PT  - JOURNAL ARTICLE
AU  - Oda, S.
AU  - Shimoda, M.
AU  - Hirayama, A.
AU  - Imai, M.
AU  - Komatsu, F.
AU  - Shigematsu, H.
AU  - Nishiyama, J.
AU  - Matsumae, M.
TI  - Neuroradiologic Diagnosis of Minor Leak prior to Major SAH: Diagnosis by T1-FLAIR Mismatch
AID  - 10.3174/ajnr.A4325
DP  - 2015 May 14
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2015/05/14/ajnr.A4325.short
4100  - http://www.ajnr.org/content/early/2015/05/14/ajnr.A4325.full
AB  - BACKGROUND AND PURPOSE: In major SAH, the only method to diagnose a preceding minor leak is to ascertain the presence of a warning headache by interview; however, poor clinical condition and recall bias can cause inaccuracy. We devised a neuroradiologic method to diagnose previous minor leak in patients with SAH and attempted to determine whether warning (sentinel) headaches were associated with minor leaks before major SAH. MATERIALS AND METHODS: We retrospectively evaluated 127 patients who were admitted with SAH within 48 hours of ictus. Previous minor leak before major SAH was defined as T1WI-detected clearly bright hyperintense subarachnoid blood accompanied by SAH blood on FLAIR images that was distributed over a larger area than bright hyperintense subarachnoid blood on T1WI (T1-FLAIR mismatch). RESULTS: The incidence of warning headache before SAH was 11.0% (14 of 127 patients, determined by interview). The incidence of T1-FLAIR mismatch (neuroradiologic diagnosis of minor leak before major SAH) was 33.9% (43 of 127 patients). Of the 14 patients with warning headache, 13 had a minor leak diagnosed by T1-FLAIR mismatch at the time of admission. Variables identified by multivariate analysis as significantly associated with minor leak diagnosed by T1-FLAIR mismatch included 80 years of age or older, rebleeding after admission, intracerebral hemorrhage on CT, and mRS scores of 3–6. CONCLUSIONS: We conclude that warning headaches diagnosed by interview are not a product of recall bias but are the result of actual leaks from aneurysms. Abbreviations BHSBbright hyperintense subarachnoid bloodICHintracerebral hemorrhage