Intracerebral Hemorrhage (ICH) is an extremely dangerous condition where a patient’s state can change drastically and become life-threatening within just a few hours of onset. The first 6 hours are particularly critical—the “battleground for treatment”—as bleeding is likely to expand, and the risk of loss of consciousness or respiratory arrest due to brainstem compression is highest.
Symptoms of Intracerebral Hemorrhage: Detailed by Location
| Bleeding Site | Typical Symptoms in the Acute Phase (First Few Hours) | Crucial Warning Signs (Call 911 Immediately!) | Common Residual Symptoms (Sequelae) |
| Putaminal Hemorrhage | * Sudden weakness/paralysis on one side of the body (Hemiparesis) * Sensory loss on one side * Eyes deviate towards the lesion and cannot return * Aphasia (inability to speak/understand) if dominant side | Decreased level of consciousness, Repeated vomiting | Hemiparesis, sensory impairment, higher brain dysfunction (e.g., attention deficit) |
| Thalamic Hemorrhage | * Numbness/tingling across the entire opposite side of the body (face to foot) * Sensation may become overly sensitive (hyperesthesia) * Eyes deviate downward/inward (Oculomotor disorder) * Dazed, sluggish reaction to calls | Sudden loss of consciousness, as if falling asleep | Thalamic pain (severe burning pain), sensory impairment, memory loss |
| Subcortical Hemorrhage(Frontal, Parietal, Temporal, Occipital Lobe) | * Symptoms vary greatly by location: Frontal: apathy, behavior change; Parietal: spatial neglect, inability to dress; Temporal: inability to comprehend speech; Occipital: visual field defect | Seizures, Rapid deterioration of consciousness | Hemi-spatial neglect, higher brain dysfunction, visual field defect |
| Cerebellar Hemorrhage | * Severe dizziness/vertigo (“the room is spinning”) * Inability to stand or walk (ataxia) * Slurred speech (dysarthria) * Severe headache + vomiting | Sudden unresponsiveness/lethargy(due to brainstem compression) | Unsteadiness (ataxia), coordination difficulties |
| Pontine Hemorrhage(Brainstem) | * Paralysis of both arms and legs (Quadriparesis) * Pinpoint pupils (miosis) * Inability to move eyes horizontally * Fever (central fever) | Coma within minutes to hours, Impending respiratory arrest | Locked-in Syndrome, severe disability, bedridden state |
| Subarachnoid Hemorrhage (SAH) (For Reference) | * “Worst headache of life” (like being hit by a hammer) * Brief loss of consciousness (seconds to minutes) * Stiff neck (nuchal rigidity) | Sudden loss of consciousness due to re-bleeding | Stroke due to vasospasm, hydrocephalus |
Symptom Changes Over Time (Extremely Important)
| Time | Commonly Observed Change |
| Immediately after onset ∼ 1 hour | Sudden severe headache, vomiting, limb paralysis, unclear consciousness |
| 1 ∼ 6 hours after onset | Bleeding expands → Symptoms rapidly worsen (especially Cerebellar/Pontine) → This period is the most dangerous! |
| 6 ∼ 24 hours after onset | Brain edema (swelling) reaches its peak → Reduced consciousness, weakened breathing |
| 2 ∼ 7 days after onset | Brain swelling gradually decreases for some, but others worsen due to hydrocephalus |
5 Major Danger Signs for Family to Remember: “If you see this, call 911 immediately!”
- A severe headache unlike any experienced before (especially one described as being hit by a bat).
- Sudden inability to move one side of the limbs or a complete loss of strength.
- Drowsiness or unresponsiveness to verbal commands.
- Repeated vomiting (especially projectile vomiting).
- Sudden inability to walk or severe unsteadiness (cannot stand).
→ If even one of these signs is present, call an ambulance immediately!
DO NOT wait to see how things develop (especially within the first 6 hours).
