Size and location make a difference when it comes to traumatic  brain injury, and Gary Coleman (l.) and Bret Michaels had very different  outcomes from their respective injuries.

Both men were relatively young when they were sidelined by a traumatic brain injury. Yet actor Gary Coleman succumbed last week at the age of 42, and rocker Bret Michaels, 47, is back on the scene, fresh off his "Celebrity Apprentice" win and looking like a bandanna-clad poster child for robust good health.

How can a cerebral hemorrhage have such different consequences? It depends upon the type of hemorrhage, its size, what area of the brain is affected and the overall health of the victim, experts say.

Both an intracranial hemorrhage (which occurs inside the brain tissue) or a subarachnoid hemorrhage (which bleeds into the lining around the brain) have the potential to kill. Bleeds in certain areas of the brain (such as the ones that control heart rate and breathing) are much more likely to be fatal than, say, a hemorrhage into a region that controls speech or vision.

"It’s like real estate - location, location, location," says Dr. Toby Gropen, chairman of the department of neurology at Long Island College Hospital. "And the size of the hemorrhage makes a difference, too."

The brain stem, which is about the size of a thumb, is an unfortunate place to suffer a brain hemorrhage, says Dr. Jeffrey Frank, neurology professor and director of neurocritical stroke care at the University of Chicago. "A substantial stroke in the brain stem could be catastrophic, while people who suffer a stroke in the language area would face disability but it would not be as devastating," he explains.

Dr. Randolph Marshall, professor of neurology at Columbia University School of Medicine and chief of the stroke division at New York Presbyterian Hospital, says Coleman's multiple health problems most likely played a significant role in his outcome after the brain injury. "He had other sources of inflammation relating to his kidney disease," Marshall says. "This can make it much more difficult to recover."

Recurrent strokes tend to be more devastating than the first stroke, says Gropen, which is why it is so important for stroke victims to pay attention to symptoms and get treatment. And, Gropen adds, there are certain risk factors for hemorrhagic strokes that people can actually control. Smoking, high blood pressure, obesity and heavy alcohol usage all can be contributing factors, he says. Drug use, especially when it includes cocaine, also ups the risk of stroke.

"We know that the treatment of risk factors and their elimination can have a profound effect on eliminating the risk," Gropen says.


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