Jacek Szypenbejl 1, Edyta Szurowska 2, Tomasz Szmuda 3, Andrzej Basiński 1, Mariusz Siemiński 1
1 Katedra i Klinika Medycyny Ratunkowej, Gdański Uniwersytet Medyczny, Gdańsk
2 II Zakład Radiologi, Gdański Uniwersytet Medyczny, Gdańsk
3 Katedra i Klinika Neurochirurgii, Gdański Uniwersytet Medyczny, Gdańsk
Background and aim. Subarachnoid haemorrhage (SAH)is the most important differential diagnosis in a patient with a thunderclap headache. Computed tomography of the head (CT) without contrast enhancement is the gold standard for diagnostic evaluation of a patient with an acute headache and its negative result frequently leads an emergency department physician (especially in hospitals without acute neurological service) to decision of dismissing the patient. This scenario brings a risk of overlooking CT- negative subarachnoid haemorrhage. Therefore, the aim of this study was to assess the frequency and clinical picture of CT-negative subarachnoid hemorrhages.
Methods. Clinical data of patients hospitalized between 01.01.2015 – 13.06. 2016 due to CT-negative SAH in a single clinical centre were retrospectively analysed. Clinical picture, angiographic findings and prognosis were described.
Results. Out of 126 patients hospitalized due to SAH there were 5 CT-negative cases (3.9%). They were younger than CT-positive cases in terms of age (mean: 50.4 vs. 55.9 years), there were 2 men and 3 women in that group. The main clinical symptom in this subgroup was sudden headache, with vomiting in 2 cases. There were no meningeal symptoms in this group apart from neck stiffness in one case. The diagnosis was made upon features of subarachnoid bleeding found in cerebrospinal fluid. Angio-CT was negative in all of the subjects and an unruptured aneurism was found in angiography in one case. There were no deaths in that group and no neurological deficits.
Conclusions. Our results show that CT alone is not a sufficient method of detecting SAH. A lumbar puncture is a must in cases suspected of SAH. Simultaneously, CT-negative SAH scarcely seems to be related to intracranial vascular anomaly and prognosis towards survival and neurological outcome is good.