J Korean Soc Radiol.  2016 Jun;74(6):380-388. 10.3348/jksr.2016.74.6.380.

Isolated Acute Nontraumatic Cortical Subarachnoid Hemorrhage: Etiologies Based on MRI Findings

• Cho E
• Kang M
• Kim S

• KMID: 2164815
• DOI: http://doi.org/10.3348/jksr.2016.74.6.380

Abstract

PURPOSE
The purpose of this study was to identify common underlying etiologies that may be responsible for isolated acute nontraumatic cortical subarachnoid hemorrhage (cSAH) by analysis of magnetic resonance imaging (MRI) findings of the brain.
MATERIALS AND METHODS
From August 2005 to February 2014, 15 cSAH patients were admitted to our institution. All patients with cSAH underwent brain MRI and magnetic resonance angiography as a part of their initial evaluation. An analysis of the patients' medical history, clinical presentations, and brain MRI findings was retrospectively performed.
RESULTS
Among the combined pathologies that were suspected causes of cSAH, 11 patients showed acute or subacute cerebral infarctions at the ipsilateral hemisphere of cSAH on the diffusion-weighted images. Four of 11 patients had only cerebral infarction, but the other 7 had combined vasculopathy of extra- and intracranial arteries. Four of 15 patients who did not have cerebral infarction, had intracranial artery stenosis, or showed possible cerebral amyloid angiopathy, or no abnormal findings on the brain MRI.
CONCLUSION
Ischemic stroke, such as cerebral infarction or vasculopathy of the extraand intracranial arteries is regarded as a common underlying etiology of the cSAH based on MRI findings.

MeSH Terms

Arteries
Brain
Cerebral Amyloid Angiopathy
Cerebral Cortex
Cerebral Infarction
Constriction, Pathologic
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging*
Pathology
Retrospective Studies
Stroke
Subarachnoid Hemorrhage*

Figure

• 

  Fig. 1 74-year-old man with isolated acute nontraumatic cortical subarachnoid hemorrhage (cSAH) and acute cerebral infarction. A. FLAIR image shows a cSAH in the right central sulcus (arrowheads). The adjacent right parietal cortex exhibits a hyperintense signal in this image (black arrows). B. DWI shows a patchy hyperintense signal in the same area, suggesting acute cerebral infarction (white arrows). The cSAH is represented by a hypointense signal along the right central sulcus on the DWI. DWI = diffusion-weighted image, FLAIR = fluid-attenuated inversion recovery

• 

  Fig. 2 52-year-old woman with cSAH and acute cerebral infarction and intracranial arterial stenosis. A. FLAIR image shows cSAH in the sulci of left frontal area. B. DWI shows focal acute infarction in the left frontal cortical area (arrowhead). C. Magnetic resonance angiographic (MRA) image shows the stenosis of the left middle cerebral artery M1 portion (arrow). cSAH = cortical subarachnoid hemorrhage, DWI = diffusion-weighted image, FLAIR = fluid-attenuated inversion recovery

• 

  Fig. 3 66-year-old man with cSAH and acute cerebral infarction and extracranial arterial stenosis. A. Pre-enhanced brain CT image shows localized high density along left central sulcus, suggesting cSAH. B. FLAIR image shows the localized high-signal intensity in the left central sulcus. C, D. DWI (D) shows multiple small hyperintense foci in the left parietal cortex departing from the cSAH, suggesting acute cerebral infarction. The cSAH is represented by a hypointense signal along the right central sulcus on the DWI (C). E. MRA image shows the stenosis of the petrous segment of the left internal carotid artery (arrow). cSAH = cortical subarachnoid hemorrhage, DWI = diffusion-weighted image, FLAIR = fluid-attenuated inversion recovery, MRA = magnetic resonance angiographic

• 

  Fig. 4 78-year-old woman with cSAH and intracranial arterial stenosis. A. Pre-enhanced brain CT image shows a localized high density along the left central sulcus (arrowheads). B. FLAIR image shows cSAH in the left central sulcus (white arrows). C, D. DWI (C) shows a strong linear signal along the left central sulcus (the same area), indicating a cSAH (black arrows). However, the apparent diffusion coefficient map (D) shows no evidence of diffusion restriction; thus, there is no evidence of acute cerebral infarction. E. However, the MRA image shows the stenosis of the left middle cerebral artery M1 portion (arrow). cSAH = cortical subarachnoid hemorrhage, DWI = diffusion-weighted image, FLAIR = fluid-attenuated inversion recovery, MRA = magnetic resonance angiographic

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