Investigating suspected subarachnoid haemorrhage in adults

Brown, Steven; Brew, Stefan; Madigan, John D.

doi:10.1136/bmj.d2644

Cited by 9 publications

(13 citation statements)

References 23 publications

(15 reference statements)

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“…Clinical decision rules that include these high-risk findings have been proposed to help identify SAH patients (6,7). If the appropriate history and symptoms are present, the classic teaching is to perform a noncontrast computed tomography (NCCT) scan of the head, followed by a lumbar puncture (LP) if the NCCT does not show clear evidence of SAH (8)(9)(10). If the LP shows no signs of xanthrochromia (visual or spectrophotometric) or elevated red blood cells, then one can safely exclude SAH as a diagnosis, with very few exceptions (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage

Meurer

Walsh

Vilke

et al. 2016

The Journal of Emergency Medicine

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, Abstract-Background: Subarachnoid hemorrhage (SAH) is frequently caused by the rupture of an intracranial aneurysmal vessel or arteriovenous malformation, leading to a cascade of events that can result in severe disability or death. When evaluating for this diagnosis, emergency physicians have classically performed a noncontrast computed tomography (NCCT) scan, followed by a lumbar puncture (LP). Recently, however, as CT technology has advanced, many studies have questioned the necessity of the LP in the SAH diagnostic algorithm and have instead advocated for noninvasive techniques, such as NCCT alone or NCCT with CT angiogram (CTA). Objective: The primary goal of this literature search was to determine the appropriate emergency department (ED) management of patients with suspected SAH. Methods: A MEDLINE literature search from October 2008 to June 2015 was performed using the keywords computed tomography AND subarachnoid hemorrhage AND lumbar puncture, while limiting the search to human studies written in the English language. General review articles and single case reports were omitted. Each of the selected articles then underwent a structured review. Results: Ninety-one articles were identified, with 31 papers being considered appropriate for analysis. These studies then underwent a rigorous review from which recommendations were developed. Conclusions: The literature search supports that NCCT followed by CTA is a reasonable approach in the evaluation of ED patients with possible SAH. Ó 2016 Elsevier Inc.

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Section: Introductionmentioning

confidence: 99%

Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage

Meurer

Walsh

Vilke

et al. 2016

The Journal of Emergency Medicine

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“…[22] It is important to perform a CT as soon as practical after headache onset because subarachnoid blood rapidly degrades. By 12 hours 2% of scans will be negative, 7% will be negative by 24 hours, 50% will be negative after 1 week and subarachnoid blood is almost completely reabsorbed within 10 days.…”

Section: Thunderclap Headachementioning

confidence: 99%

“…By 12 hours 2% of scans will be negative, 7% will be negative by 24 hours, 50% will be negative after 1 week and subarachnoid blood is almost completely reabsorbed within 10 days. [1322] Computed tomography quantifies the amount and distribution of blood and will show complications associated with SAH, such as hydrocephalus and ischemia. [22] The pattern of hemorrhage may also give an indication as to the likely location of the underlying aneurysm.…”

Section: Thunderclap Headachementioning

confidence: 99%

“…[1322] Computed tomography quantifies the amount and distribution of blood and will show complications associated with SAH, such as hydrocephalus and ischemia. [22] The pattern of hemorrhage may also give an indication as to the likely location of the underlying aneurysm. [1822]…”

Section: Thunderclap Headachementioning

confidence: 99%

“…[22] The pattern of hemorrhage may also give an indication as to the likely location of the underlying aneurysm. [1822]…”

Section: Thunderclap Headachementioning

confidence: 99%

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Neuroimaging and other investigations in patients presenting with headache

Duncan

2012

Ann Indian Acad Neurol

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Headache is very common. In the United Kingdom, it accounts for 4.4% of primary care consultations, 30% of referrals to neurology services and 0.5–0.8% of alert patients presenting to emergency departments. Primary headache disorders account for the majority of patients and most patients do not require investigation. Warning features (red flags) in the history and on examination help target those who need investigation and what investigations are required. This article summarizes the typical presentations of the common secondary headaches and what neuroimaging and other investigations are appropriate for each headache type.

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Differential diagnostic yield of lumbar puncture in investigation of suspected subarachnoid haemorrhage: a retrospective study

2013

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The diagnostic algorithm of computerized tomography (CT) and lumbar puncture (LP) for suspected subarachnoid haemorrhage (SAH) has lately been challenged by the advancement of radiological techniques, such as higher resolution offered by newer generation CT-scanners and increased availability of CT-angiography. A purely radiological workup of suspected SAH offers great advantages for both patients and the health care system, but the risks of abandoning LP in this setting are not well investigated. We have characterized the differential diagnostic yield of LP in the investigation of suspected SAH by a retrospective study. From the hospital laboratory database, we analyzed the medical records of all patients who had undergone CSF-analysis in search of subarachnoid bleeding during 2009-2011. A total of 453 patients were included. In 14 patients (3%) the LP resulted in an alternative diagnosis, the most common being aseptic meningitis. Two patients (0.5%) received treatment for herpes meningitis. Five patients (1%) with subarachnoid haemorrhages were identified. Among these, the four patients presenting with thunderclap headache had non-aneurysmal bleedings and did not require surgical intervention. We conclude that the differential diagnostic yield of LP in investigation of suspected SAH is low, which indicates that alternative diagnoses is not a reason to keep LP in the workup when a purely radiological strategy has been validated. However, algorithms should be developed to increase the recognition of aseptic meningitis. One hundred and fifty-three patients (34%) were admitted to undergo LP, which estimates the number of hospital beds that might be made available by a radiological diagnostic algorithm.

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Investigating suspected subarachnoid haemorrhage in adults

Cited by 9 publications

References 23 publications

Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage

Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage

Neuroimaging and other investigations in patients presenting with headache

Differential diagnostic yield of lumbar puncture in investigation of suspected subarachnoid haemorrhage: a retrospective study

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