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Subarachnoid Hemorrhage
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Subarachnoid hemorrhage (SAH)
            • Definitions

              • Hemorrhage into spinal subarachnoid space from variety of etiologies
                • Trauma (> 50%)
                  • MVA, occupational, etc.
                  • Postoperative
                  • Lumbar puncture, epidural or intradural catheter placement
                • Related to brain pathology
                  • Aneurysmal SAH with spinal extension
                • Spinal arteriovenous malformations
                  • Mainly types II, III, IVc, conus malformations
                  • Intradural extramedullary cavernous malformation (very rare)
                • Tumor
                  • Spinal ependymoma
                  • Spinal schwannoma (rare)
                  • Hemangioblastoma (rare)
                  • Astrocytoma (rare)
                  • Endometriosis (rare)
                • Bleeding diatheses
                • Anticoagulant therapy
                • Infection (pneumococcal meningitis, herpes)
                • Systemic disease
                  • Lupus erythematosus, polyarteritis nodosa
                • Spinal artery aneurysm (rare)
                  • High flow varieties associated with AVM, or coarctation of aorta
                  • Congenital type seen with collagen gene mutations; connective tissue disorders
                • Spontaneous idiopathic (rare)

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Pahl FH et al: Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage. Surg Neurol Int. 5:139, 2014
                                  2. Boström A et al: Spinal glomus-type arteriovenous malformations: microsurgical treatment in 20 cases. J Neurosurg Spine. 10(5):423-9, 2009
                                  3. Ros de San Pedro J et al: Massive hemorrhage in hemangioblastomas : Literature review. Neurosurg Rev. Epub ahead of print, 2009
                                  4. Sharma GK et al: Spontaneous intramedullary hemorrhage of spinal hemangioblastoma: case report. Neurosurgery. 65(3):E627-8; discussion E628, 2009
                                  5. Yu SD et al: Factors associated with traumatic fluoroscopy-guided lumbar punctures: a retrospective review. AJNR Am J Neuroradiol. 30(3):512-5, 2009
                                  6. Germans MR et al: Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage. J Neurol. 255(12):1910-5, 2008
                                  7. Ginanneschi F et al: Arachnoid cyst and arachnoiditis following idiopathic spinal subarachnoid haemorrhage. Br J Neurosurg. 22(4):578-9, 2008
                                  8. Longatti P et al: Bleeding spinal artery aneurysms. J Neurosurg Spine. 8(6):574-8, 2008
                                  9. Koch C et al: Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg. 100(4 Suppl):385-91, 2004
                                  10. Pancu D et al: EPs do not accept the strategy of "lumbar puncture first" in subarachnoid hemorrhage. Am J Emerg Med. 22(2):115-7, 2004
                                  11. Yahiro T et al: Pseudoaneurysm of the thoracic radiculomedullary artery with subarachnoid hemorrhage. Case report. J Neurosurg. 100(3 Suppl):312-5, 2004
                                  12. Berlis A et al: Subarachnoid haemorrhage due to cervical spinal cord haemangioblastomas in a patient with von Hippel-Lindau disease. Acta Neurochir (Wien). 145(11):1009-13; discussion 1013, 2003
                                  13. Bertalanffy H et al: Isolated paramedullary hemangioblastoma originating from the first cervical nerve root: case report. Spine. 28(10):E191-3, 2003
                                  14. Chatterjee T et al: Pneumococcal meningitis masquerading as subarachnoid haemorrhage. Med J Aust. 178(10):505-7, 2003
                                  15. Kastenbauer S et al: Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 126(Pt 5):1015-25, 2003
                                  16. Nozaki K et al: Spinal intradural extramedullary cavernous angioma. Case report. J Neurosurg. 99(3 Suppl):316-9, 2003
                                  17. Rabinov JD et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 24(7):1421-8, 2003
                                  18. Shah KH et al: Incidence of traumatic lumbar puncture. Acad Emerg Med. 10(2):151-4, 2003
                                  19. Yamaguchi S et al: Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm? Surg Neurol. 59(5):408-12; discussion 412, 2003
                                  20. Fahy BG et al: Current concepts in neurocritical care. Anesthesiol Clin North America. 20(2):441-62, viii, 2002
