Transcript
Announcer:
You’re listening to NeuroFrontiers on ReachMD. Today, Dr. Jay Max Findlay, Professor of Neurosurgery at the University of Alberta, will be discussing how to evaluate delayed presentations of subarachnoid hemorrhage. Here he is now.
Dr. Findlay:
Subarachnoid hemorrhage headaches don't resolve quickly. They linger, and they can linger for days and weeks. And so, occasionally, we'll see a patient who presents a day or days following their initial headache, and it just didn't get better. They're still sick with their headache, and so they present in a delayed fashion.
Now, when they do present in a delayed fashion, that allows time for some of that subarachnoid hemorrhage to clear from the scan. And so it’s especially important to scrutinize those scans carefully, because usually a trace of blood will still be seen. But the rule of thumb is that if you have a patient with a sudden onset headache and you're thinking that it might be a subarachnoid hemorrhage that occurred that day or days prior and the scan is considered normal, then they have to have more testing.
And the more testing will be either a CT angiogram looking for the actual aneurysm itself or a lumbar puncture looking for blood in the CSF—into the cerebrospinal fluid. Now, a lumbar puncture is painful, and it is something that doctors don't always like performing. And there is the problem of so-called traumatic tap—in other words, causing bleeding from the puncture itself. And that can sometimes be difficult to distinguish from a true subarachnoid hemorrhage. There are ways to make the distinction through testing, but the simplest thing these days is to get a CT angiogram. It avoids the puncture, it avoids the pain, and it will pick up any aneurysm that could have ruptured.
Announcer:
That was Dr. Jay Max Findlay talking about imaging and follow-up evaluation for suspected subarachnoid hemorrhage. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
