Pseudo-subarachnoid hemorrhage: A tricky CT finding with serious medicolegal implications

• Published in: Forensic imaging (Online) Vol. 24; p. 200427
• Main Authors: Vermeulen, Louise, Van Goethem, Alexia, Hauwe, Luc van den, Beuls, Emile, Parizel, Paul M., Jacobs, Werner
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.03.2021
• Subjects: Diffuse cerebral edema; Forensic; Postmortem; Pseudo-subarachnoid hemorrhage; NCCT; CPR; Postmortem; HIBI; Forensic; EMS; ROSC; PMCT; Diffuse cerebral edema; CT; CTA; Pseudo-subarachnoid hemorrhage; SAH
• ISSN: 2666-2256; 2666-2256
• DOI: 10.1016/j.fri.2020.200427

•Two cases of drug users, showing a pseudo-subarachnoid hemorrhage on CT.•After fatal outcome, ante-mortem imaging was compared with autopsy.•Medicolegal importance of correctly differentiating a pseudo SAH from a true SAH. Pseudo-subarachnoid hemorrhage is a radiological term used to describe increased attenuation values on computed tomography within the basal cisterns and subarachnoid spaces, simulating true subarachnoid hemorrhage. We present two cases of drug users, both showing a pseudo-subarachnoid hemorrhage pattern on computed tomography after a circulatory collapse with subsequent resuscitation. After fatal outcome, both cases underwent forensic autopsy including pathology and toxicological analysis. We compared postmortem findings with antemortem imaging, and found that differentiating pseudo-subarachnoid hemorrhage from true-subarachnoid hemorrhage can be quite challenging. However, medicolegal consequences are important (i.e. diagnosing a real subarachnoid hemorrhage as a pseudo-subarachnoid hemorrhage, or vice versa) since certain diagnoses may lead to a judicial inquiry, and careless diagnosis may lead to wrongful prosecution.