Table of ContentsView AllTable of ContentsMassive StrokesTypesSigns of a StrokeComplicationsRisk FactorsRecoveryFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Massive Strokes
Types
Signs of a Stroke
Complications
Risk Factors
Recovery
Frequently Asked Questions
Strokes, which affect around 795,000 Americans per year, occur when the brain is deprived of oxygen. This can happen either due to a blood clot that blocks blood flow (anischemic stroke) or a ruptured blood vessel in the brain (ahemorrhagic stroke).
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.
ImagesBazaar / Getty Images
Stroke Versus Massive Stroke
Any type of stroke can be severe enough to be considered massive. Some, however, are more likely than others to result in significant disabilities or death. The outcome depends on several factors, including:
When administered within three hours of the first symptoms of an ischemic stroke,tPA (tissue plasminogen activator)and tenecteplase (TNK)can help dissolve the blood clot quickly and limit the amount of damage and disability.
Neurologists use theNational Institutes of Health Stroke Scaleto calculate a stroke “score.” The score is based on an evaluation of a number of functional abilities or deficits in the patient. The higher the score, the more severe the stroke.
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. Ischemic stroke 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 strokesaffect 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. 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.
Advancedcarotid 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 can produce severe disability because they impact movement on both sides of the body.
Middle cerebral artery strokeis an example of a severe thrombotic stroke. In some patients, this can lead to severe swelling that can cause an increase in pressure in the area of the stroke. This can lead to:
Largeembolic 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.
Large blood clots are especially dangerous because they can completely stop blood from flowing through the largest, and thus most important, blood vessels in 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. Hemorrhagic strokes account for 13% of strokes.
There are two types of hemorrhagic stroke, depending on where the bleeding occurs:
Hemorrhagic strokes are extremely dangerous because the blood in the brain can sometimes lead to further complications such as:
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.
High Blood Pressure and Risk of Hemorrhagic Stroke
Brainstem Stroke
Thebrainstemconnects the brain to the spinal cord, and from there to the body. The brainstem controls many important functions, such as:
A brainstem stroke, even a small one, may lead to paralysis on one or both sides of the body. It can also cause changes in vision. Depending on the location of a stroke within the brainstem, it can result in long-term unconsciousness.
The FAST acronym can help you identify the main signs of a stroke:
Signs and Symptoms of Stroke
The most severe outcomes of a massive stroke include:
Paralysis
Coma
Brainstem strokes in particular can cause a patient to end up in acoma, 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 calledbrain 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.
Coping With Stroke
Some common factors that increase a person’s risk of all types of strokes include:
Risk factors for hemorrhagic strokes in particular, include:
Causes and Risk Factors of Stroke
Recovering from a stroke can take several months or longer, and may involve the following:
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.
Identifying what caused your first stroke is the key to preventing another stroke.
The 7 Stages of Stroke Recovery
Summary
Any stroke can potentially be severe. The chances of surviving a stroke or recovering completely depend on the type of stroke, the part of the brain involved, and how long it takes to get medical help.
Certain subtypes of stroke are more likely to be severe. This includes strokes that affect parts of the brain that receive blood from small blood vessels, those involving large blood clots, those that cause massive bleeding in the brain, and strokes that affect the brainstem.
Complications of a massive stroke can include paralysis, coma, and death. Recovering from a massive stroke can take months or longer.
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 aboutmedicationsand lifestyle changes that can help prevent you from having another stroke.
Signs that someone may be having a stroke include sudden drooping of one side of the face, slurred speech, weakness in one arm or leg, vision problems, trouble walking, and a severe headache with no known cause.Learn MoreDecerebrate Posture
Signs that someone may be having a stroke include sudden drooping of one side of the face, slurred speech, weakness in one arm or leg, vision problems, trouble walking, and a severe headache with no known cause.
