Lobar intracerebral hemorrhage

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Arteries of the brain

Hemorrhage - intraparenchymal; Hemorrhage - intracerebral (lobar)

Symptoms usually develop suddenly, without warning, often during activity. The symptoms vary, depending on the location of the bleeding and the amount of brain tissue affected.

A change in alertness or level of consciousness is the first symptom in about 50% of people, including children. The person may seem:

• Apathetic, withdrawn
• Sleepy , lethargic , stuporous
• Unconscious , comatose
• Dementia before the bleed occurs (rare in children) from cerebral amyloid

Other symptoms may include:

• Vomiting
  • Occurs frequently
  • Often described as occurring without nausea
  • Occurs more frequently in the morning
• Headache
  • May develop suddenly
  • May awaken the patient from sleep
  • Increased with change in position
  • Increased with bending, straining, coughing
• Loss of all or part of vision
• Sensation changes
  • Decreased sensation
  • Numbness or tingling
  • Abnormal sensations
• Difficulty speaking or understanding speech
• Difficulty swallowing
• Difficulty writing or reading
• Movement changes
  • Weakness of any body part
  • Difficulty moving any body part
  • Loss of fine motor skills/clumsiness
• Loss of coordination
• Loss of balance
• Seizure
• Stiff neck
• Aching of neck, shoulders
• Pain when bending neck
• Loss of muscle function or feeling
• Dysfunctional movement
• Facial paralysis
• Eyelid drooping

A neurological exam may suggest increased intracranial pressure or decreased brain functions. The person's specific symptoms can help tell which part of the brain is affected. Some patients with mild hemorrhages may only have a headache.

An eye exam may show swelling of the optic nerve from increased pressure in the brain. There may be changes in eye movement, abnormal reflexes, decreased vision, loss of movement or coordination, or inability to feel sensations properly

Tests may include:

• CBC
• Platelet count
• Bleeding time
• Prothrombin time (PT) or partial thromboplastin time (PTT)
• Liver function tests
• Kidney function tests
• Head CT -- may be preferred if bleed is less than 48 hours old
• MRI of head
• Angiography of the head -- may be necessary to determine if there is an aneurysm or arteriovenous malformation

Review Date: 07/14/2006
Reviewed By: J.A. Lee, M.D., Division of Surgery, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.