Hongmei Li1, Abudusaimaiti Ayinuer1, Jiankang Huang2. 1. Department of Neurology, Kashgar Prefecture Second People's Hospital, Kashgar, Xinjiang Uygur Autonomous Region, China. 2. Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: hjk791016@163.com.
Abstract
BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is a severe cerebrovascular condition. Some cases present with typical signs of SAH on head computed tomography (CT), whereas other cases have a condition known as pseudo-SAH, with no bleeding actually present. In our clinical experience, we noted that cases of hyperhemoglobinemia often also had pseudo-SAH. Here we investigated the relationship between hyperhemoglobinemia and pseudo-SAH and explored the underlying mechanism. METHODS: We retrospectively collected data for patients who were treated for hyperhemoglobinemia in our hospital and had available brain CT scans. An age-matched control group of patients with normal hemoglobin levels was used to compare the incidence of pseudo-SAH between individuals with elevated versus normal hemoglobin levels. Spearman correlation and logistic regression analyses were performed to identify correlations between pseudo-SAH and hemoglobin level as well as gender, history of chronic obstructive pulmonary disease, and smoking history. RESULTS: The incidence of pseudo-SAH was significantly higher in hyperhemoglobinemia group than in the control group (12.5% vs. 1.6%, respectively, P < 0.001), and within the hyperhemoglobinemia group, it was significantly higher among those with a hemoglobin value ≥210 g/L than among those with a hemoglobin value <210 g/L (29.2% vs. 8.8%, respectively, P < 0.001). Spearman correlation analysis and logistic regression analysis showed a significant correlation between pseudo-SAH and hyperhemoglobinemia but no significant correlation between pseudo-SAH and gender, COPD, or smoking history. CONCLUSION: Hyperhemoglobinemia may be a contributing factor to pseudo-SAH. Clinicians should be aware of this phenomenon and be careful to distinguish pseudo-SAH from SAH, particularly in patients with hyperhemoglobinemia.
BACKGROUND AND PURPOSE:Subarachnoid hemorrhage (SAH) is a severe cerebrovascular condition. Some cases present with typical signs of SAH on head computed tomography (CT), whereas other cases have a condition known as pseudo-SAH, with no bleeding actually present. In our clinical experience, we noted that cases of hyperhemoglobinemia often also had pseudo-SAH. Here we investigated the relationship between hyperhemoglobinemia and pseudo-SAH and explored the underlying mechanism. METHODS: We retrospectively collected data for patients who were treated for hyperhemoglobinemia in our hospital and had available brain CT scans. An age-matched control group of patients with normal hemoglobin levels was used to compare the incidence of pseudo-SAH between individuals with elevated versus normal hemoglobin levels. Spearman correlation and logistic regression analyses were performed to identify correlations between pseudo-SAH and hemoglobin level as well as gender, history of chronic obstructive pulmonary disease, and smoking history. RESULTS: The incidence of pseudo-SAH was significantly higher in hyperhemoglobinemia group than in the control group (12.5% vs. 1.6%, respectively, P < 0.001), and within the hyperhemoglobinemia group, it was significantly higher among those with a hemoglobin value ≥210 g/L than among those with a hemoglobin value <210 g/L (29.2% vs. 8.8%, respectively, P < 0.001). Spearman correlation analysis and logistic regression analysis showed a significant correlation between pseudo-SAH and hyperhemoglobinemia but no significant correlation between pseudo-SAH and gender, COPD, or smoking history. CONCLUSION: Hyperhemoglobinemia may be a contributing factor to pseudo-SAH. Clinicians should be aware of this phenomenon and be careful to distinguish pseudo-SAH from SAH, particularly in patients with hyperhemoglobinemia.
Authors: Qun Li; Xuhua Guan; Peng Wu; Xiaoye Wang; Lei Zhou; Yeqing Tong; Ruiqi Ren; Kathy S M Leung; Eric H Y Lau; Jessica Y Wong; Xuesen Xing; Nijuan Xiang; Yang Wu; Chao Li; Qi Chen; Dan Li; Tian Liu; Jing Zhao; Man Liu; Wenxiao Tu; Chuding Chen; Lianmei Jin; Rui Yang; Qi Wang; Suhua Zhou; Rui Wang; Hui Liu; Yinbo Luo; Yuan Liu; Ge Shao; Huan Li; Zhongfa Tao; Yang Yang; Zhiqiang Deng; Boxi Liu; Zhitao Ma; Yanping Zhang; Guoqing Shi; Tommy T Y Lam; Joseph T Wu; George F Gao; Benjamin J Cowling; Bo Yang; Gabriel M Leung; Zijian Feng Journal: N Engl J Med Date: 2020-01-29 Impact factor: 176.079