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Question
Patient found pulseless after submersion in water for 20 minutes. After ROSC, patient’s GCS was 3 and pupils are dilated and nonreactive.
Answer
- There is increased attenuation of the basal cisterns and subarachnoid space as well as diffuse cerebral edema.
- At first glance, it appears to be a subarachnoid hemorrhage.
- However, the Hounsfield unit of the density is lower than blood.
- This is a pseudosubarachnoid hemorrhage sign.
- This can be seen in anoxic injury with cerebral edema, pyogenic meningitis, venous sinus thrombosis, bilateral large subdural hemorrhages.
References
Kim JM, Eom TH. The pseudosubarachnoid hemorrhage: clinical implications of subarachnoid hemorrhage misdiagnosis. Pediatr Emerg Care. 2016 May 12. [Epub ahead of print]
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