Lobar intracerebral hemorrhage

Alternative names:

hemorrhage - intracerebral (lobar); hemorrhage - intraparenchymal

Symptoms:

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

• change in alertness (level of consciousness)
  • the first symptom in about 50% of people
  • in children, a change in the level of alertness
  • apathetic, withdrawn
  • sleepy, lethargic, somnolent, stuporous
  • unconscious, comatose
  • if cerebral amyloid is present, some individuals are demented before the bleed occurs (this is rare in children)

• vomiting
  • occurs frequently
  • often described as occurring without nausea
  • occurs more frequently in the morning

• possible headache
  • when flat, may awaken from sleep
  • increased with change in position
  • increased with bending, straining, coughing, etc.

• symptoms of focal (localized) damage may develop:
• vision changes
  • any change in vision
  • decreased vision, loss of all or part of vision

• sensation changes
  • decreased sensation
  • numbness, 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

• loss of coordination
• loss of balance
• seizure/spell

Other symptoms:

• stiff neck
• aching of neck, shoulders
• pain when bending neck

Additional symptoms that may be associated with this disease:

• muscle function/feeling loss
• movement, dysfunctional
• facial paralysis
• eyelid drooping

Signs and tests:

Neuromuscular examination may indicate meningeal irritation, increased intracranial pressure, or focal neurologic deficits (decreases in brain function). The specific pattern of symptoms and function changes may indicate the location of the lobar intracerebral hemorrhage. Eye examination may show swelling of the optic nerve from increased pressure in the brain, or there may be changes in eye movement. Abnormal reflexes may be present, or there may be abnormal extent of normal reflexes.

Tests to determine the amount and cause of bleeding may include:

• a CBC
• platelet count
• bleeding time
• prothrombin/partial thromboplastin time (PT/PTT)
• liver function tests
• kidney function tests

Intracerebral hemorrhage may be confirmed, and the location and amount of bleeding determined by:

• head CT scan (preferred if bleed is less than 48 hours old)
• head MRI

Angiography of the head may be performed (if symptoms allow enough time) to determine if there is aneurysm or arteriovenous malformation present.