Myelography-associated pseudo-subarachnoid hemorrhage

Sasaki, Yuya; Ishii, Keisuke; Ishii, Issei

doi:10.1016/j.visj.2016.05.004

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…Tau protein (>4,000 pg/ml), Aβ42 protein (279.6 pg/ml), 14-3-3 protein and scrapie prion protein were detected, confirming a diagnosis of sporadic CJD. Compared with previous reports [1][2][3][4], injection of only 1 mL of intra-thecal contrast media mimicked SAH, possibly resulting in transient alteration of consciousness.…”

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confidence: 69%

Contrast media mimicking subarachnoid hemorrhage after intrathecal injection in a patient with Creutzfeldt-Jakob disease

Kim¹

2022

Acute Crit Care

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An 81-year-old man visited our emergency department with a chief complaint of altered consciousness. His Glasgow coma scale (GCS) score was 11 and brain magnetic resonance imaging findings were suggestive of Creutzfeldt-Jakob disease (CJD) (Figure 1). Fluoroscopy-guided cerebrospinal fluid (CSF) drainage was attempted, but only 1 mL of contrast media could be injected into the CSF space, confirming the location of the needle, without acquisition of any CSF. Eight hours later, his GCS score dropped to 8 and brain computed

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contrasting

confidence: 69%

Contrast media mimicking subarachnoid hemorrhage after intrathecal injection in a patient with Creutzfeldt-Jakob disease

Kim¹

2022

Acute Crit Care

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“…Few cases of iatrogenic pSAH following intrathecal contrast administration have been reported in the literature with both iodine and gadolinium-based contrast agents ( Table 1 ) [1 , 4 , 6 , 10 , 13 , 14] . Of 7 cases of iatrogenic intrathecal contrast administration leading to pSAH 4 patients received contrast administrations for myelograms, 2 underwent LESI and 1 underwent a lumbar percutaneous epidural neuroplasty.…”

Section: Discussionmentioning

confidence: 99%

Pseudo-subarachnoid hemorrhage and gadolinium encephalopathy following lumbar epidural steroid injection

Platt

Ammar

Collins

et al. 2020

Radiology Case Reports

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Patients with imaging findings concerning for subarachnoid hemorrhage, however, with no evidence of hemorrhage following autopsy or cerebrospinal fluid testing are diagnosed with having pseudo-subarachnoid hemorrhage. A 73-year-old female presented to the emergency department with altered mental status one day after undergoing a lumbar epidural steroid injection at an outside hospital; a noncontrast computed tomography scan of the head revealed evidence of diffuse hyperdensity within the subarachnoid space concerning for subarachnoid hemorrhage. The patient underwent magnetic resonance imaging which demonstrated diffuse opacification of the cerebrospinal fluid spaces with gadolinium and the diagnoses of pseudo-subarachnoid hemorrhage and gadolinium encephalopathy were made. The combination of the neurologic symptoms related to gadolinium encephalopathy and the radiographic findings of pseudo-subarachnoid hemorrhage can create a clinical presentation nearly identical to ruptured aneurysmal subarachnoid hemorrhage. Patient history, magnetic resonance imaging findings, and temporal changes in computed tomography provide vital tools in establishing a diagnosis of pseudo-subarachnoid hemorrhage, especially after an iatrogenic intrathecal contrast administration.

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“…Several studies of iatrogenic pSAH were excluded. [ 4 , 21 , 36 , 41 , 45 , 50 , 52 , 53 , 62 ] Individual cases of iatrogenic pSAH within included manuscripts were excluded. [ 24 , 49 ] Studies were…”

Section: Resultsmentioning

confidence: 99%

“…[ 24 , 37 ] Cases of iatrogenic pSAH following contrast injected procedures are some of the most straightforward cases to rule out based on procedural history and thus were not included in this systematic review. [ 4 , 21 , 36 , 41 , 45 , 50 , 52 , 53 , 62 ] Cases of pSAH related to hypoxicischemic injury following cardiac arrest, conversely, can be extremely difficult to rule out from high-grade aneurysmal subarachnoid hemorrhage. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

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

Platt

Collins

Ramos

et al. 2021

Surgical Neurology International

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Background: Patients with computed tomography (CT) findings consistent with subarachnoid hemorrhage without evidence of hemorrhage following autopsy or cerebrospinal fluid testing are termed to have pseudosubarachnoid hemorrhage (pSAH). Methods: A systematic review of literature was conducted based on the preferred reporting items for systematic reviews and meta-analysis statement. Studies were evaluated for associated cause of pSAH, imaging modality used in assessment, method of confirmatory testing, and clinical outcome. Results: Fifty studies were included in qualitative analysis including 197 cases of pSAH. Systematic review revealed 23 studies including 110 patients with pSAH attributed to hypoxic-ischemic brain injury following cardiac arrest. Three studies were included in meta-analysis that quantitatively analyzed differences in CT densities in patients with pSAH and true subarachnoid hemorrhage (true SAH). A random effects model meta-analysis showed a statistically significant decrease in densities in the Sylvian fissure in patients with pSAH compared to true SAH and a statistically significant decrease in densities in adjacent parenchyma in patients with pSAH compared to true SAH. Systematic review further revealed 32 patients with pSAH associated with spontaneous intracranial hypotension, 11 patients with pSAH related to infectious etiologies, 15 patients with pSAH associated with subdural hemorrhage, 20 cases of pSAH related to hyperhemoglobinemia, 2 cases related to valproate toxicity, and individual cases related to hyponatremia, diabetic ketoacidosis, sudden infant death syndrome, cerebellar infarction, and dialysis disequilibrium syndrome. Conclusion: This study is the first systematic review of causes, diagnostic modalities, and outcomes in patients who present with pSAH. A diagnosis of pSAH may be considered following assessment of CT densities following cardiac arrest.

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Myelography-associated pseudo-subarachnoid hemorrhage

Cited by 3 publications

References 3 publications

Contrast media mimicking subarachnoid hemorrhage after intrathecal injection in a patient with Creutzfeldt-Jakob disease

Contrast media mimicking subarachnoid hemorrhage after intrathecal injection in a patient with Creutzfeldt-Jakob disease

Pseudo-subarachnoid hemorrhage and gadolinium encephalopathy following lumbar epidural steroid injection

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

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