DEAR DR. DONOHUE: I have a friend whose sickness started with a cough. Then she got a bad headache and vomited. She was taken to the hospital, where it was found that a blood vessel in her head had burst. She is now able to walk well and eat well. What caused this? – Anon.

ANSWER: Your friend had a hemorrhagic stroke – one that results from bleeding in the brain. It’s not the most common kind of stroke. The most common kind results from a blockage of blood circulation in a brain artery. That’s an ischemic (is-KEY-mick) stroke.

Hemorrhagic strokes often come from the sudden rupture of an aneurysm. An aneurysm develops from a weak spot on an artery wall, in this case a brain artery. The weakness leads to the formation of a blisterlike bulge that can suddenly break. Brain aneurysms account for up to 30,000 strokes a year in the U.S. and Canada.

When the aneurysm breaks, or just prior to its breaking, affected people often complain of the worst headache they have ever had. Their neck stiffens, and vomiting is quite common. Then they lapse into unconsciousness.

Often the immediate cause of aneurysm rupture is sudden exertion or sudden strain. A violent cough, for example, could have triggered your friend’s stroke.

The initial break often seals itself, but it can bleed again. For that reason the aneurysm has to be fixed quickly. A neurosurgeon can place a metallic clip at the base of the aneurysm to prevent another bleed, or a doctor can thread a soft, pliable tube – a catheter – into the aneurysm. When the catheter is in place, the doctor deposits platinum coils in it. The coils promote clot formation, and that obliterates the aneurysm.

There’s another kind of hemorrhagic stroke that comes from a blood vessel bursting from uncontrolled high blood pressure. Your friend’s experience doesn’t sound like this kind of stroke.

The stroke booklet provides the details of stroke treatment and recovery. Readers can obtain a copy by writing: Dr. Donohue – No. 902, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am having great pain in my shoulders and wrists because of something called pseudogout. Is it the same as gout? What’s the best way to treat it? – W.M.

ANSWER: Pseudogout – false gout – gets the “pseudo” designation because of its striking similarities to gout, but it is not gout. Gout comes from uric acid infiltrating joints. Pseudogout comes from calcium pyrophosphate seeping into them.

The attacks of pseudogout are similar to gout attacks, with joint swelling and pain. They can affect any joint, but the knees, wrists, shoulders, ankles, elbows and hands are the ones most often attacked.

There is no one best medicine, but there are many that work, and which is best has to be determined through trial. Anti-inflammatory medicines like ibuprofen and indomethacin are often effective. The gout medicine colchicine also works. Injecting a swollen joint with cortisone can bring prompt relief.

DEAR DR. DONOHUE: I am the parent of a 16-year-old boy who is small for his age and gets bullied a lot. One boy who is big and muscular hits him really hard in his stomach. Recently, after being hit in the stomach, he came home sick and couldn’t eat. What long-term damage could he suffer from this? – J.B.

ANSWER: Your son could suffer serious injuries to many abdominal organs. Spleen rupture from a hard abdominal blow is just one example.

You must take this up with the school authorities immediately and demand that these barbaric and criminal assaults be stopped immediately.

I don’t know what’s going on with the bully, but he has psychological problems that need to be addressed quickly and firmly.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.