Pseudo Subarachnoid Hemorrhage in Meningeal Leukemia

Clinical neurology and neurosurgery, 2013

Sultan Qaboos University medical journal, 2017

Annals of Indian Academy of Neurology, 2010

Materials and Methods This retrospective study was conducted at a tertiary care university hospital for neurological and cardiovascular diseases in South India. We identified patients with CHS by screening the medical records of all patients who had presented with headache (n = 2932) to the neurology outpatient service during the period 2001-2007. We diagnosed CHS by the criteria recommended by Chung et al. [1] which requires the presence of two of the three features, namely orthostatic headache, low CSF pressure (<60 mm of water), and diffuse pachymeningeal gadolinium enhancement in the MRI were satisfied. The orthostatic headache [5] was defined as a headache that occurs in <15 min after assuming the upright posture and disappears or improves in <30 min after assuming the recumbent position. MRI was done prior to the CSF study in all the patients. The presence of a convex inferior border of the dominant transverse sinus in the nonenhanced sagittal T1W image was classified as venous distension sign (VDS) in the MRI. [6] Neuroinfections were ruled out by CSF analysis. Cases with history of recent CSF rhinorrhoea or otorrhoea, head trauma, and lumbar puncture were excluded from the study. All patients who were included were contacted about their health status at last followup either by mail or by telephone using a structured proforma.

Phoenix Medical Journal

Spontaneous intracranial hypotension (SIH) is a condition in which the fluid pressure inside the skull is lower than normal. It is secondary to cerebrospinal fluid (CSF) leak at the level of the spine and the resulting loss of CSF volume. Pseudo-subarachnoidal hemorrhage is a rare condition that can occur in patients with spontaneous intracranial hypotension. The diagnosis is very important because it can be confused with true subarachnoidal hemorrhage. True subarachnoidal hemorrhage is one of the complications that may occur in SIH patients. The differentiation of these two conditions as well as computed tomography (CT) and magnetic resonance imaging (MRI) findings and the response of the blood-patch treatment applied by interventional radiology is also very valuable.

Neurology, 2005

Journal of Neurosurgery, 2013

American Journal of Neuroradiology, 2008

BACKGROUND AND PURPOSE: High-attenuation areas (HDAs) called pseudo-subarachnoid hemorrhages (SAHs) may develop in some patients resuscitated from cardiopulmonary arrest (CPA), though no hemorrhage has occurred. We investigated the imaging characteristics and clinical significance of this phenomenon. MATERIALS AND METHODS: CT images of consecutive patients resuscitated from nontraumatic CPA were reviewed and classified into cases with pseudo-SAH (pseudo-SAH[ϩ] group, n ϭ 9), those without pseudo-SAH (pseudo-SAH[Ϫ] group, n ϭ 28), and those with true SAH (SAH-CPA group, n ϭ 8). Typical patients with SAH (SAH group, n ϭ 13) and 20 healthy individuals were also extracted as control groups. The degree of brain edema was scored visually as none, mild, or severe, and the CT values of the HDAs and brain parenchyma were measured. These parameters were compared among the groups. We also compared the prognosis between the pseudo-SAH(ϩ) and pseudo-SAH(Ϫ) groups. RESULTS: On CT, pseudo-SAH was associated with severe brain edema, whereas there was mild or no edema without pseudo-SAH. The CT values of the HDAs in the pseudo-SAH(ϩ) group were significantly lower than those of the CPA-SAH and SAH groups (P Ͻ .0001). The brain parenchyma of the pseudo-SAH(ϩ) group had the lowest CT values among all of the groups (P Ͻ .0001). The prognosis of the pseudo-SAH(ϩ) group was significantly poorer than that of the pseudo-SAH(Ϫ) group in terms of both clinical outcome (P ϭ .02) and survival (P ϭ .046). CONCLUSION: The findings of pseudo-SAH have several imaging characteristics differing from SAH and predict a poor prognosis. This provides important information that can be used for deciding treatment strategies.