Learn MoreDecerebrate Posture
18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Stroke.National Institute of Neurological Disorders and Stroke.Stroke: hope through research.Warach SJ, Dula AN, Milling TJ Jr.Tenecteplase thrombolysis for acute ischemic stroke.Stroke. 2020;51(11):3440-3451. doi:10.1161/STROKEAHA.120.029749Powers WJ, Rabinstein AA, Ackerson T, et al.Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211Liberman AL, Zandieh A, Loomis C, et al.Symptomatic carotid occlusion Is frequently associated with microembolization.Stroke. 2017;48(2):394-399. doi:10.1161/STROKEAHA.116.015375Elsadek A, Gaber A, Afifi H, Farag S, Salaheldien N.Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction.Egypt J Neurol Psychiatr Neurosurg.2019;55(1):2. doi:10.1186%2Fs41983-018-0045-8Verschoof MA, Groot AE, Vermeij J, et.al.Association between low blood pressure and clinical outcomes in patients with acute ischemic stroke.Stroke. 2020;51:338–341. doi:10.1161/STROKEAHA.119.027336Walcott BP, Miller JC, Kwon CS, et al.Outcomes in severe middle cerebral artery ischemic stroke.Neurocrit Care. 2014;21(1):20-6. doi:10.1016/j.ncl.2014.07.006American Stroke Association.Hemorrhagic stroke (bleeds).Morais Filho AB de, Rego TL de H, Mendonça L de L, et al.The physiopathology of spontaneous hemorrhagic stroke: a systematic review.Rev Neurosci. 2021;32(6):631-658. doi:10.1515/revneuro-2020-0131American Stroke Association.Brain stem stroke.Ortiz de Mendivil A, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM.Brainstem stroke: anatomy, clinical and radiological findings.Semin Ultrasound CT MR.2013;34(2):131-41. doi:10.1053/j.sult.2013.01.004American Stroke Association.Stroke symptoms.National Organization for Rare Diseases.Locked-in syndrome.American Stroke Association.About stroke.Khanevski AN, Bjerkreim AT, Novotny V, et al.Recurrent ischemic stroke: Incidence, predictors, and impact on mortality.Acta Neurol Scand. 2019;140(1):3-8. doi:10.1111/ane.13093Oza R, Rundell K, Garcellano M.Recurrent ischemic stroke: strategies for prevention.Am Fam Physician. 2017;96(7):436-440Johns Hopkins Medicine.Stroke recovery timeline.Additional ReadingBevers MB, Kimberly WT.Critical care management of acute ischemic stroke.Curr Treat Options Cardiovasc Med. 2017;19(6):41. doi:10.1007/s11936-017-0542-6Malhotra K, Gornbein J, Saver JL.Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: A review.Front Neurol. 2017;8:651. doi:10.3389/fneur.2017.00651
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Stroke.National Institute of Neurological Disorders and Stroke.Stroke: hope through research.Warach SJ, Dula AN, Milling TJ Jr.Tenecteplase thrombolysis for acute ischemic stroke.Stroke. 2020;51(11):3440-3451. doi:10.1161/STROKEAHA.120.029749Powers WJ, Rabinstein AA, Ackerson T, et al.Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211Liberman AL, Zandieh A, Loomis C, et al.Symptomatic carotid occlusion Is frequently associated with microembolization.Stroke. 2017;48(2):394-399. doi:10.1161/STROKEAHA.116.015375Elsadek A, Gaber A, Afifi H, Farag S, Salaheldien N.Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction.Egypt J Neurol Psychiatr Neurosurg.2019;55(1):2. doi:10.1186%2Fs41983-018-0045-8Verschoof MA, Groot AE, Vermeij J, et.al.Association between low blood pressure and clinical outcomes in patients with acute ischemic stroke.Stroke. 2020;51:338–341. doi:10.1161/STROKEAHA.119.027336Walcott BP, Miller JC, Kwon CS, et al.Outcomes in severe middle cerebral artery ischemic stroke.Neurocrit Care. 2014;21(1):20-6. doi:10.1016/j.ncl.2014.07.006American Stroke Association.Hemorrhagic stroke (bleeds).Morais Filho AB de, Rego TL de H, Mendonça L de L, et al.The physiopathology of spontaneous hemorrhagic stroke: a systematic review.Rev Neurosci. 2021;32(6):631-658. doi:10.1515/revneuro-2020-0131American Stroke Association.Brain stem stroke.Ortiz de Mendivil A, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM.Brainstem stroke: anatomy, clinical and radiological findings.Semin Ultrasound CT MR.2013;34(2):131-41. doi:10.1053/j.sult.2013.01.004American Stroke Association.Stroke symptoms.National Organization for Rare Diseases.Locked-in syndrome.American Stroke Association.About stroke.Khanevski AN, Bjerkreim AT, Novotny V, et al.Recurrent ischemic stroke: Incidence, predictors, and impact on mortality.Acta Neurol Scand. 2019;140(1):3-8. doi:10.1111/ane.13093Oza R, Rundell K, Garcellano M.Recurrent ischemic stroke: strategies for prevention.Am Fam Physician. 2017;96(7):436-440Johns Hopkins Medicine.Stroke recovery timeline.Additional ReadingBevers MB, Kimberly WT.Critical care management of acute ischemic stroke.Curr Treat Options Cardiovasc Med. 2017;19(6):41. doi:10.1007/s11936-017-0542-6Malhotra K, Gornbein J, Saver JL.Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: A review.Front Neurol. 2017;8:651. doi:10.3389/fneur.2017.00651
