Denver Health Residency Program in Emergency Medicine, Denver, CO.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
Ann Emerg Med. 2019 Feb;73(2):130-132. doi: 10.1016/j.annemergmed.2018.07.002. Epub 2018 Aug 23.
A 22-year-old man with a history of intravenous methamphetamine use presented with severe headache for 5 days, was afebrile, and had nuchal rigidity. Computed tomography and magnetic resonance imaging results were interpreted as revealing acute subarachnoid hemorrhage. Twenty-four hours later, he developed acute neurologic deterioration. A lumbar puncture was performed, revealing the presence of Staphylococcus aureus. The false-positive image mimicking blood was potentially a result of an extremely high protein concentration present in the cerebrospinal fluid, provoked by an intense inflammatory reaction leading to disruption of the blood-brain barrier. Pyogenic meningitis is one of the causes of pseudosubarachnoid hemorrhage, or a false diagnosis of subarachnoid hemorrhage, when one does not actually exist.
一位 22 岁的男性，有静脉注射冰毒使用史，现因剧烈头痛 5 天就诊，无发热，颈项强直。计算机断层扫描和磁共振成像结果提示急性蛛网膜下腔出血。24 小时后，他出现急性神经功能恶化。行腰椎穿刺术，发现金黄色葡萄球菌。图像呈现出假性血的阳性结果可能是由于强烈的炎症反应导致血脑屏障破坏，脑脊液中存在极高的蛋白浓度所致。化脓性脑膜炎是假性蛛网膜下腔出血或实际上不存在蛛网膜下腔出血的误诊的原因之一。
