From: ClinicalPearl@...
Date: April 15, 2009 9:47:15 AM EDT
To: glennskow@...
Subject: EMedHome Clinical Pearl

The New EMedHome Clinical Pearl is: Sensitivity of CT Scan for SAH

Sensitivity of CT Scan for SAH

Between 15% and 40% of patients with a subarachnoid hemorrhage have a warning leak (sentinel hemorrhage), which usually occurs 24 hours to 2 weeks before the event and may provide an opportunity for early intervention.

The sensitivity CT scanning for a suspected SAH is inversely related to the time elapsed from the bleeding event. The estimated sensitivity of CT for detecting subarachnoid blood is 95% within 24 hours, 74% on the 3rd day, 50% after 1 week, 30% after 2 weeks, and nearly 0% after 3 weeks (1,2). Thus, the Stroke Council of the AHA continues to strongly recommend that LP be performed after a negative head CT in patients with a suspected SAH.

References:
(1) Dupont SA, et al. Thunderclap Headache and Normal Computed Tomographic Results: Value of Cerebrospinal Fluid Analysis  Mayo Clin Proc  2008; 83: 1326-1331.
(2) Edlow JA, et al.  Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage N Engl J Med  2000; 342: 29-36.
(3) Mayberg MR, et al . Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association  Stroke  1994;25: 2315-2328.

 

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