                                  21. Pai SB et al: Post lumbar puncture spinal subarachnoid hematoma causing paraplegia: a short report. Neurol India. 50(3):367-9, 2002
                                  22. Wells JB et al: Subarachnoid hemorrhage presenting as post-dural puncture headache: a case report. Mt Sinai J Med. 69(1-2):109-10, 2002
                                  23. Wityk RJ et al: Neurovascular complications of marfan syndrome: a retrospective, hospital-based study. Stroke. 33(3):680-4, 2002
                                  24. Cihangiroglu M et al: Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy. Eur J Radiol. 39(3):176-9, 2001
                                  25. Cruickshank AM: ACP Best Practice No 166: CSF spectrophotometry in the diagnosis of subarachnoid haemorrhage. J Clin Pathol. 54(11):827-30, 2001
                                  26. Hausmann et al: Coagulopathy induced spinal intradural extramedullary hematoma: report of three cases and review of the literature. Acta Neurochir (Wien). 143(2):135-40, 2001
                                  27. Hosoda H et al: Mediastinal neurilemmoma complicated with spinal subarachnoid hemorrhage. Jpn J Thorac Cardiovasc Surg. 49(6):384-7, 2001
                                  28. Ruelle A et al: Spinal subarachnoid bleeding of unknown etiology. Case reports. J Neurosurg Sci. 45(1):53-7, 2001
                                  29. Bhangoo RS et al: Cavernous angiomas of the brain stem and spinal cord. J Clin Neurosci. 5 Suppl:20-5, 1998
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Subarachnoid hemorrhage (SAH)
                                            • Definitions

                                              • Hemorrhage into spinal subarachnoid space from variety of etiologies
                                                • Trauma (> 50%)
                                                  • MVA, occupational, etc.
                                                  • Postoperative
                                                  • Lumbar puncture, epidural or intradural catheter placement
                                                • Related to brain pathology
                                                  • Aneurysmal SAH with spinal extension
                                                • Spinal arteriovenous malformations
                                                  • Mainly types II, III, IVc, conus malformations
                                                  • Intradural extramedullary cavernous malformation (very rare)
                                                • Tumor
                                                  • Spinal ependymoma
                                                  • Spinal schwannoma (rare)
                                                  • Hemangioblastoma (rare)
                                                  • Astrocytoma (rare)
                                                  • Endometriosis (rare)
                                                • Bleeding diatheses
                                                • Anticoagulant therapy
                                                • Infection (pneumococcal meningitis, herpes)
                                                • Systemic disease
                                                  • Lupus erythematosus, polyarteritis nodosa
                                                • Spinal artery aneurysm (rare)
                                                  • High flow varieties associated with AVM, or coarctation of aorta
                                                  • Congenital type seen with collagen gene mutations; connective tissue disorders
                                                • Spontaneous idiopathic (rare)

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Angiographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Pahl FH et al: Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage. Surg Neurol Int. 5:139, 2014
                                                                  2. Boström A et al: Spinal glomus-type arteriovenous malformations: microsurgical treatment in 20 cases. J Neurosurg Spine. 10(5):423-9, 2009
                                                                  3. Ros de San Pedro J et al: Massive hemorrhage in hemangioblastomas : Literature review. Neurosurg Rev. Epub ahead of print, 2009
                                                                  4. Sharma GK et al: Spontaneous intramedullary hemorrhage of spinal hemangioblastoma: case report. Neurosurgery. 65(3):E627-8; discussion E628, 2009
                                                                  5. Yu SD et al: Factors associated with traumatic fluoroscopy-guided lumbar punctures: a retrospective review. AJNR Am J Neuroradiol. 30(3):512-5, 2009
