Are delusions common after a brain bleed?

A fellow caregiver asked...

My husband had a 3cm brain bleed in the frontal lobe. He can speak and answer appropriately. He can squeeze and unsqueeze and does have movement in his legs but is very weak after 7 weeks in the hospital. He is now receiving physical therapy. But he does not seem to know where he is--like in a hospital bed. I think he sometimes thinks he is driving. Is this an expected response? Will it go away?

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

As a general "rule of thumb", stroke symptoms continue to improve, slowly, until about 6 months after the stroke. Therefore, there are still several months left for him to get better.

However, what is never clear, is the degree of expected improvement. I frequently tell people that forecasting recovery after a stroke is a very imperfect science - not unlike asking a weatherman what the weather will be like in a week, or asking an economist what the economy will look like in six months. We simply do not have good forecasting models to answer these questions. The best way to estimate his future progress is to see how far he has come already, and expect this progress to continue at about that same pace, with some slowing down of improvement, for the next few months.

Therefore, unfortunately, there is no way to give you a straightforward answer as to whether or not his delusions will stop. Delusions are quite common after a stroke, and in many cases go away.

As a final thought, I would make sure that he does not have another reason for the delusions, such as day/night confusion in his room (like keeping the windows closed at all hours), or the effect of new medicines that were started during his hospitalization.

Good luck!