PH IV drug use. Found unconscious. Urgent CT brain reported as massive SAH. No active management, patient deceased.
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Increased density of the basal meninges with obliteration of basal cisterns and generalized reduction in density of brain parenchyma. Increased density of the tentorium but no blood in ventricles or sulci, diffuse brain swelling with obliteration of sulci and generalized reduction in brain parenchymal density. Loss of grey/white matter differentiation.
These 2 images are typical for pseudo-subarachnoid haemorrhage: i.e. young person with hyoxic or cerebral ischaemic event, diffuse brain swelling and apparently increased density of the basal meninges but no blood in the ventricles or sulci over the vertex of the brain.
This was confirmed at autopsy where there was no blood in the subarachnoid space!
- Given CA 2nd, Burdette JH, Elster AD, Williams DW 3rd. Pseudo-subarachnoid hemorrhage: a potential imaging pitfall associated with diffuse cerebral edema. Am J Neuroradiol. 2003;24(2):254-6.