Abstract
Anoxic encephalopathy is frequently encountered in the medical intensive care unit (ICU). Cerebral edema as a result of anoxic brain injury can result in increased attenuation in the basal cisterns and subarachnoid spaces on computerized tomography (CT) scans of the head. These findings can mimic those seen in acute subarachnoid hemorrhage (SAH) and are referred to as pseudosubarachnoid hemorrhage (pseudo-SAH). Pseudo-SAH is a diagnosis critical care physicians should be aware of as they treat and evaluate their patients with presumed SAH, which is a medical emergency. This lack of awareness could have important clinical implications on outcomes and impact management decisions if patients with anoxic brain injury are inappropriately treated for SAH. We describe three patients who presented to the hospital with anoxic brain injury. Subsequent CT head suggested SAH, which was subsequently proven to be pseudo-SAH.
Highlights
Subarachnoid hemorrhage (SAH) is often a devastating clinical event with high mortality
Spiegel et al first described these findings in 1986 [4]. They reported that 10 patients with marked brain edema associated with a brain tumor or cerebral infarction showed SAH-like HDAs along the interhemispheric fissure and tentorium cerebelli on computerized tomography (CT) head
A pseudo-SAH is a brain CT finding that is seen as high attenuation areas (HDAs) along the basal cisterns, the sylvian fissure, the tentorium cerebelli, or the cortical sulci in patients with severe brain edema, where no SAH is seen at autopsy or lumbar puncture [6]
Summary
Subarachnoid hemorrhage (SAH) is often a devastating clinical event with high mortality. Spiegel et al first described these findings in 1986 [4] They reported that 10 patients with marked brain edema associated with a brain tumor or cerebral infarction showed SAH-like HDAs along the interhemispheric fissure and tentorium cerebelli on CT head. In 1998, on reviewing head CT examinations of 100 comatose patients with brain edema, Avrahami et al [5] found SAH-like findings along the cisterns and sulci in all of them and concluded that a CT diagnosis of SAH was unlikely. They proposed the term “pseudosubarachnoid hemorrhage” (pseudo-SAH) for this phenomenon. We describe three patients with pseudoSAH associated with diffuse cerebral edema and reviewed the literature regarding this imaging finding
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