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==Overview==
 
==Differential diagnosis==
It is clinically difficult to distinguish subarchnoid hemorrhage  from an [[ischemic stroke]]. However, the symptoms like [[headache]], [[nausea]], [[vomiting]], and depressed level of consciousness should raise the suspicion for a hemorrhagic event compared to [[ischemic stroke]].<ref name="pmid9810961">{{cite journal| author=Linn FH, Rinkel GJ, Algra A, van Gijn J| title=Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. | journal=J Neurol Neurosurg Psychiatry | year= 1998 | volume= 65 | issue= 5 | pages= 791-3 | pmid=9810961 | doi= | pmc=2170334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9810961  }} </ref><ref name="pmid1783930">{{cite journal| author=Markus HS| title=A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 12 | pages= 1117-8 | pmid=1783930 | doi= | pmc=1014694 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1783930  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 220px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Ischemic stroke]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occurs when a clot or a mass clogs a blood vessel and cutting off the blood flow to the brain
*Present as a
**Thrombotic stroke (thrombus develops at the clogged part of the vessel)
**Embolic strokes (blood clot that forms at another locations usually the heart and large arteries of the upper chest and neck, and travels to the brain)
*Urgent evaluation with brain / neurovascular imaging (such as [[MRI]], [[CT]], [[CTA]], [[MRA]]), cardiac, and metabolic evaluation is often necessary
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[transient ischemic attack| transient ischemic attack (TIA)]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Caused by a temporary clot which often called a “mini stroke”
*Occurs rapidly and  presents as a sudden onset of a focal neurologic symptom/sign lasting less than 24 hours
*Urgent evaluation with brain / neurovascular imaging (such as [[MRI]], [[CT]], [[CTA]], [[MRA]]), cardiac, and metabolic evaluation is often necessary
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute hypertensive crisis]]/[[Malignant hypertension]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents as significantly elevated blood pressure (systolic pressure ≥180 and/or diastolic pressure ≥120 mmHg) with or wihout acute end-organ injury
*Urgent evaluation with  [[MRI]] and [[CT]] of the brain, serum [[creatinine]], [[urinalysis]], cardiac ([[EKG]], [[chest x ray]], and c[[ardiac enzymes]]) and metabolic evaluation is often necessary
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Sentinel headache'''<ref name="pmid14984225">{{cite journal| author=Polmear A| title=Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. | journal=Cephalalgia | year= 2003 | volume= 23 | issue= 10 | pages= 935-41 | pmid=14984225 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14984225  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Caused by small aneurysmal leaks into the subarachnoid space
*Presents as a episode of headache similar to that accompanying [[subarachnoid hemorrhage]] (days to weeks prior to [[aneurysm]] rupture) and focal neurologic symptoms and signs are usually absent
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Sinusitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with acute and subacute headaches and facial pain
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hypoglycemia]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Pituitary apoplexy]]'''<ref name="pmid9596029">{{cite journal| author=Dodick DW, Wijdicks EF| title=Pituitary apoplexy presenting as a thunderclap headache. | journal=Neurology | year= 1998 | volume= 50 | issue= 5 | pages= 1510-1 | pmid=9596029 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9596029 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Caused by pituitary gland infarct or hemorrhage secondary to [[pitutiery adenoma]]
*Presents with  acute headache, change in mental status, ophthalmoplegia, and decreased visual acuity
