Transient ischaemic attack mimics revealing focal subarachnoid haemorrhage.
We describe here 7 elderly patients with a transient neurological deficit due to a focal subarachnoid haemorrhage, identified from the Dijon Stroke Registry over 4 years. These 7 patients presented a clinical pattern marked by focal paraesthesia, with several stereotyped focal episodes (5 of the 7 cases), lasting less than 30 min (6 of the 7 cases), and associated with a cognitive decline (4 of the 7 cases). Headache was present in only 1 case. Neuroimaging revealed focal haemorrhage present in a cortical sulcus contralateral to the symptoms. No vascular lesions nor epileptic mechanisms nor ischemic lesions were observed. This syndrome could be explained by a spreading depression, and the focal subarachnoid haemorrhage could reflect possible cerebral amyloid angiopathy, suggested by the cognitive decline present in more than 50% of our series. Our observations suggest that focal subarachnoid haemorrhage may be diagnosed by MRI in the absence of acute headache and it may be revealed by transient focal and repetitive sensory perturbations. In medical practice, it is important to evoke this diagnosis in the elderly to avoid inappropriate treatment.
Stroke Unit, Department of Neurology, University Hospital of Dijon, France. sandrinebrunot@hotmail.com
Sandrine
S
Brunot
Guy Victor
GV
Osseby
Olivier
O
Rouaud
Apolline
A
Kazemi
Frédéric
F
Ricolfi
Grégory
G
Couvreur
Aurélie
A
Catteau
Marie
M
Hervieu
Thibault
T
Moreau
Maurice
M
Giroud
Yannick
Y
Béjot
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D005602:France; D006261:Headache / Q000209:etiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D010292:Paresthesia / Q000209:etiology; D011237:Predictive Value of Tests; D012042:Registries; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis*; D013997:Time Factors; D014057:Tomography, X-Ray Computed