Platt Andrew, Collins John, Ramos Edwin, Goldenberg Fernando D
Department Neurosurgery, University of Chicago, Chicago, Illinois, United States.
Department Radiology, University of Chicago, Chicago, Illinois, United States.
Surg Neurol Int. 2021 Jan 20;12:29. doi: 10.25259/SNI_905_2020. eCollection 2021.
Patients with computed tomography (CT) findings consistent with subarachnoid hemorrhage without evidence of hemorrhage following autopsy or cerebrospinal fluid testing are termed to have pseudosubarachnoid hemorrhage (pSAH).
A systematic review of literature was conducted based on the preferred reporting items for systematic reviews and meta-analysis statement. Studies were evaluated for associated cause of pSAH, imaging modality used in assessment, method of confirmatory testing, and clinical outcome.
Fifty studies were included in qualitative analysis including 197 cases of pSAH. Systematic review revealed 23 studies including 110 patients with pSAH attributed to hypoxic-ischemic brain injury following cardiac arrest. Three studies were included in meta-analysis that quantitatively analyzed differences in CT densities in patients with pSAH and true subarachnoid hemorrhage (true SAH). A random effects model meta-analysis showed a statistically significant decrease in densities in the Sylvian fissure in patients with pSAH compared to true SAH and a statistically significant decrease in densities in adjacent parenchyma in patients with pSAH compared to true SAH. Systematic review further revealed 32 patients with pSAH associated with spontaneous intracranial hypotension, 11 patients with pSAH related to infectious etiologies, 15 patients with pSAH associated with subdural hemorrhage, 20 cases of pSAH related to hyperhemoglobinemia, 2 cases related to valproate toxicity, and individual cases related to hyponatremia, diabetic ketoacidosis, sudden infant death syndrome, cerebellar infarction, and dialysis disequilibrium syndrome.
This study is the first systematic review of causes, diagnostic modalities, and outcomes in patients who present with pSAH. A diagnosis of pSAH may be considered following assessment of CT densities following cardiac arrest.
计算机断层扫描（CT）检查结果符合蛛网膜下腔出血，但尸检或脑脊液检测未发现出血证据的患者被称为假性蛛网膜下腔出血（pSAH）。
根据系统评价和Meta分析的首选报告项目声明对文献进行系统评价。对研究的pSAH相关病因、评估中使用的成像方式、确证检测方法和临床结局进行评估。
50项研究纳入定性分析，包括197例pSAH病例。系统评价显示，23项研究纳入110例因心脏骤停后缺氧缺血性脑损伤导致pSAH的患者。3项研究纳入Meta分析，定量分析了pSAH患者与真性蛛网膜下腔出血（真性SAH）患者CT密度的差异。随机效应模型Meta分析显示，与真性SAH相比，pSAH患者大脑外侧裂密度有统计学意义的降低，与真性SAH相比，pSAH患者相邻脑实质密度有统计学意义的降低。系统评价进一步显示，32例pSAH与自发性颅内低压相关，11例pSAH与感染性病因相关，15例pSAH与硬膜下出血相关，20例pSAH与高铁血红蛋白血症相关，2例与丙戊酸盐毒性相关，个别病例与低钠血症、糖尿病酮症酸中毒、婴儿猝死综合征、小脑梗死和透析失衡综合征相关。
本研究是对pSAH患者的病因、诊断方式和结局的首次系统评价。心脏骤停后评估CT密度后可考虑诊断为pSAH。
