title: [Subarachnoid hemorrhage in young patients].
abstract: Subarachnoid hemorrhage (SAH) accounts for 5 % of strokes with a high rate of death and morbidity. It occurs in young patients, often hypertensive and smoking. Patients usually present with sudden headache. Initial clinical evaluation uses a prognosis grading scale including level of consciousness and motor deficit on admission (WFNS scale). Unenhanced CT brain imaging demonstrates the SHA together with evaluation of the initial blood amount, predictive of the occurrence of cerebral vasospasm that may lead to delayed cerebral ischemia. After referral to a multidisciplinary center with neurovascular expertise, MR, CT and/or catheter 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, as soon as possible and within the first 72 heures, either by an endovascular or microsurgical approach. Medical management includes early detection of hydrocephalus and cerebral vasospasm is a devastating complication inducing death and functional impairment. Prevention strategies remain limited and include maintenance of normovolemia and calcium antagonists such as nimodipine. Treatment of cerebral vasospasm associates maintenance of cerebral perfusion and more invasive techniques such as chemical or mechanical angioplasty.
authors.affiliation: Service d'imagerie morphologique et fonctionnelle, Inserm UMR-S894, hôpital Sainte-Anne, 75014 Paris, France. o.naggara@ch-sainte-anne.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
authors.forename: François
authors.initials: F
authors.lastname: Nataf
mesh_terms: D006801:Humans; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy