Subarachnoid Haemorrhage of Unusual Aetiology

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Abstract
The syndrome of spontaneous subarachnoid hemorrhage usually results from rupture of an intracranial aneurysm, or less commonly, a cerebral angioma, but occasionally it may be produced by a variety of pathologic lesions of the central nervous system. When the hemorrhage arises intracranially, aetiologic agents which may be implicated in occasional cases include telangiectases, intracranial neoplasms of many types, blood dyscrasias, venous sinus thrombosis, inflammatory conditions such as meningitis, abscess and infective emboli, focal vascular necrosis, vascular allergy, and miscellaneous factors including pneumoencephalography and insulin or Metrazol admn. Spinal subarachnoid hemorrhage is usually the result of vascular malformations of the spinal cord or meninges, but can occasionally be produced by intrathecal neoplasms other than angiomas. Sometimes signs of the primary disease are evident when bleeding occurs but often hemorrhage may be the first manifestation. Illustrative cases of unusual etiology, comprising 5% of a recently studied series of 312 consecutive cases of spontaneous subarachnoid hemorrhage, are reported and the relevant literature is reviewed. Recognition of such cases is of importance since many of the conditions mentioned require specific treatment. Hence all possible causes should be considered in the observation of patients with subarachnoid hemorrhage; careful clinical appraisal of each case is of the greatest importance and any unusual features in the clinical picture may indicate the need for investigations other than those commonly employed.