Pseudo-subarachnoid hemorrhage: A potential imaging pitfall associated with spontaneous intracranial hypotension

Ferrante, Enrico; Regna-Gladin, Caroline; Arpino, I.; Rubino, Fabio; Porrinis, Lara; Ferrante, M.; Citterio, Alberto

doi:10.1016/j.clineuro.2013.08.028

Cited by 31 publications

(28 citation statements)

References 20 publications

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“…In addition, subsequent neurovascular studies showed no evidence of intracranial aneurysms or vascular abnormalities. Ferrante et al reported these findings in SIH patients and termed it as “pseudo‐SAH.” It is now understood that brain sagging in SIH narrows the subarachnoid spaces and displaces CSF. The resultant subarachnoid spaces become relatively devoid of the hypo‐attenuated CSF and fill with a larger fraction of meninges and blood vessels that increase their CT attenuation, contributing to the pseudo‐SAH appearance .…”

Section: Discussionmentioning

confidence: 99%

“…Ferrante et al reported these findings in SIH patients and termed it as “pseudo‐SAH.” It is now understood that brain sagging in SIH narrows the subarachnoid spaces and displaces CSF. The resultant subarachnoid spaces become relatively devoid of the hypo‐attenuated CSF and fill with a larger fraction of meninges and blood vessels that increase their CT attenuation, contributing to the pseudo‐SAH appearance . Considering that the patients, who presented pseudo‐SAH in our series, showed a relatively large depth of SDH (Table ), pseudo‐SAH might be an alarming sign of advanced status and impending downward brain herniation of SIH.…”

Section: Discussionmentioning

confidence: 99%

“…When we evaluated brain CTs, 3 features were examined: (1) subdural fluid collections with their depth and characteristics; (2) features of “brain sagging,” and (3) pseudo‐subarachnoid hemorrhage (pseudo‐SAH, Fig. ) . In previous reports, the term “brain sagging” was defined based on sagittal images of MRI .…”

Section: Methodsmentioning

confidence: 99%

“…3). 13 In previous reports, the term "brain sagging" was defined based on sagittal images of MRI. 14 In our series, in order to use the axial CT scans as an initial screening tool, the definition of brain sagging was refined using indirect features such as obliteration of cisternal spaces around brainstem: cerebellomedullary, quadrigeminal, prepontine, and basal cisterns.…”

Section: Methodsmentioning

confidence: 99%

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Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections

et al. 2019

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Background Subdural hygromas are often found bilaterally in spontaneous intracranial hypotension (SIH). They frequently progress to chronic subdural hematomas (CSDHs), and if the hematomas are formed, it is difficult to consider SIH as an underlying cause. Whether SIH is underlying or not among the patients presenting bilateral subdural fluid collections (hygromas or CSDHs) is clinically important because the treatment strategy should be different between them. Objectives We designed a retrospective case‐control study to figure out differential clinical features of the patients presenting bilateral symptomatic subdural fluid collections owing to SIH. Methods Sixty‐two patients with bilateral symptomatic subdural fluid collections were enrolled, and their data on general demographics, clinical courses, radiological findings, treatments, and outcomes were collected. The patients were divided into “SIH” and “Non‐SIH” groups, and a simple logistic regression analysis was performed to clarify the differences between the groups. The consequent receiver operating characteristics (ROC) curve analyses were performed with the significant predictors. Results Eight patients (13%) were diagnosed with SIH. Young age (odds ratio [OR] = 0.831, 95% confidence interval [CI]: 0.743‐0.929, P = .0012), no underlying disease (OR = 0.062, 95% CI: 0.007‐0.544, P = .0121), radiological features of brain sagging (OR = 10.36, 95% CI: 0.912‐93.411, P = .0017), pseudo‐subarachnoid hemorrhage (OR = 15.6, 95% CI: 2.088‐116.52, P = .0074), and small amount of fluid collections (OR = 0.719, 95% CI: 0.579‐0.893, P = .0029) were significantly associated with SIH group. ROC curve analyses were performed in parameters of age and amount of fluid collection and the cut‐off values for each parameter were ≤55 years old and ≤22.08 mm, respectively. Patients diagnosed with SIH underwent epidural blood patches and showed good results, except 1 patient who underwent burr‐hole trephinations. Conclusion Bilateral subdural fluid collections due to underlying SIH is associated with young age (≤55 years old), no underlying diseases, smaller amount of fluid collections (≤22.08 mm of depth), and radiological findings of brain sagging or pseudo‐subarachnoid hemorrhages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections

et al. 2019

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“…The diagnosis may be made clinically by the typical headache and supported by pachymeningeal enhancement on MR scan or a low CSF pressure at lumbar puncture 2. If severe and continued, the low pressure can have serious complications, including brain sagging with subdural hygromas,4 cerebral venous sinus thrombosis,5 subdural haematoma2 and subarachnoid haemorrhage 6. Indicators of a serious complication include cranial nerve palsy and worsening mental status, progressing to coma 4.…”

Section: Introductionmentioning

confidence: 99%

Complicated spontaneous intracranial hypotension treated with intrathecal saline infusion

et al. 2015

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The pseudo-SAH sign: an imaging pitfall in postmortem computed tomography

et al. 2017

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Postmortem computed tomography (PMCT) of the brain has an important role in detection of subarachnoid hemorrhage (SAH), which has a high mortality rate. However, a phenomenon known as "pseudo-SAH," or high-attenuation areas along the cisterns mimicking SAH, may be seen on CT. The aim of this study was to evaluate the diagnostic accuracy of brain PMCT for SAH and to identify the characteristics of pseudo-SAH. Findings on PMCT (sulcal effacement, asymmetry, maximum thickness of SAH signs, presence of acute/subacute intraventricular/intraparenchymal hemorrhage) and clinical history (left ventricular assist device [LVAD] implantation, anticoagulation therapy/coagulation disorder, global ischemia) were compared between subjects with true SAH and those with pseudo-SAH. Twenty eight of 128 enrolled subjects had positive signs of SAH on PMCT, 20 (71.4%) had SAH on autopsy, and 8 (28.6%) did not. The sensitivity, specificity, positive predictive value, and negative predictive value of SAH signs seen on PMCT were 95.2, 94.6, 71.4, and 99.3%, respectively. Asymmetry of SAH signs and acute/subacute intraventricular and intraparenchymal hemorrhage were significantly more common in true SAH cases than in pseudo-SAH cases. The maximum thickness of SAH signs was significantly greater in true SAH cases. A history of LVAD implantation, anticoagulation therapy, and/or a coagulation disorder were more common in true SAH cases but not significantly so. A history of global ischemia was significantly more common in pseudo-SAH cases. If signs of SAH are observed on PMCT, it is important to look for other signs on PMCT and carefully review the clinical history to avoid a diagnostic error.

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Pseudo-subarachnoid hemorrhage: A potential imaging pitfall associated with spontaneous intracranial hypotension

Cited by 31 publications

References 20 publications

Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections

Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections

Complicated spontaneous intracranial hypotension treated with intrathecal saline infusion

The pseudo-SAH sign: an imaging pitfall in postmortem computed tomography

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