Symptoms:

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 half of patientsn. The person may seem:

• Apathetic, withdrawn
• Sleepy, lethargic, stuporous
• Unconscious, comatose

Dementia occurs before the bleed occurs in those with cerebral amyloid. This condition is rare in children.

Other symptoms may include:

• Abnormal sensations
• Clumsiness
• Difficulty moving any body part
• Difficulty speaking or understanding speech
• Difficulty swallowing
• Difficulty writing or reading
• Eyelid drooping
• Facial paralysis
• Headache
  • May develop suddenly
  • May wake you up from sleep
  • Gets worse when you change position, bending, strain, or cough
• Loss of all or part of vision
• Loss of balance
• Loss of coordination
• Loss of muscle function or feeling
• Movement changes
• Neck or shoulder ache
• Neck pain (when bending neck)
• Seizure
• Sensation changes
  • Decreased sensation
  • Numbness or tingling
  • Weakness of any body part
• Stiff neck
• Vomiting
  • Occurs frequently, usually more often in the morning
  • Often described as occurring without nausea

Signs and tests:

A neurological exam may show signs of increased intracranial pressure or decreased brain functions. Your specific symptoms can help reveal which part of the brain is affected. Some patients with mild hemorrhages may only have a headache.

An eye exam may show changes in eye movement, abnormal reflexes, and swelling of the optic nerve from increased pressure in the brain.

Tests may include:

• Angiography of the head -- may be necessary to determine if there is an aneurysm or arteriovenous malformation
• CBC
• Bleeding time
• Liver function tests
• Kidney function tests
• Head CT -- may be preferred if bleed is less than 48 hours old
• MRI of head
• Platelet count
• Prothrombin time (PT) or partial thromboplastin time (PTT)