BACKGROUND: The natural history of untreated aneurysmal subarachnoid haemorrhage carries a dismal prognosis. Case fatalities range between 32% and 67%. Treatment with either surgical clipping or endovascular coiling is highly successful at preventing re-bleeding and yet the diagnosis is still missed. METHODS: Based on the national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage and a review of other available literature this study has compiled guidance in making the diagnosis. CONCLUSION: In patients presenting with a suspected non-traumatic subarachnoid haemorrhage, computed tomography within 12 hours will reliably show 98% of subarachnoid haemorrhage. In patients who present after 12 hours with a negative computed tomogram, formal cerebrospinal fluid spectophotometry will detect subarachnoid haemorrhage for the next two weeks with a reliability of 96%. Between the early diagnosis with the aid of computed tomography and the later diagnosis with the added benefit of spectophotometry in the period where computed tomograms become less reliable, it should be possible to diagnose most cases of subarachnoid haemorrhage correctly.
BACKGROUND: The natural history of untreated aneurysmal subarachnoid haemorrhage carries a dismal prognosis. Case fatalities range between 32% and 67%. Treatment with either surgical clipping or endovascular coiling is highly successful at preventing re-bleeding and yet the diagnosis is still missed. METHODS: Based on the national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage and a review of other available literature this study has compiled guidance in making the diagnosis. CONCLUSION: In patients presenting with a suspected non-traumatic subarachnoid haemorrhage, computed tomography within 12 hours will reliably show 98% of subarachnoid haemorrhage. In patients who present after 12 hours with a negative computed tomogram, formal cerebrospinal fluid spectophotometry will detect subarachnoid haemorrhage for the next two weeks with a reliability of 96%. Between the early diagnosis with the aid of computed tomography and the later diagnosis with the added benefit of spectophotometry in the period where computed tomograms become less reliable, it should be possible to diagnose most cases of subarachnoid haemorrhage correctly.
Authors: Andrew Molyneux; Richard Kerr; Irene Stratton; Peter Sandercock; Mike Clarke; Julia Shrimpton; Rury Holman Journal: Lancet Date: 2002-10-26 Impact factor: 79.321
Authors: C D A Wolfe; A G Rudd; R Howard; C Coshall; J Stewart; E Lawrence; C Hajat; T Hillen Journal: J Neurol Neurosurg Psychiatry Date: 2002-02 Impact factor: 10.154
Authors: P Mitchell; I D Wilkinson; N Hoggard; M N Paley; D A Jellinek; T Powell; C Romanowski; T Hodgson; P D Griffiths Journal: J Neurol Neurosurg Psychiatry Date: 2001-02 Impact factor: 10.154
Authors: F H Linn; E F Wijdicks; Y van der Graaf; F A Weerdesteyn-van Vliet; A I Bartelds; J van Gijn Journal: Lancet Date: 1994-08-27 Impact factor: 79.321
Authors: Melanie D King; Melissa D Laird; Sangeetha Sukumari Ramesh; Patrick Youssef; Basheer Shakir; John R Vender; Cargill H Alleyne; Krishnan M Dhandapani Journal: Neurosurg Focus Date: 2010-01 Impact factor: 4.047