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Stroke.National Institute of Neurological Disorders and Stroke.Stroke: hope through research.Warach SJ, Dula AN, Milling TJ Jr.Tenecteplase thrombolysis for acute ischemic stroke.Stroke. 2020;51(11):3440-3451. doi:10.1161/STROKEAHA.120.029749Powers WJ, Rabinstein AA, Ackerson T, et al.Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211Liberman AL, Zandieh A, Loomis C, et al.Symptomatic carotid occlusion Is frequently associated with microembolization.Stroke. 2017;48(2):394-399. doi:10.1161/STROKEAHA.116.015375Elsadek A, Gaber A, Afifi H, Farag S, Salaheldien N.Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction.Egypt J Neurol Psychiatr Neurosurg.2019;55(1):2. doi:10.1186%2Fs41983-018-0045-8Verschoof MA, Groot AE, Vermeij J, et.al.Association between low blood pressure and clinical outcomes in patients with acute ischemic stroke.Stroke. 2020;51:338–341. doi:10.1161/STROKEAHA.119.027336Walcott BP, Miller JC, Kwon CS, et al.Outcomes in severe middle cerebral artery ischemic stroke.Neurocrit Care. 2014;21(1):20-6. doi:10.1016/j.ncl.2014.07.006American Stroke Association.Hemorrhagic stroke (bleeds).Morais Filho AB de, Rego TL de H, Mendonça L de L, et al.The physiopathology of spontaneous hemorrhagic stroke: a systematic review.Rev Neurosci. 2021;32(6):631-658. doi:10.1515/revneuro-2020-0131American Stroke Association.Brain stem stroke.Ortiz de Mendivil A, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM.Brainstem stroke: anatomy, clinical and radiological findings.Semin Ultrasound CT MR.2013;34(2):131-41. doi:10.1053/j.sult.2013.01.004American Stroke Association.Stroke symptoms.National Organization for Rare Diseases.Locked-in syndrome.American Stroke Association.About stroke.Khanevski AN, Bjerkreim AT, Novotny V, et al.Recurrent ischemic stroke: Incidence, predictors, and impact on mortality.Acta Neurol Scand. 2019;140(1):3-8. doi:10.1111/ane.13093Oza R, Rundell K, Garcellano M.Recurrent ischemic stroke: strategies for prevention.Am Fam Physician. 2017;96(7):436-440Johns Hopkins Medicine.Stroke recovery timeline.
Centers for Disease Control and Prevention.Stroke.
National Institute of Neurological Disorders and Stroke.Stroke: hope through research.
Warach SJ, Dula AN, Milling TJ Jr.Tenecteplase thrombolysis for acute ischemic stroke.Stroke. 2020;51(11):3440-3451. doi:10.1161/STROKEAHA.120.029749
Powers WJ, Rabinstein AA, Ackerson T, et al.Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211
Liberman AL, Zandieh A, Loomis C, et al.Symptomatic carotid occlusion Is frequently associated with microembolization.Stroke. 2017;48(2):394-399. doi:10.1161/STROKEAHA.116.015375
Elsadek A, Gaber A, Afifi H, Farag S, Salaheldien N.Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction.Egypt J Neurol Psychiatr Neurosurg.2019;55(1):2. doi:10.1186%2Fs41983-018-0045-8
Verschoof MA, Groot AE, Vermeij J, et.al.Association between low blood pressure and clinical outcomes in patients with acute ischemic stroke.Stroke. 2020;51:338–341. doi:10.1161/STROKEAHA.119.027336
Walcott BP, Miller JC, Kwon CS, et al.Outcomes in severe middle cerebral artery ischemic stroke.Neurocrit Care. 2014;21(1):20-6. doi:10.1016/j.ncl.2014.07.006
American Stroke Association.Hemorrhagic stroke (bleeds).
Morais Filho AB de, Rego TL de H, Mendonça L de L, et al.The physiopathology of spontaneous hemorrhagic stroke: a systematic review.Rev Neurosci. 2021;32(6):631-658. doi:10.1515/revneuro-2020-0131
American Stroke Association.Brain stem stroke.
Ortiz de Mendivil A, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM.Brainstem stroke: anatomy, clinical and radiological findings.Semin Ultrasound CT MR.2013;34(2):131-41. doi:10.1053/j.sult.2013.01.004
American Stroke Association.Stroke symptoms.
National Organization for Rare Diseases.Locked-in syndrome.
American Stroke Association.About stroke.
Khanevski AN, Bjerkreim AT, Novotny V, et al.Recurrent ischemic stroke: Incidence, predictors, and impact on mortality.Acta Neurol Scand. 2019;140(1):3-8. doi:10.1111/ane.13093
Oza R, Rundell K, Garcellano M.Recurrent ischemic stroke: strategies for prevention.Am Fam Physician. 2017;96(7):436-440
Johns Hopkins Medicine.Stroke recovery timeline.
Bevers MB, Kimberly WT.Critical care management of acute ischemic stroke.Curr Treat Options Cardiovasc Med. 2017;19(6):41. doi:10.1007/s11936-017-0542-6Malhotra K, Gornbein J, Saver JL.Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: A review.Front Neurol. 2017;8:651. doi:10.3389/fneur.2017.00651
Bevers MB, Kimberly WT.Critical care management of acute ischemic stroke.Curr Treat Options Cardiovasc Med. 2017;19(6):41. doi:10.1007/s11936-017-0542-6
Malhotra K, Gornbein J, Saver JL.Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: A review.Front Neurol. 2017;8:651. doi:10.3389/fneur.2017.00651
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
