Midline Shift or Herniation in Patients with Subarachnoid Hemorrhage and Normal Neurological Exams

In a retrospective study, 5% of patients with spontaneous SAH and normal neurological exams had computed tomographic findings that contraindicated lumbar puncture.

Controversy surrounds the issue of whether computed tomography (CT) is required before lumbar puncture (LP) in patients with suspected subarachnoid hemorrhage (SAH) and normal neurological examinations. These authors retrospectively reviewed records of 73 patients with final diagnoses of spontaneous SAH who underwent CT after presenting with sudden-onset severe headaches and normal neurological examinations.

Two neuroradiologists who were blinded to patient outcomes and original CT interpretations reviewed the scans for evidence of herniation or midline shift >2 mm. The radiologists agreed that brain herniation or midline shift was present in 4 of the 73 cases (5%); only 1 of these cases was identified in the initial radiology report. The ra…

Reviewing Author

Diane M. Birnbaumer, MD, FACEP

Disclosures

Consultant / Advisory boardSecurisyn

Editorial boardsThe Merck Manuals (Home and Physician Editions)

Diane M. Birnbaumer, MD, FACEP

Disclosures

Consultant / Advisory boardSecurisyn

Editorial boardsThe Merck Manuals (Home and Physician Editions)

Midline Shift or Herniation in Patients with Subarachnoid Hemorrhage and Normal Neurological Exams

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Reviewing Author