Convexal subarachnoid hemorrhage
Updates to Article Attributes
Convexal subarachnoid haemorrhages (cSAH), also known as convexity subarachnoid haemorrhage, are subarachnoid haemorrhages that occur within the cortical sulci of the brain.
Epidemiology
Convexal subarachnoid haemorrhage accounts for approximately 6% of all subarachnoid haemorrhage 7.
Pathology
There are various causes of convexal subarachnoid haemorrhage, including 1-6:
trauma or post-operative changes
-
vascular malformations
severe internal carotid artery stenosis or intracranial atherosclerotic disease
primary brain tumours
Radiographic features
Imaging reveals abnormalities localised to the cortical sulci. This is a markedly different pattern to other forms of subarachnoid haemorrhage, e.g. the basal cisternal distribution of aneurysmal subarachnoid haemorrhage.
CT
CT brain findings may be subtle, demonstrating curvilinear hyperdensities localised to one or more adjacent cortical sulci 5.
CT angiogram or venogram may be useful to perform as work-up for the underlying cause 6.
MRI
MRI brain demonstrates hyperintensity in the subarachnoid space on FLAIR localised to one or more adjacent cortical sulci, as well as hypointense blooming artifact on GRE/SWI 5.
Treatment and prognosis
Management depends on the underlying cause 6, with most cases being managed conservatively.
Differential diagnosis
See also
-<li><p>trauma</p></li>- +<li><p>trauma or post-operative changes</p></li>
-<li><p>severe <a href="/articles/carotid-artery-stenosis" title="Internal carotid artery stenosis">internal carotid artery stenosis</a></p></li>- +<li><p>severe <a href="/articles/carotid-artery-stenosis" title="Internal carotid artery stenosis">internal carotid artery stenosis</a> or <a href="/articles/intracranial-atherosclerotic-disease" title="Intracranial atherosclerotic disease">intracranial atherosclerotic disease</a></p></li>
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