Intracerebral Hemorrhage Health Channel

Definition

Lobar intracerebral hemorrhage is bleeding in the largest part of the brain called the cerebrum.

Alternative Names

Hemorrhage - intraparenchymal; Hemorrhage - intracerebral (lobar)

Causes, incidence, and risk factors

Lobar intracerebral hemorrhage (ICH) may be caused by:

• Angioma, a type of blood vessel tumor
• Bleeding into a tumor
• Blood clotting problems
• Blood vessel problems such as aneurysm or arteriovenous malformation
• Head injury (trauma)

In some cases, no cause can be found.

When it is not caused by trauma, lobar ICH is considered a type of hemorrhagic stroke, the most serious type of stroke.

Lobar ICH is associated with the apolipoprotein (apo) E gene, which is linked to an increased risk for Alzheimer's disease.

Lobar hemorrhages are also associated with the following:

• Cerebral amyloid
  • Decreased levels of blood platelets
  • High blood pressure
  • Liver disease (associated with increased bleeding risk)
  • Some autoimmune disorders
• Use of aspirin or blood thinners
• Various blood or bleeding disorders such as disseminated intravascular coagulation, hemophilia, sickle cell anemia, and leukemia

Symptoms

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 half of patientsn. The person may seem:

• Apathetic, withdrawn
• Sleepy, lethargic, stuporous
• Unconscious, comatose

Dementia occurs before the bleed occurs in those with cerebral amyloid. This condition is rare in children.

Other symptoms may include:

• Abnormal sensations
• Clumsiness
• Difficulty moving any body part
• Difficulty speaking or understanding speech
• Difficulty swallowing
• Difficulty writing or reading
• Eyelid drooping
• Facial paralysis
• Headache
  • May develop suddenly
  • May wake you up from sleep
  • Gets worse when you change position, bending, strain, or cough
• Loss of all or part of vision
• Loss of balance
• Loss of coordination
• Loss of muscle function or feeling
• Movement changes
• Neck or shoulder ache
• Neck pain (when bending neck)
• Seizure
• Sensation changes
  • Decreased sensation
  • Numbness or tingling
  • Weakness of any body part
• Stiff neck
• Vomiting
  • Occurs frequently, usually more often in the morning
  • Often described as occurring without nausea

Signs and tests

A neurological exam ma

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