Abstract
Only 15% of all subarachnoid haemorrhages (SAHs) are not of aneurysmal origin. Among those, circumscribed SAHs along the cortical convexity are rare and have only been described in singular case reports so far. Here, we present a collection of 12 cases of SAH along the convexity, of non-traumatic origin. Over a period of 10 years, 12 cases of circumscribed SAH along the convexity were identified at our clinic. The clinical presentations, neuroradiological SAH characteristics, further diagnostic work-up to identify the underlying aetiologies, the therapy and clinical outcome were analysed. The patients’ chief complaints were unspecific cephalgia, focal or generalised seizures and focal neurological deficits. Typical signs of basal SAH, such as nuchal rigidity, thunderclap-headache or alteration of consciousness, were rare. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed different aetiologies, namely postpartal posterior encephalopathy (three), cerebral vasculitis (two), dural sinus thrombosis (two), cortical venous thrombosis (one), intracerebral abscesses (one) and cerebral cavernoma (one). Two cases remained unresolved. Treatment of the underlying disease and symptomatic medication led to good clinical outcome in almost all cases. On the basis of these findings, we demonstrate that the clinical presentation, localisation and aetiology of cortical SAH differ clearly from other SAHs. A diagnostic work-up with MRI and eventually DSA is essential. Mostly, the causative disease can be identified, and specific treatment allows a favourable outcome.
Similar content being viewed by others
References
van Gijn J, Rinkel GJE (2001) Subarachnoid haemorrhage: diagnosis, causes and management. Brain 124:249–278
Aggarwal SK, Williams V, Levine SR, Cassin BJ, Garcia JH (1996) Cocaine-associated intracranial hemorrhage: absence of vasculitis in 14 cases. Neurology 46:1741–1743
Aoki N (1991) Do intracranial arteriovenous malformations cause subarachnoid hemorrhage? Review of computed tomography features of ruptured arteriovenous malformations in the acute stage. Acta Neurochir (Wien) 112:92–95
Cantu C, Arauz A, Murillo-Bonilla LM, Lòpez M, Barinagarrementeria F (2003) Stroke associated with sympathomimetics contained in over-the-counter cough and cold drugs. Stroke 34:1667–1673
Ciccone A, Citterio A, Santilli I, Sterzi R (2000) Subarachnoid haemorrhage treated with anticoagulants. Lancet 356:1818
Jain R, Deveikis J, Hickenbottom S, Mukherji S (2003) Varicella-Zoster vasculitis presenting with intracranial hemorrhage. Am J Neuroradiol 24:971–974
Kumar R, Wijdicks EF, Brown RD Jr, Parisi JE, Hammond CA (1997) Isolated angiitis of the CNS presenting as subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 62:649–651
Oshiro S, Motomura K, Fukushima T (2003) Systemic lupus erythematoses manifesting as subarachnoid hemorrhage induced by cortical venous thrombosis and followed by medial medullary infarction. No To Shinkei 55:791–795
Ozawa T, Sasaki O, Sorimachi T, Tanaka R (1995) Primary angiitis of the central nervous system: report of two cases and review of the literature. Neurosurgery 36:173–179
Ra CS, Lui CC, Liang CL, Chen HJ, Kuo YL, Chen WF (2001) Superior sagittal sinus thrombosis induced by thyrotoxicosis. Case report. J Neurosurg 94:130–132
Rohde V, van Oosterhout A, Mull M, Gilsbach JM (2000) Subarachnoid haemorrhage as initial symptom of multiple brain abscesses. Acta Neurochir (Wien) 142:205–208
Servillo G, Striano P, Striano S, Tortora F, Bocella P, De Robertis E, Rossano F, Briganti F, Tufano R (2003) Posterior reversible encephalopathy syndrome (PRES) in critically ill obstetric patients. Int Care Med 29:2323–2326
Shah AK (2003) Non-aneurysmal primary subarachnoid hemorrhage in pregnancy-induced hypertension and eclampsia. Neurology 61:117–120
Teksam M, Casey SO, Michel E, Truwit CL (2001) Subarachnoid hemorrhage associated with cyclosporine A neurotoxicity in a bone-marrow transplant recipient. Neuroradiology 43:242–245
Ursell MR, Marras CL, Farb R, Rowed DW, Black SE, Perry JR (1998) Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy. Implications for management. Stroke 29:1995–1998
Voigt K, Yasargil MG (1976) Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localisation, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Neurochirurgia (Stuttg) 19:59–68
Widjaja E, Romanowski CA, Sinanan AR, Hodgson TJ, Griffiths PD (2003) Thunderclap headache: presentation of intracranial sinus thrombosis?. Clin Radiol 58:648–652
Pinto AN, Canhao P, Ferro JM (1996) Seizures at the onset of subarachnoid haemorrhage. J Neurol 243:161–164
Grunwald Q, Holst B, Möller V, Reith W (2002) Clinical diagnosis and therapy of subarachnoid hemorrhage. Radiologe 42:860–870
Fessler RD, Esshaki CM, Stankewitz RC, Johnson RR, Diaz FG (1997) The neurovascular complications of cocaine. Surg Neurol 47:339–345
McEvoy AW, Kitchen ND, Thomas DGT (2000) Intracerebral haemorrhage and drug abuse in young adults. Br J Neurosurg 14:449–454
Salanova V, Taubner R (1984) Intracerebral haemorrhage and vasculitis secondary to amphetamine use. Postgrad Med J 60:429–430
Moore PM (1998) Neurology of the vasculitides and connective tissue diseases. J Neurol Neurosurg Psychiatry 65:10–22
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spitzer, C., Mull, M., Rohde, V. et al. Non-traumatic cortical subarachnoid haemorrhage: diagnostic work-up and aetiological background. Neuroradiology 47, 525–531 (2005). https://doi.org/10.1007/s00234-005-1384-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-005-1384-6