Spontaneous subarachnoid hemorrhage (SAH), although rare, may be devastating in children. The etiology of spontaneous SAH can be divided into three categories: arteriovenous malformation (AVM), cerebral aneurysm, and miscellaneous causes. AVMs occur in 1 per 100,000 children per year and are four times more common than aneurysm in patients younger than the age of 15 years. Aneurysms occur in four basic types: saccular or berry, giant,traumatic, and mycotic. Miscellaneous causes of spontaneous SAH include neoplasms, infection,leukemia, hemophilia, sickle cell disease,and ingestions (eg, cocaine,amphetamines).

The hallmark symptom of SAH is a sudden, severe headache. Reports suggest that up to 71% of patients who present to the emergency department with a sudden, severe headache have SAH as the underlying cause. Nausea and vomiting are seen in most patients. More common symptoms include loss of consciousness (believed to be caused by the sudden increase in intracranial pressure), nuchal rigidity, seizures, and focal neurologic...

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