Meningitis presenting as spontaneous subarachnoid haemorrhage (pseudo-subarachnoid haemorrhage)

Pseudo Subarachnoid Hemorrhage Sign in Bacterial Meningitis in a Patient Presenting With Acute Ischemic Stroke: A Novel Radiological Clue to Rapid Diagnosis

“…Imaging not infrequently showed increased density diffusely within the basal cisterns and along the Sylvian fissures. Nearly all of the cases resulted in death or residual sensory deficits, with only two cases showing complete resolution (Table 1) [6][7][8][9][10][11][12][13][14]. We present a case of a patient who presented with headache and focal neurologic deficits and had imaging findings consistent with diffuse SAH.…”

“…Several mechanisms have been proposed to explain the pSAH pattern. Mechanisms associated with meningitis suggest that toxins and inflammatory infiltrates in the CSF can compromise the blood-brain barrier (BBB) and allow leakage of proteinaceous exudate into the basal cisterns and subarachnoid space [2,11]. This explanation requires that protein-rich fluid appears hyperdense on CT, however, Norman et al report that pathological elevation of CSF protein does not contribute to significantly increased absorption on CT [15].…”

Pseudo-subarachnoid hemorrhage in a patient with hypoxic encephalopathy

“…Since then, further studies have been continuously performed as regards this phenomenon, and the several possible pathophysiological etiologies underlying it were proposed. The most popular theories include hypoxic-ischemic encephalopathy, reperfusion injury encephalopathy, massive cerebral infarction, viral meningoencephalitis, bilateral subdural hematoma, idiopathic intracranial hypertension, venous sinus thrombosis, and intrathecal or intravascular contrast agent injection [4][5][6][7][8][9][10][11]. These causes are excluded by detailed history, physical examination and laboratory data.…”

Unique presentation of intracranial pathology in the emergency department

“…Primarily, the mechanism is thought to be a breakdown of the blood-brain barrier allowing hyper-dense proteinaceous material to leak into the subarachnoid space. 2 This case provides a unique perspective in the literature into meningitis, exacerbated by an obstructing incidental mass that allows the formation of a distinctive radiological finding that can have major influence over a patient's immediate treatment.…”

“…1 In April 2019, a 1-week audit of all illicit drug-related presentations (IDRPs) to our ED found IDRPs were 6.9% (n = 96) of all attendances, with methamphetamine 61.5% of the cohort, being 4.2% of all attendances (eight per day). 2 For 6-13 April 2020, we repeated our 1-week audit, which provides a remarkable opportunity to compare pre-COVID data with COVID data as a natural experiment. This was coincidentally timed with the hard border closure of Western Australia at midnight 5 April.…”