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Subarachnoid Hemorrhage Diagnosis Requires Lumbar Puncture

Subarachnoid hemorrhage (SAH) cannot be ruled out by CT scan or history with physical examination alone, according to a recent study published in Annals of Emergency Medicine. A lumbar puncture with examination of the cerebrospinal fluid is the only way to rule subarachnoid bleeding. Previous studies have reported that a clinical decision rule can rule out SAH with 100% sensitivity. Other studies have reported that a CT scan of the brain within 6 hours can rule SAH out with 100% accuracy. This study says otherwise. The researchers retrospectively looked at cases of SAH in patients with normal neurological exams and also looked at the accuracy of the clinical rule test and the CT imaging test. Sixty two percent (62%) of these patients had cerebral aneurysms and were presenting with signs of small early sentinel bleeds. This is important proper diagnosis allows treatment time prior to catastrophic rupture.

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