Journal of The Chinese Medical Association, 2005

Background: Acute subarachnoid hemorrhage (SAH) has traditionally been diagnosed by computed tomography (CT); however, fluid-attenuated inversion recovery (FLAIR) is a magnetic resonance imaging (MRI) modality currently used to detect acute SAH. CT is insensitive in the detection of subacute or chronic SAH. The purpose of this study was to compare 4 MRI pulse sequences and CT in the detection of SAH in acute and subacute-to-chronic stages. Methods: From 2001-2003, we collected data for 22 patients (12 men and 10 women, aged 35-80 years) with SAH due to ruptured aneurysm (n = 11), trauma (3), or unknown origin (8). All patients underwent MRI and CT examination, with an interval of less than 12 hours between the 2 procedures. We divided patients into 2 groups according to the time from symptom onset to MRI evaluation: patients with MRI performed ≤ 5 days post-ictus had acute-stage illness, whereas patients with MRI performed from day 6-30 post-ictus had a subacute-to-chronic condition. MRI (1.5-T) pulse sequences comprised spin-echo T1-weighted, fast spin-echo T2-weighted, FLAIR, and gradient-echo (GE) T2*-weighted images. Results: In the acute-stage group, SAH was seen as an area of high signal intensity compared with surrounding cerebrospinal fluid in 36.4% of cases on T1-weighted images, and in 100% on FLAIR images; low signal intensities were seen in 18.2% of cases on T2-weighted images, and in 90.9% on GE T2*-weighted images. High-attenuated SAH was seen on CT in 90.9% of cases. FLAIR (p = 0.008), GE T2*-weighted images (p = 0.012) and CT images (p = 0.012) were all statistically significant indicators of acute SAH. In the subacute/chronic-stage group, SAH was detected on T1-weighted images (36.4% of cases), FLAIR (33.3%), T2-weighted images (9.1%), GE T2*-weighted images (100%), and CT (45.5%). GE T2*-weighted images were significantly superior (p = 0.001) to other MRI pulse sequences and CT as indicators of subacute-to-chronic SAH. Conclusion: FLAIR and GE T2* MRI pulse sequences, and CT scans, are all statistically significant indicators of acute SAH. GE T2*-weighted images are statistically significant indicators of subacute-to-chronic SAH, whereas other MRI pulse sequences, and CT scans, are not. [J Chin Med Assoc 2005;68(3):131-137]

The American Journal of Emergency Medicine, 2009

The objective of the study is to demonstrate the pitfalls in the diagnosis of cerebral venous thrombosis (CVT) especially when subarachnoid hemorrhage (SAH) is associated and discuss the diagnostic value of computed tomography (CT) imaging as well as the use of other diagnostic modalities. In addition, we will briefly summarize the pathophysiology of SAH in the setting of CVT. Methods: We reviewed 16 articles, which included 26 different case reports of SAH associated with CVT. In addition, we presented our experience with a case of SAH secondary to CVT. Results: Nonenhanced CT was able to detect SAH in 86% of cases and CVT in only 36%. Further imaging testing was necessary to further characterize the extent of the thrombosis. The location of the SAH varied, but it never involved the skull base. Risk factors for CVT development included hypercoagulable states, oral contraceptives use, history of recent fracture or surgery, family or personal history of deep vein thrombosis, smoking, and hyperlipidemia and migraines. Sixty-two percent of patients had acute onset severe headaches, 35% presented with nuchal rigidity, and 35% presented with seizures. Conclusions: Cerebral venous thrombosis must be considered in the differential diagnosis of patients presenting with a broad range of neurological presentations especially in the presence of new onset of seizures. Computed tomographic offers many clues to the diagnosis of CVT when concomitant SAH is present. These include the presence of SAH at cerebral convexities with associated basal cisterns and skull base sparing. Recognition of these subtleties will allow prompt and appropriate management and, when in doubt, encourage further investigations.

--Indus script graphemes Brāhmī word majhitha, कणण क du. the two legs spread out (AV. xx , 133), ayo 'fish' (on chest), mẽḍhā ram (horns), badhi 'boar' (head) + unicorn (on chest) જ ંગડિયો jangaḍiyo 'maritime treasure-guard'