IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Pseudo-subarachnoid hemorrhage

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis certain

Presentation

Post cardiac arrest infant with prolonged downtime at the scene. Maintained on inotropic support and mechanical ventilation.

Patient Data

Age: 12 month
Gender: Male

CT without contrast

ct
  • significant generalized low attenuation of the entire brain parenchyma and to less extent cerebellum (density of cerebellum is greater than cerebral hemispheres => reversal sign) 
  • evidence of diffuse cerebral edema with effacement of the grey-white matter borders and marked effacement of the brain sulci as well as major cisterns 
  • attenuated (non visualized) ventricular system with no midline shift
  • associated hyper-density is noted within the cisterns giving the appearance of pseudo-subarachnoid hemorrhage due to effacement of the subarachnoid space surrounding blood vessels. 
  • grey-white matter interface has been lost as well

CT angiography (with contrast)

ct

CT angiography demonstrates faint/poor opacification of the cortical cerebral arteries distal to the middle cerebral arteries and internal cerebral veins, however, fair opacification of carotid and vertebral arteries.

Case Discussion

A typical case of pseudo-subarachnoid hemorrhage in an infant with post cardiac arrest with resultant hyoxic/anoxic cerebral insult. Consequent diffuse brain edema and swelling where there is global decrease in parenchymal attenuation. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.