Pseudo-subarachnoid hemorrhage

Case contributed by Dr. Chris O'Donnell

Presentation

PH IV drug use. Found unconscious. Urgent CT brain reported as massive SAH. No active management, patient deceased.

Patient Data

Age: 20 years
Gender: Female

Brain

CT

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. 

Case Discussion

These two images are typical for pseudo-subarachnoid hemorrhage: i.e. a young person with a hypoxic or cerebral ischemic 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.

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