Extended Pseudo-Subarachnoid Hemorrhage Post-Percutaneous Coronary Intervention

Honton, Benjamin; Sauguet, Antoine; Farah, Bruno; Gellee, Stéphane; Rivière, Louis David

doi:10.1016/j.jaccas.2020.06.032

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…Honton et al (2020) diagnosed sulcal hyperdensity on CT scans as pseudo-SAH based on the lack of hyperintensity on the FLAIR image of MRI. 23 ) However, even a high signal on FLAIR may not indicate bleeding because hyperintensity on FLAIR images has been reported in some pathological states, such as those with meningitis, meningeal carcinomatosis, and a small amount of protein leakage in the subarachnoid space. 24 ) We previously reported sulcal hyperintensity on FLAIR in epileptic chronic subdural hemorrhage without abnormal findings in GRE T2*-WI.…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid Hemorrhage Confirmed by Magnetic Resonance Imaging in a Patient with Brain Death owing to Hypoxic Encephalopathy Following Suicide by Hanging

OSHIDA,

YOKOSAWA,

ARAYA

et al. 2024

NMC Case Report Journal

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Although true subarachnoid hemorrhage (SAH) is an atypical complication owing to suicide by hanging, pseudo-SAH can often develop because of hypoxic encephalopathy. Therefore, differentiating pseudo-SAH from true SAH using brain computed tomography (CT) is often challenging. In Japan, an individual's cause of brain death must be determined to be eligible for organ donation, regardless of whether true SAH is involved or not. Herein, we report a case of SAH confirmed by magnetic resonance imaging (MRI) in a patient with brain death owing to hypoxic encephalopathy following suicide by hanging. A 48-year-old man attempted suicide by hanging. Upon arrival at the hospital, he developed pulseless electrical activity with apnea. Although spontaneous circulation returned within a few minutes of his arrival, spontaneous breathing did not recover. The patient was in deep comatose state without response to pain stimulation, brainstem reflexes, or electrical activities on an electroencephalogram. Consequently, the patient met diagnostic criteria for clinical brain death based on the Japanese organ transplantation law. Brain CT revealed global hypoxic injury and high density in the basal cisterns and subarachnoid space. Brain MR T2*-weighted imaging revealed low intensity at the left Sylvian fissure underlying the hematoma. These findings indicated brain death owing to hypoxic encephalopathy following hanging, and incidental true SAH was confirmed by MRI. Donor surgery and organ transplantation were performed. Spontaneous SAH can often develop secondary to hanging, and brain MRI can effectively determine whether the cause of brain death involves true SAH.

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Section: Discussionmentioning

confidence: 99%

Subarachnoid Hemorrhage Confirmed by Magnetic Resonance Imaging in a Patient with Brain Death owing to Hypoxic Encephalopathy Following Suicide by Hanging

OSHIDA,

YOKOSAWA,

ARAYA

et al. 2024

NMC Case Report Journal

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Pseudosubarachnoid hemorrhage sign in a patient with tetralogy of Fallot

Goyal,

Jain,

Doddamani

et al. 2024

JNRP

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Subarachnoid hemorrhage (SAH) constitutes a common neurosurgical emergency. Non-contrast computerized tomography (NCCT) head has very high specificity and sensitivity in detecting SAH. However, in certain conditions, the computed tomography (CT) may be falsely positive, termed as pseudo-SAH. We hereby report a rare case of pseudo-SAH in a patient with tetralogy of Fallot and discuss the possible etiopathogenesis and the pertinent literature. We present here a case of a 15-year-old male patient, who was diagnosed with tetralogy of Fallot (TOF) physiology. He presented to the cardiology outpatient clinic with complaints of dyspnea on exertion, headache, and drowsiness. The NCCT head revealed diffuse hyperdensity in the basal cisterns and sulcal spaces, which were suggestive of diffuse SAH. However, in the setting of negative CT and magnetic resonance angiography along with high hematocrit levels (84%), diagnosis of pseudo-SAH was considered. The patient was appropriately managed with beta-blockers, intravenous fluids, and serial phlebotomies. The patient underwent a palliative shunt connecting the ascending aorta to the main pulmonary artery (central shunt), following which his saturation improved, and hematocrit decreased (40%) leading to significant symptomatic improvement. Knowledge of pseudo-SAH signs is essential for the treating physician and plays an important part in the management of this patient population.

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Extended Pseudo-Subarachnoid Hemorrhage Post-Percutaneous Coronary Intervention

Cited by 2 publications

References 3 publications

Subarachnoid Hemorrhage Confirmed by Magnetic Resonance Imaging in a Patient with Brain Death owing to Hypoxic Encephalopathy Following Suicide by Hanging

Subarachnoid Hemorrhage Confirmed by Magnetic Resonance Imaging in a Patient with Brain Death owing to Hypoxic Encephalopathy Following Suicide by Hanging

Pseudosubarachnoid hemorrhage sign in a patient with tetralogy of Fallot

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