Complications of Subarachnoid Hemorrhage

Abstract

The contributors of this article present an up-to-date review of the principal complications of subarachnoid meningeal hemorrhages and their treatment. After recalling the initial symptomatology and the principal etiologies, the common complications are reviewed: rise of temperature, vomiting causing electrolyte disturbances, electrocardiographic changes, rise of tension. Epileptic attacks sometimes leadint to a status epilepticus are suppressed by anticonvulsants; they may provoke hemorrhage symptomatic of angioma. Cerebral edema, whose pathogeny is recalled, yields to injections of mannitol or sorbitol, the effect of which is visualized by continuous measurement of the pressure of the CSF. Intracerebral hematoma, ventricular flooding and recurrence of the hemorrhage are severe complication, the symptomatology of which is recalled. Acute communicating hydrocephalus diminishes the cerebral circulation as is shown by the diagram presented by the authors: the removal of the CSF increases the cerebral circulation as tested by Xenon 133. In the course of recent years attention has been drawn to a late complication: chronic communicating hydrocephalus with negative pressure. The authors emphasize the elements of the diagnosis of this disorder of cerebral hydraulics which may be remedied by ventriculo-cisternal shunt of the CSF. Vascular spasm are a complication that is brought to light when arteriographies are done in the search for aneurysms or angiomas: they may mask the aneurysm, be the source of a localized ischemia or of an embolization arising from the aneurysmal sac. The medicamentous therapy of these spasms is difficult. (48 references) (Isch - Strasbourg)