Dear Dr. Donohue • A friend of mine, 46 years old, with a wife and two children, died of a stroke. I also heard he died of a subarachnoid hemorrhage. Are they the same? He was the picture of health and was devoted to exercise. Could his exercise be responsible? He was almost a fanatic about it? — P.M.
Answer • A subarachnoid hemorrhage is a special kind of stroke. It's due to the bursting of an aneurysm on one of the brain arteries. Aneurysms are small, balloon-like protrusions of a brain artery. They're weak spots. "Subarachnoid" indicates that the artery is below one of the brain's coverings — the arachnoid. It's the same place where cerebrospinal fluid circulates. A rush of a large volume of blood into this space compresses the brain and compromises its function. The increased pressure on the brain adds to the threat of death.
Sometimes these weak bulges have been there from birth. In most instances, they arise during life. High blood pressure, smoking and excessive intake of alcohol contribute to their development. From 10 million to 15 million Americans have a cerebral aneurysm. Only a small percentage of these people die from it.
At the onset of bleeding, the involved person complains of a terrible headache, the worst he or she has ever had. The person then becomes unresponsive and slips into a coma. This sort of stroke has a high fatality rate, around 50 percent.
Answering your question about your friend's devotion to exercise and its influence on his death is hard. Exercise did not cause the aneurysm to form. In unusual circumstances, it might have caused the aneurysm to break. Straining to lift a very heavy load while simultaneously holding the breath has been described as a possible reason for rupture of this kind of artery problem.
The booklet on strokes describes the more common stroke causes and their treatment. People can order a copy by writing: Dr. Donohue — No. 902, Box 536475, Orlando, Fla. 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.
Dear Dr. Donohue • How does beer cause urination that's out of line with the volume of liquid drunk? I haven't measured, but I swear that after two cans of beer, I urinate a bigger volume of urine than was in those two cans. Is this for real, or am I imagining it? — R.T.
Answer • All alcohol is a diuretic. It slows the production of antidiuretic hormone, a hormone made by the pituitary gland at the base of the brain. This hormone stops the production of urine. When the hormone level is on the low side, urine production increases.
Write Dr. Donohue at P.O. Box 536475, Orlando, Fla. 32853-6475.