Subarachnoid Hemorrhage: Four Leading Causes

Bret Michael’s recent hospitalization with a subarachnoid hemorrhage(SAH) demonstrates that fame and celebrity cannot shield you from medical realities.  The former lead for the rock band Poison and reality show star recently suffered a brain bleed, which has kept him in the ICU in critical condition.  Michael’s has been very public with his diabetes diagnosis, a chronic condition that requires vigilant maintenance but this recent blood vessel rupture causing bleeding in the brain has potentially life threatening and long term disabilities. 

It is suspected that Michaels suffered a subarachnoid hemorrhage.  A subarachnoid hemorrhage occurs when there is bleeding into the subarachnoid space that covers the brain and spinal cord.  The four leading causes of these types of hemorrhages are aneurysms, arteriovenous malformation(AVM), hypertension and head trauma. 

Leading causes for brain hemorrhages:

 A brain hemorrhage or bleeding in the brain is a type of stroke. The most common non-traumatic cause of bleeding in the brain is a rupture of an aneurysm.  An aneurysm is a balloon like bulge in an artery.  Aneurysms can be the result of congenital abnormalities and present no symptoms until they bleed.

 A brain arteriovenous malformation (AVM) is an abnormal connection between the arteries and veins and generally these develop before birth. Sometimes symptoms are mild with only headaches and at times there are no symptoms until bleeding occurs. Other times patients experience seizures, pulsating buzzing in their head, or progressive weakness from the AVM.

Hypertension is another leading cause of brain hemorrhages because it can weaken blood vessel walls over time and this makes them susceptible to rupture.   Drug abuse, frequently an occupational hazard of the rock and roll lifestyle, especially cocaine and amphetamines, can also cause artery walls to inflame and weaken.  Smoking is another risk factor for this type of stroke.  It is unclear if Michaels was either a heavy smoker or drug abuser.

Traumatic injury to the brain can cause blood clots on the surface of the brain or within the brain. The brain can be permanently damaged by this trauma.

Bret Michaels reported a severe headache prior to his hospitalization.  This is a classic symptom of a ruptured aneurysm.   Some patients report a popping or snapping sensation accompanied with a headache described as the worst they have ever experienced.  Vomiting, fainting, weakness, confusion and seizures are also symptoms of bleeding in the brain.  Some of the early signs of a ruptured aneurysm can also be masked by the chronic symptoms of diabetes but the biggest differentiator is the excruciating headache that most victims feel at the time of rupture.

About 10% of patients with a ruptured aneurysm die before receiving medical care.  If untreated 50% will die within a month, with 25% of patients sustaining another bleed within a week.   Treatment generally includes finding the source of the bleeding and cutting off that source.  Surgical clipping and endovascular clotting off of the aneurysm are the most common procedures to repair the cause of the bleeding. 

In most cases after a rupture the bleeding stops quickly.  However blood is very irritating to the brain and brain cells become damaged upon contact with blood.   Blood in the cerebrospinal fluid (CSF) increases the pressure on the brain leading to hydrocephalus.  Hydrocephalus can make a patient lethargic, confused or incontinent.

Bret Michaels is still undergoing testing to determine the source of his bleeding.   Hopefully he will have a quick recovery and not suffer any long-term effects.   Everyone knows the hangover from a life as a rock and roll star has a long reach but it is difficult to imagine the medical drama Michaels’ has embarked upon.