                                                                  6. Germans MR et al: Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage. J Neurol. 255(12):1910-5, 2008
                                                                  7. Ginanneschi F et al: Arachnoid cyst and arachnoiditis following idiopathic spinal subarachnoid haemorrhage. Br J Neurosurg. 22(4):578-9, 2008
                                                                  8. Longatti P et al: Bleeding spinal artery aneurysms. J Neurosurg Spine. 8(6):574-8, 2008
                                                                  9. Koch C et al: Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature. J Neurosurg. 100(4 Suppl):385-91, 2004
                                                                  10. Pancu D et al: EPs do not accept the strategy of "lumbar puncture first" in subarachnoid hemorrhage. Am J Emerg Med. 22(2):115-7, 2004
                                                                  11. Yahiro T et al: Pseudoaneurysm of the thoracic radiculomedullary artery with subarachnoid hemorrhage. Case report. J Neurosurg. 100(3 Suppl):312-5, 2004
                                                                  12. Berlis A et al: Subarachnoid haemorrhage due to cervical spinal cord haemangioblastomas in a patient with von Hippel-Lindau disease. Acta Neurochir (Wien). 145(11):1009-13; discussion 1013, 2003
                                                                  13. Bertalanffy H et al: Isolated paramedullary hemangioblastoma originating from the first cervical nerve root: case report. Spine. 28(10):E191-3, 2003
                                                                  14. Chatterjee T et al: Pneumococcal meningitis masquerading as subarachnoid haemorrhage. Med J Aust. 178(10):505-7, 2003
                                                                  15. Kastenbauer S et al: Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 126(Pt 5):1015-25, 2003
                                                                  16. Nozaki K et al: Spinal intradural extramedullary cavernous angioma. Case report. J Neurosurg. 99(3 Suppl):316-9, 2003
                                                                  17. Rabinov JD et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 24(7):1421-8, 2003
                                                                  18. Shah KH et al: Incidence of traumatic lumbar puncture. Acad Emerg Med. 10(2):151-4, 2003
                                                                  19. Yamaguchi S et al: Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm? Surg Neurol. 59(5):408-12; discussion 412, 2003
                                                                  20. Fahy BG et al: Current concepts in neurocritical care. Anesthesiol Clin North America. 20(2):441-62, viii, 2002
                                                                  21. Pai SB et al: Post lumbar puncture spinal subarachnoid hematoma causing paraplegia: a short report. Neurol India. 50(3):367-9, 2002
                                                                  22. Wells JB et al: Subarachnoid hemorrhage presenting as post-dural puncture headache: a case report. Mt Sinai J Med. 69(1-2):109-10, 2002
                                                                  23. Wityk RJ et al: Neurovascular complications of marfan syndrome: a retrospective, hospital-based study. Stroke. 33(3):680-4, 2002
                                                                  24. Cihangiroglu M et al: Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy. Eur J Radiol. 39(3):176-9, 2001
                                                                  25. Cruickshank AM: ACP Best Practice No 166: CSF spectrophotometry in the diagnosis of subarachnoid haemorrhage. J Clin Pathol. 54(11):827-30, 2001
                                                                  26. Hausmann et al: Coagulopathy induced spinal intradural extramedullary hematoma: report of three cases and review of the literature. Acta Neurochir (Wien). 143(2):135-40, 2001
                                                                  27. Hosoda H et al: Mediastinal neurilemmoma complicated with spinal subarachnoid hemorrhage. Jpn J Thorac Cardiovasc Surg. 49(6):384-7, 2001
                                                                  28. Ruelle A et al: Spinal subarachnoid bleeding of unknown etiology. Case reports. J Neurosurg Sci. 45(1):53-7, 2001
                                                                  29. Bhangoo RS et al: Cavernous angiomas of the brain stem and spinal cord. J Clin Neurosci. 5 Suppl:20-5, 1998