Pseudo-subarachnoid hemorrhage in a patient with hypoxic encephalopathy

Zhang, J; Li, Q; Z, Zhang; Sun, Xiaodi

doi:10.1016/j.neuchi.2014.08.003

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Although there are many similarities between localized pseudo-SAH and real SAH CT manifestations, there are some differences between them: Density: Most previous studies distinguish real SAH from pseudo-SAH by comparing CT values, and it has certain clinical signi cance. The relative high density shadow density in pseudo-SAH is lower than that in real bleeding, CT values are 29-33 Hu [8] , and 60-70 Hu [9] , respectively. Enhancement method: high-density images of pseudo-SAH can signi cantly enhance in contrast-enhanced CT, which is signi cantly different from SAH [5] .…”

Section: Discussionmentioning

confidence: 99%

Localized pseudo-subarachnoid hemorrhage

Sun

Jian

Dai

et al. 2022

Preprint

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Background: To analyze the imaging and clinical data of patients with localized pseudo-subarachnoid hemorrhage (pseudo-SAH), so as to improve the correct understanding of this sign by radiologists. Methods: The imaging and clinical data of patients with localized pseudo-SAH on head CT scan without contrast from January 2013 to March 2022 were retrospectively analyzed, and the imaging and clinical characteristics were summarized. Results: The etiology of 9 patients with pseudo-SAH was viral encephalitis (2 cases), acute cerebral infarction (4 cases) and hypoxic ischemic encephalopathy (3 cases). All patients underwent CT scan without contrast, CT scan with contrast, MRI and lumbar puncture examination. All patients' head CT scan without contrast showed local swelling of brain tissue (less than two lobes), stenosis and occlusion of adjacent subarachnoid space, with its inner strip of high-density shadow. CT scan with contrast found that the high density shadow was significantly enhanced. MRI and lumbar puncture were performed to rule out true SAH and confirm pseudo-SAH. Finally, 8 patients were discharged from hospital after treatment, and 1 patient died of multiple organ failure. Conclusion: Localized pseudo-SAH often indicates localized brain lesions and has a relatively good prognosis. It has certain characteristics in CT value, enhancement mode and morphology.

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Section: Discussionmentioning

confidence: 99%

Localized pseudo-subarachnoid hemorrhage

Sun

Jian

Dai

et al. 2022

Preprint

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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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