Emergency radiology: don’t miss 3 of 8
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Cases/Central nervous systemVascular
Case 1010

Subarachnoid hemorrhageWhat is the diagnosis?

Case image 1 CT 1 / 2

Axial non-contrast CT of the head.

Image: Dr. George Jallo, CC BY-SA 3.0 — source

Answer hidden. Review the images and history, decide on your diagnosis, then reveal.

Findings

  • Hyperdense blood filling the basal cisterns and Sylvian fissures
  • Dilated temporal horns, indicating early hydrocephalus
  • The second patient also has intraventricular blood

Case discussion

Blood in the basal cisterns after a thunderclap headache is subarachnoid hemorrhage, most often from a ruptured aneurysm. CT angiography is the next step to look for the aneurysm.

Non-contrast CT is very sensitive in the first six hours, but sensitivity falls with time. Hydrocephalus, rebleeding and delayed cerebral ischaemia are the main early complications.

Encyclopedia

Subarachnoid hemorrhageBleeding into the subarachnoid space, most often from trauma or, in spontaneous cases, a ruptured intracranial aneurysm.

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