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Hemorragia subaracnoide

Last reviewed: 22 Aug 2025
Last updated: 20 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • cefaleia
  • fotofobia
  • perda de consciência
  • paralisia do terceiro nervo craniano
Full details

Other diagnostic factors

  • idade >50 anos
  • sexo feminino
  • raça negra
  • náuseas/vômitos
  • estado mental alterado
  • meningismo
  • paralisia unilateral ou bilateral do sexto nervo craniano
  • hemorragia intraocular
  • deficits neurológicos focais
  • convulsões
Full details

Risk factors

  • hipertensão
  • tabagismo
  • história familiar
  • doença renal policística autossômica dominante (DRPAD)
  • uso de bebidas alcoólicas
  • uso de cocaína
  • Síndrome de Marfan
  • Síndrome de Ehlers-Danlos
  • pseudoxantoma elástico
  • neurofibromatose do tipo I
Full details

Diagnostic investigations

1st investigations to order

  • tomografia computadorizada (TC) do crânio
  • Hemograma completo
  • coagulograma
  • eletrólitos séricos
  • troponina I
  • glicose sérica
  • eletrocardiograma (ECG)
Full details

Investigations to consider

  • punção lombar (PL)
  • angiografia digital por subtração (ADS)
  • angiotomografia (ATG)
  • angiografia por ressonância magnética (ARM)
Full details

Treatment algorithm

ACUTE

todos os pacientes

Contributors

Authors

Salah Keyrouz, MD, FAHA, FCCM

Professor

Neurology and Neurosurgery

Washington University School of Medicine

St. Louis

MO

Disclosures

SK is an author of a reference cited in this topic.

Acknowledgements

Dr Salah Keyrouz would like to gratefully acknowledge Dr Michael N. Diringer, a previous contributor to this topic.

Disclosures

MND is an author of a number of references cited in this topic.

Peer reviewers

Venkatesh Aiyagari, MD

Associate Professor

Department of Neurology and Rehabilitation

University of Illinois at Chicago

Chicago

IL

Disclosures

VA declares that he has no competing interests.

Peter Martin, MA, BM BCh, MD, FRCP

Consultant Neurologist

Addenbrookes Hospital

Cambridge

UK

Disclosures

PM declares that he has no competing interests.

Giovanni Grasso, M.D., PhD

Aggregate Professor of Neurosurgery

Neurosurgical Clinic

Department of Clinical Neuroscience

University of Palermo

Palermo

Italy

Disclosures

GG declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Thompson BG, Brown RD Jr, Amin-Hanjani S, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015 Aug;46(8):2368-400.Full text  Abstract

Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-70.Full text  Abstract

Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013 Feb 7;35(2):93-112.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Hemorragia subaracnoide images
  • Differentials

    • Hemorragia subaracnoide (HSA) perimesencefálica não aneurismática
    • Dissecção arterial
    • Malformação arteriovenosa (MAV) cerebral e cervical
    More Differentials
  • Guidelines

    • Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals
    • Guidelines for the management of neurocritical care management of aneurysmal subarachnoid hemorrhage
    More Guidelines
  • Patient information

    Hemorragia subaracnoide

    More Patient information
  • Videos

    Punção lombar diagnóstica em adultos: demonstração animada

    Intubação traqueal - Vídeo de demonstração

    More videos
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