[Consequences of meningeal hemorrhage during the first days after its onset].

Results of subarachnoid hemorrhage (SAH) in the acute phase are represented by the direct threat of vasospasm. The first step still is to recognise SAH, so that all misleading clinical aspects of arterial aneurysm rupture do not misguide, or even fail to do the right diagnosis. If so, rebleeding still remains a real danger. Among biological patterns, hyponatremia is an important factor of vasospasm. Cardiovascular symptoms are represented by a sudden and transient arterial hypertension which can drive to a diagnostic error and electrocardiographic abnormalities, which are directly related with the degree of vasospasm; their evolution is completely regressive. Main intracranial consequences are early hydrocephalus, worsening of consciousness and progressive ventricular distension on CT scan and vasospasm, which occurs between the 4th and the 12th day, may be asymptomatic or symptomatic, responsive for delayed ischemia, followed by deterioration of consciousness and focal neurological signs. The main factors responsible for the vasospasm are a high amount of blood in basal cisterns on CT scan; an increase of substances released by the lysis of hemoglobin in CSF; hyponatremia, hypovolemia, and decrease in cerebral blood flow. Consequences of these disorders have to be well known in the medical treatment before and after operation.