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

Platt, Andrew; Collins, John W.; Ramos, Edwin; Goldenberg, Fernando D.

doi:10.25259/sni_905_2020

Cited by 6 publications

(6 citation statements)

References 67 publications

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“…However, there are reports that the rate of glucose correction, initial blood glucose level, plasma osmolality, and the extent to which plasma osmolality decreases during treatment do not affect cerebral edema. 3 Therefore, relative reductions in cerebral blood flow and inflammatory changes have also been hypothesized as causes of DKA-related cerebral edema rather than the intravascular and brain cell osmotic pressure gap. Kiabetic ketoacidosis causes relative ischemia due to decreased cerebral blood flow as a result of hyperventilation, regardless of increased cerebral metabolism.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no consensus on the rate of glucose correction for adult patients with DKA, it is reasonable that blood glucose should be reduced to 50–75 mg/dL/h or less, in accordance with pediatric guidelines. However, there are reports that the rate of glucose correction, initial blood glucose level, plasma osmolality, and the extent to which plasma osmolality decreases during treatment do not affect cerebral edema 3 …”

Section: Discussionmentioning

confidence: 99%

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Cerebral edema associated with diabetic ketoacidosis: Two case reports

Namatame

Igarashi

Nakae

et al. 2023

Acute Medicine & Surgery

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BackgroundDiabetic ketoacidosis (DKA) is associated with a high mortality rate, especially if cerebral edema develops during the disease course. It is rarer and more severe in adults than in children. We present cases of two patients with cerebral edema‐related DKA.Case presentationThe first patient was a 38‐year‐old man with diabetes mellitus who presented with DKA‐related disturbed consciousness. Although glycemic correction was performed slowly, he showed pupil dilation 11 h later. He underwent emergency ventricular drainage, but died of cerebral herniation. The second patient was a 25‐year‐old woman who presented with impaired consciousness secondary to DKA. Head computed tomography showed subarachnoid hemorrhage and cerebral edema. No related intraoperative findings were observed; it was concluded that the first computed tomography scan revealed pseudo‐subarachnoid hemorrhage.ConclusionDiabetic ketoacidosis‐related cerebral edema develops despite treatment according to guidelines and is difficult to predict. Therefore, adult patients should be treated cautiously during DKA management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cerebral edema associated with diabetic ketoacidosis: Two case reports

Namatame

Igarashi

Nakae

et al. 2023

Acute Medicine & Surgery

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“…Pseudo-subarachnoid hemorrhage was postulated to define this phenomenon [41]. The transposition of edematous brain tissue into the subarachnoid space, transposition of cerebrospinal fluid, and distension of superficial pial veins should be the mechanisms of this appearance CT-brain [42]. Hyperdensity area suspected blood at Sylvian fissure is usually less than 35 Hounsfield unit in pseudo-subarachnoid hemorrhage, but more than 50 Hounsfield unit in actual subarachnoid hemorrhage [43][44][45].…”

Section: Neuroimaging Studies 41 Computer Tomography (Ct-brain)mentioning

confidence: 99%

Prognostication in Post-Cardiac Arrest Patients

Piyayotai¹,

Muengtaweepongsa²

2022

Cardiac Arrhythmias - Translational Approach From Pathophysiology to Advanced Care

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After resuscitation from cardiac arrest, a combination of the complex pathophysiologic process, known as post-cardiac arrest syndrome (PCAS), is attributed to multiple organ damage. Global ischemic cascade occurs in the brain due to generalized ischemia during cardiac arrest and the reperfusion process after the return of spontaneous circulation (ROSC), leading to hypoxic/ ischemic brain injury. Targeted temperature management (TTM) is a well-known neuroprotective therapy for ischemic/hypoxic brain injury. This global brain injury is a significant cause of death in PCAS. The implementation of TTM for PCAS leads to a reduction in mortality and better clinical outcomes among survivors. Prognostication is an essential part of post-resuscitation care. Before the TTM era, physicians relied on the algorithm for prognostication in comatose patients released by the American Academy of Neurology in 2006. However, TTM also announced more significant uncertainty during prognostication. During this TTM era, prognostication should not rely on just a solitary parameter. The trend of prognostication turns into a multimodal strategy integrating physical examination with supplementary methods, consisting of electrophysiology such as somatosensory evoked potential (SSEP) and electroencephalography (EEG), blood biomarkers, particularly serum neuron-specific enolase (NSE), and neuro-radiography including brain imaging with CT/MRI, to enhance prognostic accuracy.

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“…Increased attenuation of the subarachnoid space on computed tomography (CT) of the head is a characteristic finding of acute subarachnoid hemorrhage (SAH). However, several radiographic mimics of SAH have been reported [1][2]. Pseudo subarachnoid hemorrhage (pSAH) is an entity defined when characteristic CT findings of SAH are seen without evidence of hemorrhage on autopsy or cerebrospinal fluid (CSF) analysis.…”

Section: Introductionmentioning

confidence: 99%

“…Pseudo subarachnoid hemorrhage (pSAH) is an entity defined when characteristic CT findings of SAH are seen without evidence of hemorrhage on autopsy or cerebrospinal fluid (CSF) analysis. The most common causes of pSAH are diffuse cerebral edema, hypoxic-ischemic injury, post percutaneous coronary intervention, and acute bacterial meningitis (ABM) [1]. Prompt diagnosis of ABM can be difficult due to its nonspecific presentation.…”

Section: Introductionmentioning

confidence: 99%

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

Fretwell¹,

Mullaguri²,

Sivakumar³

et al. 2022

Cureus

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Pseudo subarachnoid hemorrhage (SAH) is an entity defined when characteristic computed tomography (CT) findings of SAH are seen without evidence of hemorrhage on MRI, autopsy, or cerebrospinal fluid analysis. This imaging phenomenon has been reported in association with multiple clinical settings including diffuse cerebral edema, hypoxic-ischemic injury, post percutaneous coronary intervention, and the focus of our report, acute bacterial meningitis. The mechanisms leading to this finding are poorly understood. Current hypotheses explaining this pattern vary widely depending on the associated pathology. In this report, we present a case of pseudo SAH associated with bacterial meningitis and a literature review on the causes, neuroimaging findings, and mechanisms associated with pseudo SAH. We discuss dual energy CT as a possible tool for differentiating pseudo SAH from true SAH. We analyze the timing of imaging studies and the role timing plays in the presentation of the pseudo SAH sign. We conclude that the extravasation of iodine contrast into the subarachnoid space can mimic SAH on CT. Ultimately, our case adds to the growing body of evidence that clinicians should be aware of acute bacterial meningitis as a potential mimic of SAH on CT.

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

Cited by 6 publications

References 67 publications

Cerebral edema associated with diabetic ketoacidosis: Two case reports

Cerebral edema associated with diabetic ketoacidosis: Two case reports

Prognostication in Post-Cardiac Arrest Patients

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

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