Symptomatology is usually sudden and progressive (progressing) over minutes and hours. The differentiation between intracerebral hemorrhage (hemorrhagic apoplexy) and ischemic apoplexy, which is so important for treatment, is not possible on the basis of symptoms alone! The following general symptoms and complaints may indicate intracerebral hemorrhage:
- Sudden and severe headache (almost always).
- Decrease in vigilance (decrease in attention).
- Loss of consciousness (within seconds or a few minutes) (common).
- Delirium (state of confusion)
- Epileptic seizures (does not have to be)
- Measured high blood pressure (systolic > 220 mmHg).
- Neurologic deficits – depending on the location and size of the hemorrhage (see below).
Associated symptoms
- Nausea (nausea)
- Emesis (vomiting)
Symptoms and complaints can also be described depending on the localization of the hemorrhage:
Basal ganglion hemorrhage (“loco typico hemorrhage”/typical localization).
- Aphasia (speech disorders)
- Homonymous hemianopsia – impaired vision affecting one side of the visual field.
- Conjugate gaze deviation to the side of the brain lesion – involuntary and noninfluential movement of both eyes in the same direction; occurs in unilateral brain lesions
- Contralateral hemiparesis – incomplete paralysis of one side of the body; in this case, the contralateral (opposite) side is affected in relation to the location of the hemorrhage
Thalamus (largest part of the diencephalon) (“loco typico hemorrhage”).
- Clouding of consciousness up to coma
- Choreoathetosis – complex movement disorder of the muscles of the extremities and face.
- Hemiataxy – gait disorder affects only one half of the body.
- Hemiparesis – incomplete paralysis of one half of the body.
- Contralateral sensorimotor hemisymptomatics – a hemisymptomatics describes side differences in terms of sensory and motor abilities.
- Vertical gaze palsy (gaze paralysis) – eye movement disorders during rapid upward and downward gaze.
Caudate nucleus
- Hemiparesis – incomplete paralysis of one half of the body.
- Incursion of hemorrhage into the ventricular system (cavity system in the brain) (intraventricular hemorrhage (IVB)) (common)
Pons (“bridge”; a section of the brain that is part of the hindbrain along with the cerebellum) (“loco typico hemorrhage”)
- Flexion and extension synergisms – sudden flexion and extension movements.
- Clouding of consciousness up to coma
- Contralateral hemisymptomatics – lateral differences in spontaneous mobility and postural control (here, affecting the opposite side (contralateral)).
- Tetraparesis (paralysis of all four extremities).
- Et al
Midbrain
- Clouding of consciousness to coma
- Horner syndrome – one side of the face is affected:
- Parinaud syndrome – vertical gaze paralysis combined with other neurological deficits due to damage to the cranial nerve nuclei in the midbrain area.
- Et al
Cerebellum (“Loco typico hemorrhage”).
- Hemiataxy – the gait disorder affects only one half of the body.
- Dysarthria (speech disorders)
- Emesis (vomiting)
- Spontaneous nystagmus – uncontrollable and rhythmic movements of the eye; they already occur without external stimuli.
- Vertigo (dizziness)
- Among other things
Medulla oblongata (continuation of the spinal cord into the brain area).
- Clouding of consciousness to coma
- Dysphagia (difficulty swallowing)
- Dysphonia (hoarseness)
- Tetraparesis (paralysis of all four extremities).
- Vertigo (dizziness)
