Value of Computed Tomography in the Diagnosis and Management of Subarachnoid Hemorrhage

Abstract

Abstract The diagnostic value of computed tomography is analyzed in 31 patients with documented spontaneous subarachnoid hemorrhage. In 50% of all cases, the computed tomogram confirmed the presence of subarachnoid hemorrhage. This figure rose to 68% for cooperative patients examined within 24 hours of their ictus. With enhanced tomography the responsible aneurysm was identified in 30% of the cases. The distribution of the subarachnoid hemorrhage correctly predicted the location of the aneurysm in an additional 35%. Intracerebral or intraventricular hemorrhages were present in 35%. They occurred most frequently within the first 24 hours, were most commonly associated with ruptured anterior communicating aneurysms, and carried a poor prognosis. Cerebral infarction was demonstrated in five patients. Ventricular dilatation was present in 11 (63%) of the 19 patients who were examined during the first 24 hours after the hemorrhage. Seven patients showed progressive hydrocephalus on serial scanning. Shunting before aneurysm surgery was required in four cases. Computed tomography is the procedure of choice for the detection of intracerebral and intraventricular hemorrhage and cerebral infarction: it is superior to angiography in this respect. Computed tomography is also helpful in detecting the presence of subarachnoid hemorrhage and determining ventricular size. Frequently the offending aneurysm can be identified or its location can be accurately predicted, allowing more effective management. We recommend that a computerized tomographic scan be performed (preferably within 24 hours of the ictus) on all patients suspected of having had a subarachnoid hemorrhage. The studies should be done before and after enhancement with a contrast medium.