Retard diagnostique dans les hémorragies méningées

The mortality and morbidity of subarachnoid hemorrhage can be reduced if detected precociously. The objective of this article is to determine the causes of delayed diagnostic. We reviewed records of subarachnoid hemorrhage managed in the neurosurgery unit between 2002 and 2003 and selected cases of delayed diagnosis. The rate of delayed diagnosis was 16%, in accordance with data of the literature. All patients with late diagnosed subarachnoid hemorrhage were initially in good clinical condition. The diagnosis must be systematically considered in patients with sudden or severe headache because it is the most common presenting symptom. However, neck stiffness is often not present (two thirds of the cases), leading to the majority of diagnostic errors. Thunder clap headache can have the same presentation and is the principal differential diagnosis, but requires swift evaluation with investigations aimed at excluding subarachnoid hemorrhage (CT-scan and a lumbar puncture if it is normal).