**Brain CT and MRI are the preferred imaging techniques
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cerebral venous thrombosis]]'''<ref name="pmid8961993">{{cite journal| author=de Bruijn SF, Stam J, Kappelle LJ| title=Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group. | journal=Lancet | year= 1996 | volume= 348 | issue= 9042 | pages= 1623-5 | pmid=8961993 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8961993 }} </ref><ref name="pmid3975957">{{cite journal| author=Bousser MG, Chiras J, Bories J, Castaigne P| title=Cerebral venous thrombosis--a review of 38 cases. | journal=Stroke | year= 1985 | volume= 16 | issue= 2 | pages= 199-213 | pmid=3975957 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3975957 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with isolated gradual onset headache or in combination with [[papilledema]], [[seizures]], bilateral focal deficits, and change in mental status
*Brain MRI with venography should be considered
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Colloid cyst|Colloid cyst of the third ventricle]]'''<ref name="pmid14830663">{{cite journal| author=KELLY R| title=Colloid cysts of the third ventricle; analysis of twenty-nine cases. | journal=Brain | year= 1951 | volume= 74 | issue= 1 | pages= 23-65 | pmid=14830663 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14830663 }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Caused by an acute [[obstructive hydrocephalus]] secondary to sudden obstruction in cerebrospinal fluid flow by the cyst
*Presents with an acute onset fronto-parietal or fronto-occipital headache which relieved by taking the supine position and may be associated with nausea, vomiting, mental status changes, seizures, coma
*Head CT or MRI of the brain are usually diagnostic
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[dissection|Cervical artery dissection]]'''<ref name="pmid1423556">{{cite journal| author=Mitsias P, Ramadan NM| title=Headache in ischemic cerebrovascular disease. Part I: Clinical features. | journal=Cephalalgia | year= 1992 | volume= 12 | issue= 5 | pages= 269-74 | pmid=1423556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1423556  }} </ref><ref name="pmid14638953">{{cite journal| author=Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL et al.| title=Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. | journal=Neurology | year= 2003 | volume= 61 | issue= 10 | pages= 1347-51 | pmid=14638953 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14638953  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*It usulay occurs spontaneously or after head and neck injury
*Presents with gradual onset head and neck pain with a local manifestations (such as [[Horner syndrome]], pulsatile [[tinnitus]], bruit, or cranial [[neuropathies]])
*Neuroimagings are usually preferred  (brain MRI with MRA and cranial CT with CTA)
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Reversible cerebral vasoconstriction syndrome'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Occurs spontaneously and trigerred by sexual activity, exertion, emotion, and constriction of the cerebral arteries
*Presents with acute severe headache with or without focal deficits or seizures that resolves spontaneously within 12 weeks
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[intracranial hypotension|Spontaneous intracranial hypotension]]'''<ref name="pmid1549206">{{cite journal| author=Rando TA, Fishman RA| title=Spontaneous intracranial hypotension: report of two cases and review of the literature. | journal=Neurology | year= 1992 | volume= 42 | issue= 3 Pt 1 | pages= 481-7 | pmid=1549206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1549206  }} </ref><ref name="pmid11270540">{{cite journal| author=Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK| title=Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage. | journal=Neurosurgery | year= 2001 | volume= 48 | issue= 3 | pages= 513-6; discussion 516-7 | pmid=11270540 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11270540  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with orthostatic headaches, nausea, vomiting, dizziness,  diplopia, interscapular pain
*Caused by [[cerebrospinal fluid|cerebrospinal fluid (CSF)]] leakage from spinal meningeal defects or [[dural]] tears
*Brain MRI is the preferred imaging techniques
|}
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 14:47, 7 December 2016

