Mayele M'Peko Osawa F, Bertrand X
Service des Urgences, CHC Espérance et St Joseph, Liège, Belgique.
Service des Urgences, CHR Citadelle, Liège, Belgique.
Rev Med Liege. 2018 May;73(5-6):344-350.
Subarachnoid hemorrhage is a neurovascular emergency affecting relatively young adults. A ruptured cerebral aneurysm is the main non-traumatic cause. Except for the non-specific symptom of headache, which frequently occurs in subarachnoid hemorrhage, the clinical presentation is atypical, making the diagnosis difficult with possible dramatic consequences. The diagnosis is based on the CT scan without contrast, which, when negative, will be followed by a lumbar puncture. The etiologic analysis is based on an urgent arteriography, revealing the characteristics of the aneurysm such as the anatomy of the intracerebral vessels, the identification of the bleeding site and the size and location of the aneurysm. The main complications are bleeding relapse, hydrocephaly and vasospasm. Early treatment is based on the final repair of the aneurysm through two possible approaches: microvascular neurosurgical clipping or coiling via endovascular access. This article discusses the diagnostic and therapeutic aspects of subarachnoid hemorrhage.
蛛网膜下腔出血是一种影响相对年轻成年人的神经血管急症。脑动脉瘤破裂是主要的非创伤性病因。除了蛛网膜下腔出血常出现的非特异性头痛症状外，临床表现不典型，这使得诊断困难，并可能产生严重后果。诊断基于非增强CT扫描，若结果为阴性，则需进行腰椎穿刺。病因分析基于紧急血管造影，以揭示动脉瘤的特征，如脑内血管的解剖结构、出血部位的确定以及动脉瘤的大小和位置。主要并发症包括出血复发、脑积水和血管痉挛。早期治疗基于通过两种可能的方法对动脉瘤进行最终修复：微血管神经外科夹闭或血管内介入栓塞。本文讨论了蛛网膜下腔出血的诊断和治疗方面。
