a coma, a state of unconsciousness. A stroke in the brain stem can leave someone in a “locked-in” state in which the person is paralyzed, cannot speak, and can only move the eyes up and down.
Brain Death
Sometimes severe strokes can produce so much damage to the brain that the brain becomes unable to function in a way that sustains life, which is a condition called brain death. This may occur after a very large stroke or after a stroke in a vital region of the brain, such as the brainstem.
Death
Stroke is the number five cause of death in the United States. In some cases a stroke can be lethal instantly, or within days or weeks.
A person who has already had a stroke is at an increased risk of having another stroke, and a recurrent stroke is more likely to be fatal than the first one. Almost 25% of the strokes that occur in the United States each year are recurrent strokes.
Causes
Causes that are common to all types of stroke include:
Uncontrolled high blood pressure Atherosclerosis High cholesterol Coronary artery disease Atrial fibrillation
Causes of hemorrhaghic strokes in particular include:
Arteriovenous malformations Ruptured brain aneurysms Bleeding disorders Traumatic injuries to the head
Recovery
Recovering from a stroke can take several months or longer, and may involve the following:
Physical therapy: Physical therapy is intended to help people regain the ability to walk, stand, and sit. Physical therapists use exercises to restore balance and coordination. Occupational therapy: Occupational therapists help stroke patients relearn skills needed to perform the activities of daily living, such as dressing, bathing, eating, and using the bathroom. Exercises as well as modifications to the home can contribute to success in this area,Speech therapy: Speech therapy can help when a stroke results in difficulties forming words or understanding someone else when they are speaking. Mental health counseling: It is common for people to experience depression, anxiety, and other mood changes after a stroke. Therapy, sometimes along with medication, can help ease some of these problems.
The first three months after a stroke are the most important and where the most significant improvements in regaining function are made, though gains can continue to be made for up to a year.
Therapy and medicine may help with depression or other mental health conditions following a stroke. Joining a patient support group may help you adjust to life after a stroke. Talk with your health care team about local support groups, or check with an area medical center.
A Word From Verywell
If you or a loved one has had one of these types of strokes, you may have a long recovery ahead, or even a long-lasting and substantial change in your abilities.
Many people do experience a degree of recovery, even from severe strokes. It may take some time for the stroke to stabilize and for you and your loved ones to gain an idea of what to expect as far as the long-term stroke outcome. Make sure to talk to your doctor about medications and lifestyle changes that can help prevent you from having another stroke.
