meningeal hemorrhage

Subarachnoid hemorrhage: Is it serious? (Diagnosis and treatment)

THEmeningeal hemorrhage mainly affects the women over 40 years old. It's about a neurovascular emergency which can cause a cerebrovascular accident (CVA) in 20% of cases. It is a serious bleeding with consequences and a high mortality rate. In this article, discover how a subarachnoid hemorrhage is diagnosed and treated.

What is subarachnoid hemorrhage?

Anatomy of the meninges

Fullerenes brain are the membranes that cover the central nervous system (brain and spinal cord). They protect the liquid cerebral-spinal (cephalo-spinal) contained in the spinal cord as well as vessels blood which nourish and provide immunity to the nervous system.

From the outside to the inside, there are 3 membranes:

  • la dura mater ;
  • thearachnoid ;
  • la foot-mother.

Definition of subarachnoid hemorrhage

subarachnoid hemorrhage, or hemorrhage under-arachnoid, translates a bleeding between the arachnoid and the pia mater (subarachnoid space). It corresponds to an irruption of blood in this space which normally contains the cerebrospinal fluid.




What are the causes of subarachnoid hemorrhage?

In 85% of cases, the most common cause of a non-traumatic subarachnoid hemorrhage is the breaking of a swollen vessel in the brain. That's what we call aneurysm rupture. It's about a hemorrhage spontaneous ou primitive which can occur after an intense effort for example.

The aneurysm appears as an eminence produced on an artery. It develops without any risk factors that can influence its formation. However, its occurrence can be favored by certain hereditary diseases such as type 1 neurofibromatosis or Marfan syndrome. Cerebral aneurysms are generally located at the level of the anterior and posterior communicating artery as well as at the level of the middle cerebral artery.

The larger the aneurysm, the more likely it is to rupture. On the other hand, in the case of subarachnoid hemorrhage, the aneurysms are rather looking size.

The factors that favor the ruptured brain aneurysms are there alcohol intake, tobacco or some contraceptives oral et hypertension blood.

In approximately 60% of cases, the break of a malformation at the level of an artery or a vein in the cerebral region is responsible for a hemorrhage meningeal non-traumatic.

In 20% of cases, other etiologies can be considered such as:

  • of hemorrhagic diseases: haemophilia, excess vitamin K antagonist;
  • of maladies infectious: typhoid, whooping cough, brucellosis, leptospirosis, endocarditis…;
  • of you die brain: glioma, papilloma…;
  • others maladies like Behçet's, systemic lupus erythematosus and many others that could weaken the small arteries in the meninges.

In 20% of cases, there is a cryptogenic subarachnoid hemorrhage. This means that the true cause is not determined, despite a thorough examination and diagnosis.

On the other hand, subarachnoid hemorrhage can also be due to head injuries. This is also a very common cause.

How does subarachnoid hemorrhage manifest?

Subarachnoid hemorrhage is manifested by various symptoms:

  • of severe headaches and brutal;
  • of nausea ;
  • of vomiting.

After a short time, other signs appear:

  • loss of consciousness ;
  • consciousness disorders and vigilance ;
  • neurological deficits can become irremediable.

In some cases, the patient has a stiffness typical at the level of the neck.

After a few days, the patient still feels severe headache and sometimes from fever.

It is worth noting that these symptoms occur suddenly in a person who until then was still healthy.

How is subarachnoid hemorrhage diagnosed?


First, the diagnosis consists of a exam clinical. It must indicate the symptoms mentioned above, or even a meningeal syndrome. THEfundus examination of the patient shows a edema and hemorrhage. It is also possible that the doctor notices a abnormal acceleration of heart and respiratory rates.


La severity of this intracranial bleeding is assessed by a scale. This determines the level motor deficit and consciousness which translate the Glasgow coma score and Fischer-score. The latter requires the production of a brain scan without injection, to determine the amount of blood associated with hemorrhage.

Any patient suspected of having this type of bleeding should have a brain scan as soon as possible. This examination may show the presence of blood in the subarachnoid space and sometimes the presence of a hematoma or intracerebral edema. This allows to Diagnose hemorrhage meningeal. The scanner can guide the treatment.

If necessary, other Additional tests can be made:

  • IRM et angio-IRM: these examinations make it possible to highlight aneurysms;
  • angiography : it provides more details on aneurysms and spasms, it is contraindicated in patients who are too old or in those in critical condition;
  • puncture lumbar: it is contraindicated in case ofintracranial hypertension. It is only carried out if the scan is negative. It helps to better identify the causes of blood irruption in the subarachnoid space. If it evokes a positive subarachnoid hemorrhage, this would result in a high red blood cell count in the collected cerebrospinal fluid.

Other exams such as the electrocardiogram and doppler transcranial may be useful for the assessment of blood flow velocity and vasospasm.

Prognosis and chance of survival in subarachnoid hemorrhage

The prognosis and chance of survival depend on several factors:

  • the extent of injury and bleeding;
  • the speed and feasibility of treatment.

In subarachnoid hemorrhage, mortality reaches 35% to 70%. While le morbidity rate neighbor them 50%. People who recover have a greater than 15% risk of death within a few weeks of the first rupture.

Despite this severe prognosis, the chance of survival is still significant if the treatment is carried out in time and correctly.

As for the possible sequelae non negligable and risk of recurrence, they correspond to:

  • 3 to 4% over the next 24 hours;
  • 1-30% after one month, but decreases up to 3% over the years.

What is the treatment for a subarachnoid hemorrhage?


The patient suffering from subarachnoid hemorrhage must be taken care of as soon as possible. This, within a center or service specialized in neurosurgery and neuro-resuscitation.

The first treatments consist of control blood pressure and symptoms. To do this, the patient must be repos et bedridden. The following are examples of prescribed medications:

  • la nimodipine which inhibits the spasm of the arteries;
  • la nicardipine which controls blood pressure.

Follows a etiological treatment which usually consists of a occlusion for aneurysms and malformations responsible for blood eruption. This can be done by endovascular route (hyperselective embolization) by microcoils for small aneurysms and by open-skull neurosurgery for large sizes (microdissection and clip placement no later than 8 days after rupture).

Monitoring is essential for limit complications :

  • hydrocephalus acute: treated through an external ventricular bypass;
  • vasospasms: treated with nimodipine, or even angioplasty;
  • epilepsy: in rare cases.

To conclude, subarachnoid hemorrhage is a pathology very serious responsible for a high mortality rate, significant sequelae and various complications. The consequences can be controlled by rapid and adequate treatment as well as by the fight against risk factors, in particular alcoholism and smoking.

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