Symptoms:

The symptoms vary depending on the location of the bleed and the amount of brain tissue affected. Symptoms usually develop suddenly, without warning, and often during activity. They may come and go (be episodic) or slowly get worse over time.

Symptoms may include:

• Change in alertness (level of consciousness)
  • Apathetic
  • Coma
  • Lethargy
  • Sleepiness
  • Stupor
  • Unconsciousness
  • Withdrawn
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty writing or reading
• Headache
  • Occurs when lying flat
  • Wakes you up from sleep
  • Gets worse when you change positions or when you bend, strain, or cough
  • Starts suddenly
• Loss of coordination
• Loss of balance
• Movement changes, usually on only one side of the body
  • Difficulty moving any body part
  • Loss of fine motor skills
• Nausea or vomiting
• Seizure
• Sensation changes, usually on only one side of the body
  • Decreased sensation
  • Numbness or tingling
• Weakness of any body part
• Vision changes
  • Decreased vision
  • Loss of all or part of vision

Signs and tests:

A neurologic exam is almost always abnormal. The patient may look drowsy and confused. An eye examination may show abnormal eye movements and changes in the back of the eye. The patient may have abnormal reflexes. However, these findings do not necessarily mean a person is having a brain hemorrhage, and could be due to another medical condition.

A CT scan of the brain is the most important test used to confirm a brain hemorrhage. It should be done without delay.

A brain magnetic resonance imaging (MRI) scan can be done later to better understand what caused the bleeding.

Conventional angiography may be done in some cases to identify aneurysms or an arteriovenous malformation, although CT and MRI are more often used.

Other tests may include:

• Complete blood count (CBC)
• Blood clotting studies --prothrombin time (PT) and partial thromboplastin time (PTT)
• CSF (cerebrospinal fluid) exam