Diagnostic imaging evaluation to exclude secondary causes of subarachnoid hemorrhage

Imaging evaluation is typically performed for patients with spontaneous SAH to identify or exclude a ruptured cerebral aneurysm. Evaluation for nonaneurysmal causes is also warranted for patients with isolated convexity SAH who present with bleeding restricted to the surface of the cerebral hemispheres and for other patients once ruptured aneurysm has been excluded. Further imaging and/or other testing may be indicated for patients with acute SAH to monitor for complications and those who deteriorate clinically. Refer to UpToDate topic for additional details.

CT: computed tomography; CTA: computed tomographic angiography; DSA: digital subtraction angiography; MRI: magnetic resonance imaging; SAH: subarachnoid hemorrhage.

* Refer to UpToDate content for additional information on the causes and imaging evaluation of patients with isolated convexity subarachnoid hemorrhage.

¶ Refer to UpToDate topics for additional information on management of causes of SAH.

Δ Perimesencephalic pattern of acute SAH on head CT performed within 72 hours of onset consists of blood centered anterior to and in contact with the prepontine, interpeduncular, and/or suprasellar cisterns. Extent of blood on head CT should be restricted to the suprasellar, interpeduncular, crural, ambient, quadrigeminal, prepontine, and/or cerebellomedullary cisterns.

◊ Additional diagnostic testing is generally performed for patients with atypical features suggestive of a spinal source to bleeding such as those with prominent radicular symptoms and cervicomedullary location of bleeding or if the sensitivity of initial testing is limited by the presence of acute blood or vasospasm. Refer to UpToDate topic for additional details.

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Diagnostic imaging evaluation to exclude secondary causes of subarachnoid hemorrhage