Clinical presentations, imaging patterns and etiologies. Kumar S. et al. Neurology 2010; 74: 893-399
Authors include LR Caplan
Convexal SAH is about 8 percent of all SAH. Authors found 29 patients at Beth Israel, about two thirds were women. There was a dichotomy in presentation by age. The under 60's had a strong tendency to present with a severe headache, whereas that was rare in the over 60's, who presented with TIA-like presentations, migraine creeping numbness mimic (even repetitively) or lethargy. Angiography/MRA/CTA was almost always negative. The under 60's were most likely to have reversible cerebral vasoconstriction syndrome (formerly Call syndrome), whereas the over 60's were more likely to have amyloid angiopathy. The latter group tends to have recurrent disease, but this study does not have good followup. Headaches often were prolonged, associated with retching or vomiting, and described as "thunderclap" in younger patients. Surface eeg's were always negative for seizures among those presenting with repetitive sensory phenomena. They were more likely to have superficial siderosis on imaging.
The differential of the presentation includes, in addition to the two above causes, cortical vein occlusion, PRES, coagulopathy, cocaine, lupus vasculitis, cavernoma, brain aneurysm, ephedra, HELLP syndrome, post LP headache, and arterial dissection.
Authors include LR Caplan
Convexal SAH is about 8 percent of all SAH. Authors found 29 patients at Beth Israel, about two thirds were women. There was a dichotomy in presentation by age. The under 60's had a strong tendency to present with a severe headache, whereas that was rare in the over 60's, who presented with TIA-like presentations, migraine creeping numbness mimic (even repetitively) or lethargy. Angiography/MRA/CTA was almost always negative. The under 60's were most likely to have reversible cerebral vasoconstriction syndrome (formerly Call syndrome), whereas the over 60's were more likely to have amyloid angiopathy. The latter group tends to have recurrent disease, but this study does not have good followup. Headaches often were prolonged, associated with retching or vomiting, and described as "thunderclap" in younger patients. Surface eeg's were always negative for seizures among those presenting with repetitive sensory phenomena. They were more likely to have superficial siderosis on imaging.
The differential of the presentation includes, in addition to the two above causes, cortical vein occlusion, PRES, coagulopathy, cocaine, lupus vasculitis, cavernoma, brain aneurysm, ephedra, HELLP syndrome, post LP headache, and arterial dissection.
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