Subarachnoid haemorrhage (teaching)

Case contributed by UoE Radiology

Presentation

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

Patient Data

Age: 80
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.

SUMMARY Subarachnoid haemorrhage.  Suggest further imaging to identify possible underlying aneurysm.

CT

Follow up study (five days)

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 haemorrhage.  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.

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

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Case information

rID: 34157
Case created: 6th Feb 2015
Last edited: 3rd Mar 2016
Inclusion in quiz mode: Included

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