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

Lobar intracerebral hemorrhage (ICH) may be caused by traumatic brain injury or blood vessel problems, such as aneurysm, arteriovenous malformation, or angioma, a type of blood vessel tumor.

When it is not caused by trauma, lobar intracerebral hemorrhage 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:

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

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• Apathetic, withdrawn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