Pseudo-Subarachnoid Hemorrhage: A Potential Imaging Pitfall

Lin, Chun Yuan; Lai, Ping Hong; Fu, Jui H.; Wang, Po Chin; Pan, Huay‐Ben

doi:10.1016/j.carj.2013.07.003

Cited by 22 publications

(15 citation statements)

References 18 publications

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“…Avrahami et al [ 4 ] later reported that contrary to the previous understanding that this is a rare phenomenon, it is in fact common; detected in younger patients (below 40 years old) with high cerebral/skull volume, usually in the context of drug abuse, trauma, or cardiorespiratory arrest, leading to cerebral edema as a result of the hypoxic-ischemic injury. At present, multiple reports and studies have documented other causes of this finding, which include meningitis, subdural hemorrhage, infarction, contrast administration, spontaneous intracranial hypotension, post myelography, polycythemia, and chronic hypoxaemia, among others [ 5 – 7 ].…”

Section: Discussionmentioning

confidence: 99%

Development of pseudo-subarachnoid hemorrhage secondary to hypoxic-ischemic injury due to bleeding pulmonary arterio-venous malformation

Noh

Rashid

2018

BMC Neurol

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BackgroundThe computed tomography (CT) finding of a pseudo-subarachnoid hemorrhage (SAH) may lead the treating physician into a diagnostic dilemma. We present a case of a pseudo-SAH in a patient with post-resuscitative encephalopathy, secondary to a newly diagnosed bleeding pulmonary arterio-venous malformation (AVM).Case presentationA 19-year-old female presented acutely with massive hemoptysis. Cardiopulmonary resuscitation (CPR) followed, and the patient was subsequently intubated for airway protection with intensive care unit (ICU) admission. Urgent CT angiography of the thorax showed a bleeding pulmonary AVM, with evidence of hemothorax. Non-contrasted cranial CT initially revealed cerebral edema. Day 3 post admission, repeat cranial CT showed worsening cerebral edema, with evidence of pseudo-SAH. Patient passed away the next day.ConclusionsPseudo-SAH, if present, carries a poor prognosis. It should be recognized as a potential CT finding in patients with severe cerebral edema, due to various causes. The diagnosis is vital, to avoid wrongful treatment institution, as well as determination of cause of death.

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Section: Discussionmentioning

confidence: 99%

Development of pseudo-subarachnoid hemorrhage secondary to hypoxic-ischemic injury due to bleeding pulmonary arterio-venous malformation

Noh

Rashid

2018

BMC Neurol

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“…The proteinaceous material in the subarachnoid space leads to vasogenic and cerebral edema, which contribute to the appearance of pseudo-SAH. Clinical history, CSF analysis, and enhancement of the basal cistern in postcontrast CT head can help differentiate between SAH and pseudo-SAH in this case [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has a high sensitivity for the detection of SAH, up to 98% [ 2 ] in patients scanned within 24 hours of symptom onset. CT head finding of high attenuation areas (HDAs) along the basal cisterns or cortical sulci is thought to be specific for SAH [ 3 ]. A similar appearance in the CT of the head may occur in the absence of blood in the subarachnoid spaces.…”

Section: Introductionmentioning

confidence: 99%

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Anoxic Brain Injury Presenting as Pseudosubarachnoid Hemorrhage in the Medical Intensive Care Unit

Lewis

Afreen

Folaranmi

et al. 2017

Case Reports in Critical Care

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Anoxic encephalopathy is frequently encountered in the medical intensive care unit (ICU). Cerebral edema as a result of anoxic brain injury can result in increased attenuation in the basal cisterns and subarachnoid spaces on computerized tomography (CT) scans of the head. These findings can mimic those seen in acute subarachnoid hemorrhage (SAH) and are referred to as pseudosubarachnoid hemorrhage (pseudo-SAH). Pseudo-SAH is a diagnosis critical care physicians should be aware of as they treat and evaluate their patients with presumed SAH, which is a medical emergency. This lack of awareness could have important clinical implications on outcomes and impact management decisions if patients with anoxic brain injury are inappropriately treated for SAH. We describe three patients who presented to the hospital with anoxic brain injury. Subsequent CT head suggested SAH, which was subsequently proven to be pseudo-SAH.

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“…Intracranial hypotension has also been found to cause a pseudosubarachnoid hemorrhage on imaging due to hyperdensities in sulci and cisterns on CT (36).…”

Section: Storey 10mentioning

confidence: 98%

Unilateral Acute Closed-Angle Glaucoma After Elective Lumbar Surgery Reveals Multiple Intracranial Aneurysms. A Case Report and Discussion on Workup of Differential Diagnoses

et al. 2015

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Pseudo-Subarachnoid Hemorrhage: A Potential Imaging Pitfall

Cited by 22 publications

References 18 publications

Development of pseudo-subarachnoid hemorrhage secondary to hypoxic-ischemic injury due to bleeding pulmonary arterio-venous malformation

Development of pseudo-subarachnoid hemorrhage secondary to hypoxic-ischemic injury due to bleeding pulmonary arterio-venous malformation

Anoxic Brain Injury Presenting as Pseudosubarachnoid Hemorrhage in the Medical Intensive Care Unit

Unilateral Acute Closed-Angle Glaucoma After Elective Lumbar Surgery Reveals Multiple Intracranial Aneurysms. A Case Report and Discussion on Workup of Differential Diagnoses

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