Intracranial Hemorrhage Clinical Presentation

Updated: Dec 07, 2018
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Onset of symptoms of intracerebral hemorrhage is usually during daytime activity, with progressive (ie, minutes to hours) development of the following:

  • Alteration in level of consciousness (approximately 50%)

  • Nausea and vomiting (approximately 40-50%)

  • Headache (approximately 40%)

  • Seizures [4] (approximately 6-7%)

  • Focal neurological deficits

Lobar hemorrhage due to cerebral amyloid angiopathy may be preceded by prodromal symptoms of focal numbness, tingling, or weakness.

A history of hypertension, trauma, illicit drug abuse, or a bleeding diathesis may be elicited.



Clinical manifestations of intracerebral hemorrhage are determined by the size and location of hemorrhage, but may include the following:

  • Hypertension, fever, or cardiac arrhythmias

  • Nuchal rigidity

  • Subhyaloid retinal hemorrhages

  • Altered level of consciousness

  • Anisocoria

  • Focal neurological deficits

    • Putamen - Contralateral hemiparesis, contralateral sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, aphasia, neglect, or apraxia

    • Thalamus - Contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous hemianopia, miosis, aphasia, or confusion

    • Lobar - Contralateral hemiparesis or sensory loss, contralateral conjugate gaze paresis, homonymous hemianopia, abulia, aphasia, neglect, or apraxia

    • Caudate nucleus - Contralateral hemiparesis, contralateral conjugate gaze paresis, or confusion

    • Brain stem - Quadriparesis, facial weakness, decreased level of consciousness, gaze paresis, ocular bobbing, miosis, or autonomic instability

    • Cerebellum - Ataxia, usually beginning in the trunk, ipsilateral facial weakness, ipsilateral sensory loss, gaze paresis, skew deviation, miosis, or decreased level of consciousness



Possible causes are as follows:

  • Hypertension [5]

  • Aneurysmal rupture

  • Intracranial neoplasm

  • Coagulopathy

  • Hemorrhagic transformation of an ischemic infarct

  • Cerebral venous thrombosis

  • Sympathomimetic drug abuse

  • Sickle cell disease

  • Eclampsia or postpartum vasculopathy

  • Infection

  • Vasculitis

  • Neonatal intraventricular hemorrhage

  • Trauma