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Pseudosubarachnoid Hemorrhage After Cardiopulmonary Arrest

  • Cara M. Borelli , Morgan Mickalis and Amit Sanghi
Published/Copyright: April 1, 2019
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 119 Issue 4

Keywords: cardiopulmonary arrest; subarachnoid hemorrhage

A 46-year-old woman had a sudden cardiopulmonary arrest directly after a surgical procedure. She was resuscitated twice for 15 minutes each time; however, despite return of spontaneous circulation, the patient never regained consciousness. Noncontrast head computed tomography (CT) findings 1 day after resuscitation were unremarkable. Forty-eight hours later, a repeated head CT showed the development of extensive cerebral edema, effacement of the sulci, slitlike ventricles, and apparent subarachnoid hemorrhage (image, arrow) with effacement of the basal cisterns. However, the hyperattenuation of the subarachnoid space was lower than would be expected in true subarachnoid hemorrhage, suggesting pseudosubarachnoid hemorrhage. Because of the patient's poor prognosis, the decision was made to withdraw care.

Pseudosubarachnoid hemorrhage is a CT sign that is commonly due to cerebral edema from anoxic ischemic encephalopathy.1-3 Other causes include severe leptomeningitis, intrathecal contrast, and venous sinus thrombosis.1,4 Hounsfield unit (HU) measurements on CT can help distinguish true subarachnoid hemorrhage from pseudosubarachnoid hemorrhage: the hyperattenuation of the subarachnoid space is lower in pseudosubarachnoid hemorrhage (30-40 HU) than in true subarachnoid hemorrhage (60-70 HU).

From the Edward Via College of Osteopathic Medicine in Spartanburg, South Carolina (Student Doctor Borelli and Dr Mickalis), and the Regional Medical Center in Orangeburg, South Carolina (Dr Sanghi).
Financial Disclosures: None reported.
Support: None reported.

*Address correspondence to Cara M. Borelli, OMS III, 4482 Columbia Rd, Orangeburg, SC 29118-9320. Email:

References

1. Given CA II , BurdetteJH, ElsterAD, Williams DWIII. Pseudo-subarachnoid hemorrhage: a potential imaging pitfall associated with diffuse cerebral edema. AJNR Am J Neuroradiol. 2003;24(2):254-256.Search in Google Scholar

2. Yuzawa H , HiganoS, MugikuraS, et al. Pseudo-subarachnoid hemorrhage found in patients with postresuscitation encephalopathy: characteristics of CT findings and clinical importance. AJNR Am J Neuroradiol. 2008;29(8):1544-1549. doi:10.3174/ajnr.A1167Search in Google Scholar PubMed PubMed Central

3. Patzig M , LaubC, JanssenH, ErtlL, FeslG. Pseudo-subarachnoid haemorrhage due to chronic hypoxaemia: case report and review of the literature. BMC Neurol. 2014;14:219. doi:10.1186/s12883-014-0219-7Search in Google Scholar PubMed PubMed Central

4. Marder CP , NarlaV, FinkJR, Tozer FinkKR. Subarachnoid hemorrhage: beyond aneurysms. AJR Am J Roentgenol. 2014;202(1):25-37. doi:10.2214/AJR.12.9749Search in Google Scholar PubMed

Received: 2018-07-23
Accepted: 2018-07-30
Published Online: 2019-04-01
Published in Print: 2019-04-01

© 2019 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  4. JAOA/AACOM MEDICAL EDUCATION
  5. Role of Debt and Loan Forgiveness/Repayment Programs in Osteopathic Medical Graduates’ Plans to Enter Primary Care
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  12. APPENDIX
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  14. CLINICAL IMAGES
  15. Pseudosubarachnoid Hemorrhage After Cardiopulmonary Arrest
https://doi.org/10.7556/jaoa.2019.045
Keywords for this article
cardiopulmonary arrest; subarachnoid hemorrhage
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. EDITORIAL
  2. Growth, Debt, and Diversity Driving Innovation in Medical Education
  3. The Evolution of Osteopathic Board Certification
  4. JAOA/AACOM MEDICAL EDUCATION
  5. Role of Debt and Loan Forgiveness/Repayment Programs in Osteopathic Medical Graduates’ Plans to Enter Primary Care
  6. Longitudinal Assessment of Medical Student Emotional Intelligence Over Preclinical Training
  7. Comprehensive Medical College Admission Test Preparatory Course as a Strategy to Encourage Premedical Students to Pursue Osteopathic Medicine in Rural Areas
  8. Improving Medical Education by Coupling Basic Science Lectures With ICD-10 Codes
  9. Single Accreditation System for Graduate Medical Education: Transition Update
  10. CASE REPORT
  11. Osteopathic Manipulative Treatment as a Novel Way to Manage Postvasectomy Pain Syndrome
  12. APPENDIX
  13. Appendix: Osteopathic Graduate Medical Education, 2019
  14. CLINICAL IMAGES
  15. Pseudosubarachnoid Hemorrhage After Cardiopulmonary Arrest
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