Development of pseudo-subarachnoid hemorrhage secondary to hypoxic-ischemic injury due to bleeding pulmonary arterio-venous malformation

Abstract

BackgroundThe computed tomography (CT) finding of a pseudo-subarachnoid hemorrhage (SAH) may lead the treating physician into a diagnostic dilemma. We present a case of a pseudo-SAH in a patient with post-resuscitative encephalopathy, secondary to a newly diagnosed bleeding pulmonary arterio-venous malformation (AVM).Case presentationA 19-year-old female presented acutely with massive hemoptysis. Cardiopulmonary resuscitation (CPR) followed, and the patient was subsequently intubated for airway protection with intensive care unit (ICU) admission. Urgent CT angiography of the thorax showed a bleeding pulmonary AVM, with evidence of hemothorax. Non-contrasted cranial CT initially revealed cerebral edema. Day 3 post admission, repeat cranial CT showed worsening cerebral edema, with evidence of pseudo-SAH. Patient passed away the next day.ConclusionsPseudo-SAH, if present, carries a poor prognosis. It should be recognized as a potential CT finding in patients with severe cerebral edema, due to various causes. The diagnosis is vital, to avoid wrongful treatment institution, as well as determination of cause of death.

Pseudosubarachnoid hemorrhage: A systematic review of causes, diagnostic modalities, and outcomes in patients who present with pseudosubarachnoid hemorrhage

“…[ 24 , 49 ] Overall 110 patients with pSAH following hypoxic-ischemic injury were included [ Table 1 ]. [ 1 - 3 , 10 , 14 , 17 , 23 , 24 , 30 , 33 , 34 , 39 , 40 , 46 , 49 , 56 , 60 , 63 , 64 , 66 , 68 - 70 ] Cases attributable to hypoxic-ischemic injury occurred following cardiac arrest with return of spontaneous circulation. All patients were evaluated with CT scans of the brain revealing pSAH.…”