Brain hemorrhage

My grandmother suffered a brain hemorrhage a few days ago. She was rushed to the hospital and is currently in the neurological ICU. Initially, she lost movement on her right side and couldn't speak. She’s slowly starting to regain some movement on that right side, though her speech hasn't returned yet. The doctor says it's too early to make any definitive predictions, but I guess I'm wondering what the typical long-term consequences are for a 73-year-old woman after a hemorrhage like this, and how the recovery process generally unfolds.

It really all boils down to a multitude of variables, doesn't it? Most likely, that bleeding was a direct consequence of the stroke itself, and honestly, the entire trajectory of her recovery hinges entirely upon how severe the damage was and where exactly it took place in the brain. If she’s regaining mobility on her right side this quickly, then we can probably assume it wasn't an incredibly massive insult to her nervous system. As for predicting exactly when she'll be back to herself, well, nobody can give you a definitive timeline because at the end of the day, it rests squarely on her own shoulders and her sheer tenacity. The most vital thing you can do right now is simply soothe her anxiety—tell her everything is going to be alright, mention that you've already had a word with the doctor, and reassure her that she’s going to pull through this just fine.

Just a quick little tweak to what was said before—spontaneous brain bleeding actually is a type of stroke itself, not just a side effect of one... whether it's subdural, subarachnoid, or intracerebral and happens out of nowhere (usually because of high blood pressure or a burst vessel like an aneurysm), it’s classified as a hemorrhagic stroke... but honestly, that's getting into the weeds...🙂

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Like hiddencrane18 mentioned earlier... how things turn out really depends on where the bleed happened, how big it was, and the specific type of hemorrhage we're looking at. The final outcome can range from—God forbid—a fatal situation to being completely paralyzed on one side, or even full recovery with just some minor motor issues. Being older definitely doesn't help the odds, but that isn't always the deciding factor.
The fact that the right side of the body is affected suggests the bleed was likely in the left hemisphere of the brain. Aside from all the stuff you can't control right now, recovery heavily relies on keeping blood pressure under wraps; you really shouldn't let it spike above 160 or 170 mmHg. Those sudden pressure spikes can easily trigger another bleed. Also, using sedatives in the right doses can really help manage restlessness or agitation, which is super common and something you definitely want to avoid during early treatment (obviously, only if the doctor says so). On top of that, managing brain swelling is huge—using things like Mannitol IVs or Lasix shots helps prevent cerebral edema, which is a big risk with these kinds of hemorrhages. At the same time, you have to be careful not to "dry out" the patient by under-hydrating them with fluids, whether through an IV or drinking, because that’s just as bad.
As for whether they should stay in bed or move around... that's the big question, and it's vital for recovery, but the neurologist has to make that call. In those very early stages, staying still is absolutely necessary. Once the acute phase passes, though, physical therapy and getting them moving becomes super important. For example, you really have to push those exercises on the right side to get that movement going again. Like I said, the neurologist is the one who decides when to start the PT.
From what I've seen, on average, people usually clear the acute phase after about two or three weeks following the stroke.
Having great nursing care—things like massages, turning the patient to prevent bedsores, and keeping up with good hygiene—makes a massive difference in how well they heal.
Lastly, psychological support is huge for someone who suddenly finds themselves unable to do everything they've done their whole life; it matters throughout the entire process. It might be less critical in the very beginning when they need to just rest and stay calm, but it becomes absolutely essential during the later rehab stages.

As the previous poster mentioned... the prognosis depends on where the bleeding happened, its size, and the specific type of hemorrhage.

I guess we just didn't realize that the doctor hadn't actually specified the exact consequences or the type of bleed. We were all pretty overwhelmed during those first few days, so I suppose we didn't think to ask everything we needed to.

The final outcome of a brain bleed can range from—God forbid—a fatal result to complete paralysis on one side, or even full rehabilitation with just minor motor issues. Age isn't exactly helping here, though maybe that isn't the deciding factor.

Age and general health are complicating factors since the doctor noted she wasn't in great shape beforehand. She has some vein issues in her legs and struggles with mobility, plus she’s overweight. Well, hopefully, being on an IV will help her drop some weight.

The fact that the right side is paralyzed suggests the bleed was likely in the left hemisphere. Aside from things out of our control, recovery will depend on keeping her blood pressure steady; it really shouldn't be spiking above 160 or 170 mmHg.

That was actually one of our hurdles, because the day before yesterday her pressure hit 100/170, so they spent the whole day trying to stabilize it. She also has a urinary tract infection, so she's on antibiotics now.

Using sedatives in appropriate doses usually manages restlessness and agitation, which are common and undesirable during early treatment, so they should be used if the doctor recommends them.

When she was in the ICU, she was given sedatives and slept for 24 hours straight; she was even snoring.

On the other hand, you can't let a patient get dehydrated by under-treating them with fluids, whether through an IV or orally, as that isn't good either.

When we visited yesterday, her mouth was extremely dry and she seemed hot. She isn't getting anything by mouth, so I hope she's getting enough fluids via the IV, because the catheter bag is always full, but the fluid is dark yellow. I know that's not ideal. In any case, she probably isn't getting enough hydration.

Whether or not she needs bed rest is the question... that's vital for recovery, but the neurologist has to make that call. Rest is necessary in the early stages. However, physical therapy and mobilization become important once the acute phase passes. For instance, we'll need to focus on exercising the right side to encourage movement. As I said, the neurologist decides when to start PT.

I know it's too early to tell since she's still in the ICU—not quite in the shock room, but not back in a regular ward yet. Yesterday she perked up and was awake for about 45 minutes while we were there. She was talking constantly, though it was mostly unintelligible. We could understand maybe every fiftieth word, but she even laughed a couple of times, so maybe there's some progress.
Thanks everyone, I have a better idea of what I need to ask the doctor now.👍

Scott Allen10 said:Just a quick little correction to what was said before—spontaneous brain bleeding is actually a specific type of stroke itself, rather than just a consequence of one... whether we are talking about subdural, subarachnoid, or intracerebral bleeding that occurs spontaneously (which most often stems from high blood pressure or an aneurysm), it constitutes a hemorrhagic insult... but honestly, it’s a distinction without much practical difference in this context...🙂

Thanks, Scott Allen10, I definitely fumbled my wording there!🙂

hiddencrane18 said:My grandmother suffered a brain hemorrhage a few days ago. She was rushed to the hospital and she's currently in the neurology ICU. At first, her right side was paralyzed and she couldn't speak. Now, she's slowly starting to move her right side again, though her speech hasn't come back yet. The doctor says it's too early to make any real predictions, but I'm wondering what the long-term effects look like for a 73-year-old woman and how the recovery process usually goes.

Based on everything you’ve shared, there’s actually a really good chance for recovery. Since she’s already starting to regain some function, I think if she gets intense rehabilitation, the odds are looking veeeery good. Of course, the most important thing is having great support—basically, finding a high-quality physical therapist who truly knows their stuff and is dedicated to the work. You can help out a lot too; just talk to her constantly and encourage her to speak, even if it's hard to understand her right now. I could actually recommend the specialists over at Cleveland, they have some incredibly talented people working there...

Generally speaking, with hemorrhagic strokes, patients shouldn't be getting out of bed during those first two weeks, but all the other physical therapy should start immediately. The more intensive, the better (though you have to balance it with medical vitals so you don't push too hard regarding blood pressure). Right now, the biggest priority is making sure she doesn't pick up a hospital-acquired infection or pneumonia from being bedridden (make sure she coughs as much as she can so fluid doesn't build up in her lungs). Given how some of our neurology wards operate—good luck! Honestly, my own family went through something very similar recently, though it was an ischemic stroke. Forgive me, but some of the staff at that clinic in rural Ohio really deserved to experience exactly what happened to my grandfather because of how they handled "patient care"... Since physical therapy is my profession, it was even harder to watch because I know so much about the subject, but since I work in Washington, D.C., there wasn't much I could do to change things, and arguing wouldn't have helped anything anyway...

The paralysis on the right side and the speech issues suggest the middle cerebral artery was likely involved, but honestly, that's not what matters most for you right now. What matters is finding a solid physical therapist who can help get your grandma back to her old self. And keeping that blood pressure under control.

Good luck!

Scott Allen10 said:Quality nursing care—things like massages, repositioning patients, preventing pressure sores, keeping hygiene up... all that stuff—really makes a huge difference in how well someone recovers.

I mean, what kind of massages are we even talking about here? What is there to massage? Honestly, you’re lucky if they just remember to turn a patient so they don't end up with nasty bedsores. Don't get me wrong, there are definitely some nurses out there who go above and beyond, but those few who really let you down? You never forget them...

Casey Palmer5 said:Given how our neurology departments are set up lately—good luck to you!

Honestly, I'm right there with you on this one... it's just a bummer.

Casey Palmer5 said:Massage therapy? Please, what kind of massages are nurses even doing? Honestly, you’re lucky if they just roll a patient over so they don't end up with nasty pressure sores. I mean, sorry, there really are some people who go above and beyond, but those rare exceptions get totally overshadowed by the ones who make your life miserable—you never forget them.

And that's just the truth of it... unfortunately. Yeah, staffing shortages are a huge issue, but... could things be handled better? Absolutely.