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Lobar intracerebral hemorrhage


Definition:

Lobar intracerebral hemorrhage is bleeding in the largest part of the brain called the cerebrum.

Alternative Names:

Hemorrhage - intraparenchymal; Hemorrhage - intracerebral (lobar)

Causes, incidence, and risk factors:

Lobar intracerebral hemorrhage (ICH) may be caused by:

  • Angioma, a type of blood vessel tumor
  • Bleeding into a tumor
  • Blood clotting problems
  • Blood vessel problems such as aneurysm or arteriovenous malformation
  • Head injury (trauma)

In some cases, no cause can be found.

When it is not caused by trauma, lobar ICH is considered a type of hemorrhagic stroke, the most serious type of stroke.

Lobar ICH is associated with the apolipoprotein (apo) E gene, which is linked to an increased risk for Alzheimer's disease.

Lobar hemorrhages are also associated with the following:

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:

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

Other symptoms may include:

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:

Treatment:

The treatment depends on the specific location, severity, and cause of the bleeding. Treatment may include a lifesaving measure called medical hyperventilation, which involves inserting a breathing tube and forcing the person to breathe rapidly. This reduces pressure in the brain.

Surgery may be needed in some cases to repair or remove structures causing the bleed (such as a cerebral aneurysm or arteriovenous malformation).

Medicines may be prescribed to control pain, reduce swelling, and control seizures. If a bleeding disorder is present, medications or blood products may also be given.

Expectations (prognosis):

How well a patient does depends on the amount of swelling and how much blood collects in the brain.

Recovery may occur completely, or there may be some permanent loss of brain function. Death is possible, and may quickly occur despite prompt medical treatment.

Medications, surgery, or other treatments may have severe side effects.

Complications:

Complications will vary depending on the extent of damage and the location of the bleed.

In general, blood irritates the tissues of the brain and may cause swelling (cerebral edema). Blood collects into a mass (hematoma). These complications put increasing pressure on the brain and can destroy brain tissue. Blood can also irritate the delicate tissues covering the brain. This is called meningeal irritation.

Complications may include:

  • Complications of surgery
  • Hydrocephalus (fluid build-up the brain)
  • Permanent loss of any brain function
  • Seizure disorder
  • Side effects of medications used to treat the disorder
Calling your health care provider:

Go to the emergency room or call 911 if symptoms of a brain hemorrhage occur.

Any type of intracerebral hemorrhage is a severe condition requiring prompt medical attention. It may develop quickly into a life-threatening situation.

Emergency symptoms include difficulty breathing, seizures, loss of ability to move or swallow, sudden loss of sensations, sudden change in mental state, and loss of consciousness.

Prevention:

Treatment and controlling any risk-related disorders may reduce the risk of developing a brain 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. Abruptly stopping such medications could lead to this disorder.

If you take blood thinners such as Coumadin, your health care provider will order regular blood tests to make sure your medication dosage isn't raising your risk for a hemorrhage.

References:

Zivin JA. Hemorrhagic cerebrovascular disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 432.

Goldstein LB. Prevention and management of stroke. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders;2007:chap 58.


Review Date: 9/13/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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