Pitfalls in the diagnosis of subarachnoid haemorrhage

BMJ 1995;311:871-872 (30 September)

Letters

Pitfalls in the diagnosis of subarachnoid haemorrhage

EDITOR,--Damianos E Sakas and colleagues report on four casesin which subarachnoid haemorrhage could have been mistaken forhead injury and emphasise the role of computed tomography insuch cases. We recently reviewed 26 patients who had both computedtomography and lumbar puncture out of 208 patients with confirmedsubarachnoid haemorrhage seen at our institution over 41 months.Two clinically important pitfalls in the diagnosis of subarachnoidhaemorrhage by computed tomography were highlighted.

Firstly, only six of 18 patients in whom computed tomographyshowed an abnormality had xanthochromia on analysis of cerebrospinalfluid. Our laboratory uses naked eye examination to detect xanthochromia.This method is insensitive and in a previous study detectedonly half of cases in a series of 32 samples of cerebrospinalfluid in which xanthochromia was found on spectropho-tometry.²Failure to see xanthochromia does not exclude subarachnoid haemorrhage.

Secondly, only eight patients had an entirely normal computed. . . [Full text of this article]

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Lesson of the Week: Subarachnoid haemorrhage presenting as head injury: Damianos E Sakas, Lal S Dias, and David Beale
BMJ 1995 310: 1186-1187. [Extract] [Full Text]