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Focal subarachnoid haemorrhage mimicking transient ischaemic attack--do we really need MRI in the acute stage?

Lorenz Ertl1, Dominik Morhard, Maria Deckert-Schmitz

  • 1Department of Radiology, Nuclear Medicine & Neuroradiology, Klinikum München-Harlaching, Sanatoriumsplatz 2, Munich D-81545, Germany. lorenz.ertl@med.uni-muenchen.de.

BMC Neurology
|April 12, 2014
PubMed
Abstract

Insights

Thin-sliced CT effectively diagnoses focal subarachnoid hemorrhage (fSAH), a TIA mimic, when MRI is unavailable. However, MRI remains crucial for definitive diagnosis within 24-72 hours.

Area of Science:

  • Neurology
  • Radiology
  • Emergency Medicine

Background:

  • Acute non-traumatic focal subarachnoid hemorrhage (fSAH) mimics transient ischemic attack (TIA).
  • Early and accurate diagnosis is critical to prevent misdiagnosis and improper treatment.
  • The diagnostic roles of CT and MRI for fSAH require evaluation.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of CT and MRI in patients with fSAH.
  • To compare the sensitivity of CT and MRI in detecting fSAH.
  • To assess the utility of CT as an emergency tool for fSAH.

Main Methods:

  • Retrospective analysis of seven fSAH patients with CT and MRI within 3 days.
  • MRI protocol included FFE, DWI, FLAIR, and TOF MRA sequences.
  • Literature review to compare CT and MRI sensitivity for fSAH detection.

Main Results:

  • CT and FFE/FLAIR MRI detected fSAH in all seven own cases.
  • CT sensitivity for fSAH was 95% (95/100 cases) in literature data.
  • MRI sensitivity for fSAH was 100% (69/69 cases) in literature data.
  • MRI revealed additional microbleeds and superficial siderosis in some patients.

Conclusions:

  • Thin-slice unenhanced CT is a valuable emergency tool for ruling out intracranial hemorrhage, including fSAH.
  • MRI is crucial for definitive fSAH diagnosis and should be completed within 24-72 hours.
  • CT can serve as an initial diagnostic step when immediate MRI is not feasible.

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