Subarachnoid Hemorrhage Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Differential diagnosis

It is clinically difficult to distinguish subarchnoid hemorrhage from an ischemic stroke. However, the symptoms like headache, nausea, vomiting, and depressed level of consciousness should raise the suspicion for a hemorrhagic event compared to ischemic stroke.[1][2]

Disease Findings
Ischemic stroke
  • Occurs when a clot or a mass clogs a blood vessel and cutting off the blood flow to the brain
  • Present as a
    • Thrombotic stroke (thrombus develops at the clogged part of the vessel)
    • Embolic strokes (blood clot that forms at another locations usually the heart and large arteries of the upper chest and neck, and travels to the brain)
  • Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
transient ischemic attack (TIA)
  • Caused by a temporary clot which often called a “mini stroke”
  • Occurs rapidly and presents as a sudden onset of a focal neurologic symptom/sign lasting less than 24 hours
  • Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
Acute hypertensive crisis/Malignant hypertension
  • Presents as significantly elevated blood pressure (systolic pressure ≥180 and/or diastolic pressure ≥120 mmHg) with or wihout acute end-organ injury
  • Urgent evaluation with MRI and CT of the brain, serum creatinine, urinalysis, cardiac (EKG, chest x ray, and cardiac enzymes) and metabolic evaluation is often necessary
Sentinel headache[3]
  • Caused by small aneurysmal leaks into the subarachnoid space
  • Presents as a episode of headache similar to that accompanying subarachnoid hemorrhage (days to weeks prior to aneurysm rupture) and focal neurologic symptoms and signs are usually absent
Sinusitis
  • Presents with acute and subacute headaches and facial pain
Hypoglycemia
Pituitary apoplexy[4]
  • Caused by pituitary gland infarct or hemorrhage secondary to pitutiery adenoma
  • Presents with acute headache, change in mental status, ophthalmoplegia, and decreased visual acuity
    • Brain CT and MRI are the preferred imaging techniques
Cerebral venous thrombosis[5][6]
  • Presents with isolated gradual onset headache or in combination with papilledema, seizures, bilateral focal deficits, and change in mental status
  • Brain MRI with venography should be considered
Colloid cyst of the third ventricle[7]
  • Caused by an acute obstructive hydrocephalus secondary to sudden obstruction in cerebrospinal fluid flow by the cyst
  • Presents with an acute onset fronto-parietal or fronto-occipital headache which relieved by taking the supine position and may be associated with nausea, vomiting, mental status changes, seizures, coma
  • Head CT or MRI of the brain are usually diagnostic
Cervical artery dissection[8][9]
  • It usulay occurs spontaneously or after head and neck injury
  • Presents with gradual onset head and neck pain with a local manifestations (such as Horner syndrome, pulsatile tinnitus, bruit, or cranial neuropathies)
  • Neuroimagings are usually preferred (brain MRI with MRA and cranial CT with CTA)
Reversible cerebral vasoconstriction syndrome
  • Occurs spontaneously and trigerred by sexual activity, exertion, emotion, and constriction of the cerebral arteries
  • Presents with acute severe headache with or without focal deficits or seizures that resolves spontaneously within 12 weeks
Spontaneous intracranial hypotension[10][11]
  • Presents with orthostatic headaches, nausea, vomiting, dizziness, diplopia, interscapular pain
  • Caused by cerebrospinal fluid (CSF) leakage from spinal meningeal defects or dural tears
  • Brain MRI is the preferred imaging techniques

References

  1. ↑ Linn FH, Rinkel GJ, Algra A, van Gijn J (1998). "Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache". J Neurol Neurosurg Psychiatry. 65 (5): 791–3. PMC 2170334. PMID 9810961.
  2. ↑ Markus HS (1991). "A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage". J Neurol Neurosurg Psychiatry. 54 (12): 1117–8. PMC 1014694. PMID 1783930.
  3. ↑ Polmear A (2003). "Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review". Cephalalgia. 23 (10): 935–41. PMID 14984225.
  4. ↑ Dodick DW, Wijdicks EF (1998). "Pituitary apoplexy presenting as a thunderclap headache". Neurology. 50 (5): 1510–1. PMID 9596029.
  5. ↑ de Bruijn SF, Stam J, Kappelle LJ (1996). "Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group". Lancet. 348 (9042): 1623–5. PMID 8961993.
  6. ↑ Bousser MG, Chiras J, Bories J, Castaigne P (1985). "Cerebral venous thrombosis--a review of 38 cases". Stroke. 16 (2): 199–213. PMID 3975957.
  7. ↑ KELLY R (1951). "Colloid cysts of the third ventricle; analysis of twenty-nine cases". Brain. 74 (1): 23–65. PMID 14830663.
  8. ↑ Mitsias P, Ramadan NM (1992). "Headache in ischemic cerebrovascular disease. Part I: Clinical features". Cephalalgia. 12 (5): 269–74. PMID 1423556.
  9. ↑ Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL; et al. (2003). "Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study". Neurology. 61 (10): 1347–51. PMID 14638953.
  10. ↑ Rando TA, Fishman RA (1992). "Spontaneous intracranial hypotension: report of two cases and review of the literature". Neurology. 42 (3 Pt 1): 481–7. PMID 1549206.
  11. ↑ Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK (2001). "Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage". Neurosurgery. 48 (3): 513–6, discussion 516-7. PMID 11270540.

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