Investigation into the Causes of Delayed Diagnosis of Subarachnoid Hemorrhage

Ferro, José M.; Lopes, José Fernando Scarelli; Melo, Teresa Pinho e; Oliveira, V.; Crespo, M Riesco; Campos, J G; Trindade, A.; Antunes, J L

doi:10.1159/000108834

Cited by 20 publications

(11 citation statements)

References 11 publications

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“…This investigation used the data recorded in our SAH data bank [5] for all cases of SAH admitted to the Departments of Neurology and Neurosurgery from January 1985 to December 1990. Fortythree patients who did not have CT performed on admission were not included.…”

Section: Methodsmentioning

confidence: 99%

Seizures at the onset of subarachnoid haemorrhage

1996

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In a prospective study of 253 patients with subarachnoid haemorrhage, 16 (6.3%) had seizures at the onset of bleeding. None had a previous history of seizures. One was an alcoholic. None had metabolic imbalance. Hemiparesis, Hunt's grade > 3, the amount of subarachnoid blood and the presence of an aneurysm were significantly more frequent in patients with seizures at the onset of subarachnoid haemorrhage. Although rebleeding and mortality or severe disability at discharge were more frequent in these patients, seizures were not a significant predictor of prognosis. One of the survivors with early seizures developed recurrent epileptic seizures 1 year later.

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Section: Methodsmentioning

confidence: 99%

Seizures at the onset of subarachnoid haemorrhage

1996

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“…Factors influencing early hospital referral and admission have been described for several stroke types [1,2,3,4,5,6], including subarachnoid haemorrhage [7,8,9,10], but not for cerebral vein and dural sinus thrombosis (CVT). This type of stroke is far less frequent and has more diverse presenting patterns than arterial stroke, and these factors complicate its recognition and delay clinical suspicion and diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Delay in Hospital Admission of Patients with Cerebral Vein and Dural Sinus Thrombosis

et al. 2005

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Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41–14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00–0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97–7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61–13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome.

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“…Most patients with subarachnoid hemorrhage (SAH) present with a sudden onset of headache or loss of consciousness, and in these patients the diagnosis can easily be made, although two studies have found physician's delay in one-fourth of patients [1,5]. In the era before computed tomography (CT), Miller-Fisher [13] pointed out that an acute confusional state (ACS) may be the presenting syndrome in SAH.…”

Section: Introductionmentioning

confidence: 99%

Acute confusional state as presenting feature in aneurysmal subarachnoid hemorrhage: frequency and characteristics

Reijneveld¹,

Wermer²,

Boonman³

et al. 2000

J Neurol

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In many patients with subarachnoid hemorrhage (SAH) there is a delay between the onset of symptoms and admission to hospital. An important cause for the delay is an initially erroneous diagnosis. The goal of this study was to determine the frequency of acute confusional state (ACS) as a presenting symptom of SAH and to describe the clinical and radiological characteristics of these patients. We studied all 717 patients registered from January 1989 to July 1997 in the SAH database of the University Medical Center Utrecht. For patients who presented with ACS we reviewed the computed tomography scans for baseline characteristics: the amount of cisternal blood, intraventricular or intracerebral hemorrhage, and hydrocephalus. Details about features of onset were known for 646 patients. Nine patients (1.4%) presented with ACS. In five patients ACS was either preceded by a period of loss of consciousness or accompanied by severe headache. Subtle focal deficits were found at initial neurological examination in four patients. Computed tomography demonstrated a frontal hematoma in three patients and hydrocephalus in four. The site of the ruptured aneurysm was at the anterior communicating artery in four patients, at the internal carotid artery in two, and at the basilar artery in two. In our series, one per 70 patients with SAH presents with ACS. Keys to early diagnosis of SAH in patients presenting with ACS are a preceding period of loss of consciousness and severe headache on neurological assessment.

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Investigation into the Causes of Delayed Diagnosis of Subarachnoid Hemorrhage

Cited by 20 publications

References 11 publications

Seizures at the onset of subarachnoid haemorrhage

Seizures at the onset of subarachnoid haemorrhage

Delay in Hospital Admission of Patients with Cerebral Vein and Dural Sinus Thrombosis

Acute confusional state as presenting feature in aneurysmal subarachnoid hemorrhage: frequency and characteristics

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