Hémorragie méningée : prise en charge

Subarachnoid hemorrhage (SAH) accounts for 5% of strokes with a high rate of death and complications. It occurs in a fairly young, often hypertensive and smoking, population. Patients usually present with sudden headache. Clinical evaluation uses a prognostic scale including level of consciousness and motor deficit on admission. CT brain scanning evaluates the initial blood amount, predictive of the occurrence cerebral vasospasm. After referral to a multidisciplinary center with neurovascular expertise, angiography detects the ruptured aneurysm, the cause of SAH in 85% of cases. Since rebleeding is an imminent danger, occlusion of the aneurysm should be performed on an emergency basis within the first 72 h, either by endovascular or microsurgical approach. Medical management includes early detection of hydrocephalus, maintenance of normovolemia and oral calcium antagonists. Cerebral vasospasm is a devastating complication inducing death and functional impairment related to delayed cerebral ischemia. Since pathophysiological knowledge is incomplete, prevention strategies remain limited. Treatment of cerebral vasospasm associates maintenance of cerebral perfusion and more invasive techniques such as chemical or mechanical angioplasty.