Hemorrhage - intracerebral (deep); Intracranial bleed

• Headache
  • May occur when lying flat
  • May cause patient to awaken from sleep
  • May increase with change in position
  • Often starts suddenly
  • May increase with bending, straining, and coughing
• Nausea, vomiting
• Change in alertness (level of consciousness)
  • Apathetic, withdrawn
  • Sleepy, lethargic, somnolent, stuporous
  • Unconscious, comatose
• Decreased vision
• Loss of all or part of vision
• Sensation changes, usually on only one side of the body
  • Decreased sensation
  • Numbness, tingling
  • Abnormal sensations
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty writing or reading
• Movement changes, usually on only one side of the body
  • Weakness of any body part
  • Difficulty moving any body part
  • Loss of fine motor skills
• Loss of coordination
• Loss of balance
• Seizure

Neurological examination may indicate increased intracranial pressure or decreases in specific brain functions. The specific pattern of symptoms and function changes may indicate which of the deep brain tissues are affected. For example, sudden nausea, vomiting, loss of balance, headache, and rapid decrease in consciousness may indicate a bleed in the cerebellum or brainstem.

Eye examination may show swelling of the optic nerve from pressure in the brain, or there may be changes in eye movement. Abnormal reflexes may be present.

Tests to determine the cause of bleeding 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
• Angiogram (may be necessary)