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Pseudo-subarachnoid hemorrhage: a potential imaging pitfall associated with diffuse cerebral edema
Curtis A Given1, Jonathan H Burdette, Allen D Elster
1Departments of Neuroradiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
AJNR. American Journal of Neuroradiology
|February 20, 2003
Summary
Computed tomography (CT) scans can mimic subarachnoid hemorrhage in patients with diffuse cerebral edema. Autopsy and lumbar puncture findings helped exclude true subarachnoid hemorrhage, identifying a pseudohemorrhage.
Area of Science:
- Neuroradiology
- Neuroimaging
- Cerebrovascular diseases
Background:
- Diffuse cerebral edema presents diagnostic challenges in neuroimaging.
- Increased attenuation in basilar cisterns on CT can mimic subarachnoid hemorrhage.
- Distinguishing true subarachnoid hemorrhage from other causes is critical for patient management.
Purpose of the Study:
- To report CT findings in patients with diffuse cerebral edema and basilar cistern hyperattenuation.
- To differentiate this appearance from true subarachnoid hemorrhage using autopsy and lumbar puncture data.
- To explore the pathophysiology of pseudo-subarachnoid hemorrhage in diffuse cerebral edema.
Main Methods:
- Retrospective review of CT scans from seven patients.
- Correlation of imaging findings with autopsy results (three cases).
- Correlation of imaging findings with lumbar puncture results (four cases).
Main Results:
- CT scans showed increased attenuation in basilar cisterns in all seven patients.
- Autopsy and lumbar puncture excluded true subarachnoid hemorrhage in all cases.
- The findings suggest a pseudo-subarachnoid hemorrhage pattern due to diffuse cerebral edema.
Conclusions:
- Diffuse cerebral edema can manifest as a pseudo-subarachnoid hemorrhage on CT.
- Pathophysiologic changes associated with cerebral edema can explain this imaging finding.
- Accurate diagnosis requires careful consideration of clinical context and exclusion of true hemorrhage.