Symptoms vary depending on the extent of damage and the location of the bleed. Symptoms most commonly develop suddenly, without warning, or often during activity. They may occasionally develop in a stepwise, episodic manner or in a progressive manner. There is a rapid loss of function(s) on one side of the body. These symptoms can be the same as when there is insufficient circulation to the brain (stroke).

Symptoms can include the following:

• Vision changes
  • Any change in vision
  • Loss of vision off to one side
  • Decreased vision
• Sensation changes
  • Numbness, tingling
  • Decreased sensation
  • Abnormal sensations
• Movement changes
  • Weakness of any body part
  • Difficulty moving any body part
  • Loss of fine motor skills
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty reading or writing
• Loss of coordination
• Loss of balance
• Seizure
• Headache
  • When lying flat
  • May awaken from sleep
  • Increases with change in position, bending, straining, coughing
• Nausea, vomiting
• Decreased consciousness
  • Apathetic, withdrawn
  • Sleepy, lethargic, somnolent, stuporous
  • Unconscious, comatose

Neurologic examination may indicate increased intracerebral pressure, such as swelling of the optic nerve or changes in eye movement. Localized abnormalities in brain function are detected by observing abnormal reflexes or movement. The specific pattern of function changes may indicate the location of the problem within the brain. However, an image of the brain (CT scan or MRI) is necessary to prove the condition is due to intracerebral hemorrhage.

In order to diagnose the hemorrhage as a hypertensive hemorrhage, there must be some evidence of high blood pressure. Often the blood pressure is still very elevated when the patient is examined. Other times, there are other findings on examination or tests to suggest hypertension, such as abnormal blood vessels in the eyes or abnormal kidney function.

Tests to determine the amount and cause of bleeding include:

• CBC
• Platelet count
• Bleeding time
• Prothrombin time
• Partial thromboplastin time
• Liver function tests
• Kidney function tests
• Angiography of the head (if symptoms allow enough time to perform this test) -- reveals any aneurysm or arteriovenous malformation present

• Head CT scan (preferred if the hemorrhage began less than 48 hours earlier)
• Head MRI