Subarachnoid hemorrhage

Case contributed by UoE Radiology


Sudden onset headache. Disorientation, confusion. No previous imaging.

Patient Data

Age: 80 years
Gender: Female

Diffuse hyperdensity throughout the basal cistern, interhemispheric fissure and Sylvian fissures.

Also small left subdural collection, also likely representing blood.

Incidental calcification left basal ganglia.


Subarachnoid hemorrhage.  Suggest further imaging to identify possible underlying aneurysm.

Follow up study (five days later)


Follow up scan five days later shows some improvement. The subarachnoid blood is less dense suggesting partial reabsorption of blood products.

Bulky appearance to anterior communicating artery (ACOM) but no angiographic sequences performed.

Case Discussion

This is a case of subarachnoid hemorrhage.  These typically present in the elderly with "thunderclap" headache and altered neurological status. The underlying cause is usually an arterial aneurysm which allows blood into the subarachnoid space irritating the brain linings.  Trauma is another cause.

CT is the best imaging modality to show acute bleeds and any major mass effect from them.

These patients require neurosurgical management or review, along with aggressive hydration and blood pressure control while preserving cerebral blood flow.


Thanks to Dr David Cuete for originally uploading this case. The original can be viewed here.

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