title: Subarachnoid and intra-cerebral hemorrhage in young adults: rare and underdiagnosed.
abstract: OBJECTIVE
  Convexity subarachnoid and intra-cerebral hemorrhages, in patients aged<50 years, are always a diagnostic challenge. This condition is characterized by acute headaches with or without neurological symptoms and/or seizures, and by the radiological demonstration of subarachnoid and/or intra-cerebral hemorrhages and, more rarely, by the association of ischemic events.
  
  
  METHODS
  In a prospective series of 30 consecutive patients (median age 31 years; 22 women) with a subarachnoid and intra-cerebral hemorrhages, 19 were diagnosed with reversible cerebral vasoconstriction syndrome (RCVS), 7 with cerebral venous sinus thrombosis (CVST), and 4 with a bleeding mycotic aneurysm (MA).
  
  
  RESULTS
  RCVS appeared spontaneously in 16 patients and was related to the postpartum period in three cases. Subarachnoid hemorrhage (SAH) was demonstrated in 24 patients as follows: 18 cases were in cortical areas, 4 were in the polygon of Willis, one was inter-hemispheric, and one was inter-hemispheric/intra-cerebral. A convexity pure intra-cerebral hemorrhage (ICH) was recorded in 6 cases. Among the 7 patients suffering from CVST, the superior sagittal sinus was involved in 4 cases, the transverse sinuses (TS) in 2, and the TS plus sigmoid sinus (SS) in one.
  
  
  CONCLUSIONS
  The three most common causes in this series were RCVS, followed by CVST and bleeding from MA. Because of atypical clinical or radiological presentations, this large spectrum of etiologies can cause diagnostic difficulties. Therefore, careful analysis is needed to ensure correct and prompt diagnosis and to avoid any dangerous delays in management.
authors.affiliation: Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France. Electronic address: bertrand.mathon@neurochirurgie.fr.
authors.forename: B
authors.initials: B
authors.lastname: Mathon
authors.affiliation: Service de neurologie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: A
authors.initials: A
authors.lastname: Ducros
authors.affiliation: Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: D
authors.initials: D
authors.lastname: Bresson
authors.affiliation: Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: A
authors.initials: A
authors.lastname: Herbrecht
authors.affiliation: Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: G
authors.initials: G
authors.lastname: Mirone
authors.affiliation: Service de neuroradiologie interventionnelle, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: E
authors.initials: E
authors.lastname: Houdart
authors.affiliation: Service de neuroradiologie interventionnelle, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Saint-Maurice
authors.affiliation: Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: P
authors.initials: P
authors.lastname: Di Emidio
authors.affiliation: Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: B
authors.initials: B
authors.lastname: George
authors.affiliation: Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: S
authors.initials: S
authors.lastname: Chibbaro
mesh_terms: D000293:Adolescent; D000328:Adult; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
keywords: Anévrysme mycotique; Cerebral sinus thrombosis; Cerebral venous thrombosis; Hémorragie intracérébrale; Hémorragie méningée; Intra-cerebral hemorrhage; Mycotic aneurysm; Reversible cerebral vasoconstriction syndrome; Subarachnoid hemorrhage; Syndrome de vasoconstriction cérébrale réversible; Thrombophlébite cérébrale; Thrombose veineuse cérébrale; Vasospasm; Vasospasme