Types of Strokes With Severe Outcomes

There is a range of outcomes after a stroke, and the most severe strokes can cause significant disability or even death. These types of strokes are more serious due to their location in the brain or due to their size.

Patient sleeping while his wife sits next to him looking concerned
ImagesBazaar / Getty Images

There are a few categories of strokes that are more likely to result in worse outcomes. These include:

  • Brainstem strokes
  • Bilateral strokes — affecting both sides of the brain
  • Hemorrhagic strokes
  • Large strokes

If you or a loved one has had one of these types of strokes, you may have a long recovery or even a long-lasting and substantial change in your abilities.

Brainstem Strokes

The brainstem connects all of the nerve impulses that go from the brain to the body, which is why brainstem strokes can be devastating.

The brainstem controls many important functions, such as breathing, blood pressure, and heart rate, and contains the brain's awareness center, which allows us to stay conscious.

A brainstem stroke, even if it is small in size, 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.​

Bilateral Watershed Strokes

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.

Ischemia can occur during times of extremely low blood pressure, often caused by extreme blood loss, dehydration, heart attack, or sepsis.

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.

Hemorrhagic Strokes

Hemorrhagic strokes involve bleeding in the brain . There are multiple reasons why people develop bleeding in the brain, and some of the most common include:

  • Arteriovenous malformations
  • Ruptured aneurysms
  • Uncontrolled high blood pressure
  • Bleeding disorders
  • Traumatic injuries to the head
  • Dural sinus thrombosis
  • Brain tumors

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.

Large Thrombotic Strokes

Thrombotic strokes are caused by large blood clots that form in an artery, one of the main blood vessels of 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.

Middle cerebral artery stroke is an example of such as stroke. Swelling, which is a combination of fluid and inflammatory cells, may ensue as a result of a large stroke. The swelling causes a rapid increase in brain pressure throughout the entire brain. In turn, this high pressure leads to global brain dysfunction, impaired consciousness and very often, to brain herniation (significant pressure and pushing on the brain) and death.

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.

A Word From Verywell

It can be shocking to hear that you or a loved one has had a stroke. Strokes vary in severity, prognosis and long term effects. The most severe types of strokes can produce outcomes that may alter your life and the lives of your loved ones forever.

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.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Neurological Disorders and Stroke. Stroke: hope through research. Updated August 13, 2019

  2. 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

  3. 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

  4. 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

  5. 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

Additional Reading