[Primary cerebromeningeal hemorrhages in children (except newborn infants)]

The authors report their experience on 22 children admitted for spontaneous subarachnoid hemorrhages, to the pediatric and neurosurgery units of the University-Hospital of Saint-Etienne. There were seven cases of subarachnoid hemorrhages (five ruptured arterial aneurysms and one angioma) and 15 cases with associated intracranial hematomas (eight angiomas, one cavernoma, one aneurysm). Seven of 15 children with hematoma died, compared to two of seven children with subarachnoid hemorrhage. Half of the patients with hematomas and 20% of those with subarachnoid hemorrhage had sequellae. This rare pathology should be diagnosed in emergency, since brain damage occurs secondary to raised intracranial pressure. The respective roles of tomodensitometry, lumbar puncture and arteriography are discussed. The surgery should be performed in emergency, because the most frequent etiology is a vascular malformation, and because there is a risk of unexpected deterioration. When an underlying cause cannot be found neither by arteriography not by surgery, the follow-up should include a tomodensitometry and/or magnetic imaging.