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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
Published on: August 30, 2020
Aneurysmal subarachnoid hemorrhage: update for emergency physicians.
Jonathan A Edlow1, Adel M Malek, Christopher S Ogilvy
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
The Journal of Emergency Medicine
|December 25, 2007
Summary
Aneurysmal subarachnoid hemorrhage (SAH) is a common stroke cause, often misdiagnosed due to varied symptoms. Prompt diagnosis and specialized care are crucial for better patient outcomes.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- Aneurysmal subarachnoid hemorrhage (SAH) affects 30,000 North Americans annually, presenting a significant stroke risk.
- Misdiagnosis of SAH is common due to its diverse clinical presentations, including isolated headache with normal neurological exams.
Purpose of the Study:
- To outline diagnostic challenges and initial management strategies for emergency physicians encountering suspected SAH.
- To review the roles and limitations of computed tomography (CT) and lumbar puncture (LP) in SAH diagnosis.
- To emphasize the importance of timely specialist consultation and advanced imaging for definitive diagnosis and treatment.
Main Methods:
- Discussion of diagnostic modalities including CT scanning and lumbar puncture (LP).
- Analysis of cerebrospinal fluid (CSF) for xanthochromia, comparing visual inspection and spectrophotometry.
- Review of neuroimaging techniques such as CT angiography and magnetic resonance angiography.
Main Results:
- CT sensitivity decreases over time and is lower in mildly affected patients.
- Distinguishing traumatic LP from true SAH is critical; xanthochromia measurement methods are debated.
- Advanced imaging (CT/MR angiography) sensitivity approaches conventional catheter angiography.
Conclusions:
- Emergency physicians require expertise in SAH diagnosis and initial stabilization.
- Early identification and transfer to specialized neurovascular centers improve patient outcomes.
- Integrated neurosurgical and endovascular capabilities are essential for comprehensive SAH management.
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