Cryptogenic spontaneous subarachnoid haemorrhage

Patients with spontaneous primary subarachnoid haemorrhage (SAH) in whom initial diagnostic investigation, including cerebral four-vessel angiography, does not reveal a cause, present a difficult problem. In a series of 95 patients a cause became apparent in about 10% of cases during the first three weeks, predominantly missed aneurysms. After three weeks the clinical evolution was benign. Cryptogenic SAH seems to be a disease of its own, but in the individual case the possibility of missed aneurysm or later of no re-bleed aneurysm always remains.     

Terson's syndrome in spontaneous spinal subarachnoid haemorrhage.

This paper is a case report of Terson's Syndrome (TS) in spontaneous spinal subarachnoid haemorrhage (SAH). A 66-year-old woman with acute onset of severe back pain was transferred to our institution for management of her sciatica. The presence of an intraretinal haemorrhage alerted us to consider intracranial SAH, but investigations showed no intracranial source. Eventually, the patient was diagnosed with a thoracic spinal SAH. The patient's symptoms gradually improved with conservative management but within 1 month she had a recurrence. A spinal and CT angiogram did not elicit the aetiology. The diagnosis of spontaneous spinal SAH can be difficult. The recognition of TS has important prognostic implications, often heralding subarachnoid rebleeding. Fundoscopic examination appears mandatory as a tool for diagnosis and regular non-invasive monitoring of patients with SAH.     

CSF spectrophotometry in the diagnosis and exclusion of spontaneous subarachnoid haemorrhage.

AIMS: To assess the sensitivity and specificity of CSF spectrophotometry for the detection of xanthochromia in patients with clinical symptoms suggestive of subarachnoid haemorrhage (SAH) but normal cranial computed tomography (CT). METHODS: All consecutive patients undergoing both cranial CT and lumbar puncture for investigation of possible SAH at the Princess Alexandra Hospital, Brisbane, between January 2000 and April 2003 were included in the study. All case histories, radiology and laboratory results were retrospectively assessed. The sensitivity, specificity and positive predictive value of the spectrophotometry test were calculated. RESULTS: 253 patients were included in the study. Spectrophotometry was shown to have a sensitivity of 100% but a specificity of only 75.2%. The positive predictive value of spectrophotometry as an indicator of SAH was 3.3%. CONCLUSIONS: CSF spectrophotometry has an unacceptably low specificity and positive predictive value, which greatly limit its use as a clinical tool.     

Measurement of total circulating blood volume following subarachnoid haemorrhage: methodological aspects.

The total circulating blood volume (TCBV) and total body/venous haematocrit ratio (Htb/Hv) was determined by simultaneous measurement of the red cell volume (RCV) and the plasma volume (PV) in 10 subarachnoid haemorrhage (SAH) patients, 10 supine bedresting control patients and 20 ambulant out-patients. The mean Htb/Hv of the SAH patients, 0.866, was found to be significantly lower than that of the supine controls, 0.908, and the ambulant patients, 0.909, (p less than 0.01). Using the ratio 0.866 the total circulating blood volume of the SAH patients was calculated from either their RCV or their PV and compared with their measured TCBV. Expressed as a percentage of measured TCBV the mean errors of these single volume determinations were 2.84% and 1.76% respectively. The significance of these changes in the Htb/Hv ratio of SAH patients is discussed in relation to the circulatory disturbances they suffer.     

Computed tomography in aneurysmal subarachnoid haemorrhage.

The initial CT scans of 76 patients with aneurysmal subarachnoid haemorrhage were reviewed, and the amount of blood visible in the basal CSF cisterns was quantified. The outcome of surgery was found to correlate significantly with the quantity of blood seen on the scan, as did the pre-operative grade of the patient, a history of pre-existing hypertension, and the presence of angiographic vasospasm.     

Temporary alopecia after subarachnoid haemorrhage.

Primary endovascular intervention is increasingly the first choice of treatment for cerebral aneurysms, particularly for those with complex anatomy in the posterior circulation. However, their clinical management and follow-up continue to be predominantly in the hands of neurosurgeons. In this report, the development of alopecia following the coiling of posterior circulation aneurysms is described. The alopecia was transient and lasted for approximately 6 months, and occurred in the occipital and suboccipital regions of the scalp. This report aims to highlight this condition, which has not been previously reported in the neurosurgical literature. The potential hazards of irradiation should be borne in mind while carrying out complex endovascular procedures. The patient should be counselled and all necessary steps undertaken to limit radiation exposure.     

Eclamptic subarachnoid haemorrhage without hypertension.

Subarachnoid haemorrhage in pregnancy is often the result of aneurysmal rupture or severe hypertension. A young woman with postpartum eclampsia and 'normal' blood pressure developed sudden-onset head pain, and was found to have minor biconvexity subarachnoid hemorrhages. Serial angiograms of the cervicocranial vessels revealed no evidence of aneurysm or arteriovenous malformation. A follow-up angiogram revealed diffuse vessel narrowing, consistent with postpartum angiopathy. Treatment consisted only of nimodipine for the prevention of vasospasm. The patient made an excellent recovery, without residual neurological deficits.