A report of nontraumatic cortical subarachnoid hemorrhage and subsequent management

Written by Mao DQ, Addess D & Valsamis H

Aim: Report a case of cortical subarachnoid hemorrhage (cSAH) and discuss its management. Patient & methods: A 66-year-old woman presents with acute onset left arm numbness and weakness. Initial head CT shows small hyperdensity in sulci typical for cSAH. Extensive workup with MRI, lumbar puncture and blood tests is performed. No signs of infection, vascular malformations, thrombosis or cancer are found. At outpatient follow-up, she is diagnosed with cSAH secondary to amyloid angiopathy. She is treated with gabapentin. Results & conclusion: Diagnosis of cSAH is challenging given its subtle findings, and management is empiric as there are only a few case series in literature.
Cortical subarachnoid hemorrhage (cSAH) is a rare form of subarachnoid hemorrhage characterized by unique imaging findings. Diagnosis is challenging given its subtle findings, and management is empiric as there are only a few case series in literature [1–6]. Incidence of this disease is not known, but case series estimate that cSAH represent 7.5–19% of all subarachnoid hemorrhage. Given that incidence of subarachnoid hemorrhage is 10–15 per 100,000 person years, a rough estimate places incident of cSAH on order of 0.7–2.8 per 100,000 person years [7].

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