Subarachnoid hematoma in staphylococcal septicemia. A report of two cases

Two cases of subarachnoid hematoma, due to a Staphylococcus aureus septicemia are described. The clinical as well as the pathological findings suggest a two-step evolution, consisting first in the appearance of a small to moderate stroke, due to a septic embolic occlusion of a leptomeningeal artery and to cerebral infarction, followed by rupture of the artery and the formation of the subarachnoid hematoma, acting as a mass-lesion and leading to death by uncal herniation and brain stem compression. The typical location of the hematoma over the convex surface of a cerebral hemisphere suggests that local factors, such as the vicinity of patent leptomeningeal anastomoses and the fibrosis of the leptomeninges, are probably predisposing factors for its occurrence.