Lobar intracerebral hemorrhage occurs when there is bleeding in the white matter of the cerebrum (part of the brain).

It may be caused by trauma (brain injury) or abnormalities of the blood vessels, such as aneurysm, arteriovenous malformation (AVM), or angioma (tumors involving blood vessels). When it is not caused by trauma, lobar intracerebral hemorrhage can be considered a type of stroke.

Lobar intracerebral hemorrhage can be associated with amyloid deposits in the blood vessels (amyloid angiopathy). In some patients, the use of blood thinners may result in lobar hemorrhage. Brain tumors or (rarely) infections can also lead to bleeding in the brain. In some cases, no cause can be found.

Risks for lobar intracerebral hemorrhage, in addition to the causative disorders listed above, include the following:

• Various blood or bleeding disorders
  • Disseminated intravascular coagulation
  • Hemophilia
  • Sickle cell anemia
  • Leukemia
• Decreased levels of blood platelets
• Use of aspirin or anticoagulant medications (blood thinners)
• Liver disease (associated with increased bleeding risk)
• Cerebral amyloid
• Some autoimmune disorders

• Change in alertness (level of consciousness)*
  • Apathetic, withdrawn
  • Sleepy, lethargic, somnolent, stuporous
  • Unconscious, comatose
  • Presence of cerebral amyloid, causing dementia before the bleed occurs (rare in children)
• Vomiting
  • Occurs frequently
  • Often described as occurring without nausea
  • Occurs more frequently in the morning
• Possible headache
  • May develop suddenly
  • May awaken the patient from sleep
  • Increased with change in position
  • Increased with bending, straining, coughing, etc.

*This is the first symptom in about 50% of people, including children

Symptoms of focal (localized) damage may develop:

• Decreased vision (loss of all or part of vision)
• Sensation changes
  • Decreased sensation
  • Numbness, 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

Neurological examination may indicate increased intracranial pressure, or focal neurologic deficits (decreases in brain function). The specific pattern of symptoms and function changes may indicate the location of the lobar intracerebral hemorrhage. Some patients with mild hemorrhages may only have a headache.

Findings on physical examination may include 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 to determine the amount and cause of bleeding may include:

• Platelet count
• Bleeding time
• Prothrombin time (PT) or partial thromboplastin time (PTT)
• Liver function tests
• Kidney function tests

• Head CT scan (preferred if bleed is less than 48 hours old)
• Head MRI

The treatment is variable depending on the specific location, extent and cause of the bleeding. Treatment goals may include lifesaving interventions such as intubation and hyperventilation (when a breathing tube is inserted and the person is forced to breathe rapidly to reduce pressure in the brain). Treatment goals may also include supportive measures or control of symptoms.

If the bleed is small and does not cause increased pressure within the brain, treatment may be conservative and focused on control of symptoms.

Surgical removal of hematomas (areas of pooled blood) may be appropriate in some cases. Surgical repair of structures causing the bleed such as repair of aneurysm or arteriovenous malformation may be appropriate in some cases.

Medication may be needed to reduce brain swelling. Anticonvulsants can be used to control seizures, analgesics may be needed to control pain, and other medications may be required for symptoms particular to the area affected.

If a bleeding disorder is present, medications or blood products may be needed to control it.

The long-term outcome is highly variable. Death may occur quickly despite prompt medical treatment. Recovery may occur completely or with any level of permanent loss of brain functions.

Medications, surgery, or treatments for this condition may have severe side effects.

Blood irritates the tissues of the brain and may cause swelling (cerebral edema). Blood collects into a mass (hematoma). Both cerebral edema and the presence of a hematoma within the brain will put increasing pressure on the tissues of the brain and can destroy those tissues.

Blood may collect in the subarachnoid space and irritate the membranes covering the brain (meningeal irritation). Complications will vary depending on the extent of damage and the location of the bleed:

• Hydrocephalus (water on the brain)
• Permanent loss of any brain function
• Side effects of medications used to treat the disorder
• Complications of surgery
• Seizure disorder

Go to the emergency room or call the local emergency number (such as 911) if symptoms indicate lobar intracerebral hemorrhage.

Intracerebral hemorrhage is a severe condition ("brain attack") requiring prompt medical attention. It may develop quickly into a life-threatening situation.

Treatment and control of causative and risk-related disorders may reduce the risk of developing intracerebral hemorrhage.

High blood pressure should be treated as appropriate. Do not stop taking prescription medications unless advised to do so by your health care provider; abrupt cessation could lead to this disorder.

If you take blood thinners, your medication dosage needs to be monitored by blood tests, as directed by your health care provider, to make sure that the medications aren't making bleeding too likely and increasing your risk of hemorrhage.