Subarachnoid hemorrhage and raised ICP

Case contributed by Heather Pascoe
Diagnosis certain


Collapse and PEA arrest

Patient Data

Age: 35 years

There is a extensive subarachnoid blood within all the basal cisterns, the cerebral sulci bilaterally, the sylvian fissures bilaterally and the interhemispheric fissure. There is interventricular blood. There is diffuse sulcal effacement and effacement of the lateral ventricles. There is diffuse loss of grey-white matter differentiation. There is tonsillar herniation below the foramen magnum.

 CTA demonstrates minimal opacification on the of the intracranial vasculature due to raised intracranial pressure. There is only opacification of the M1 segments bilaterally and the proximal basilar artery, with no opacification beyond these points.

Patchy airspace opacities at the apices may be due to aspiration. Previous mandibular fixation. Cervical spine is within normal limits. ETT and NGT in situ. 

Case Discussion

Extensive subarachnoid hemorrhage with diffuse cerebral edema. Minimal opacification of the intracranial vasculature on CTA due to raised intracranial pressure. 

Absence of intracranial flow on CTA is one of the imaging tests for determining brain death but should not be used in isolation. Brain death is primarily a clinical diagnosis.

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