title: Evaluation of misdiagnosed cases of subarachnoid hemorrhage and causal factors for misdiagnosis.
abstract: BACKGROUND
  Diagnosis has a major impact on the outcome of subarachnoid hemorrhage (SAH). We studied patients with SAH who were admitted to our hospital in an effort to identify ways to prevent misdiagnosis.
  
  
  METHODS
  A total of 494 patients with SAH were admitted to the Department of Neurosurgery from 2003 through 2010. Misdiagnosis occurred in 30 patients (6.1%). We studied the symptoms and the types of misdiagnoses in these 30 patients.
  
  
  RESULTS
  Misdiagnosis occurred 37 times in the 30 patients (6 patients were given more than 1 misdiagnosis). There were 3 types of misdiagnoses. Type 1 cases were misdiagnosed as a common cold, type 2 cases were misdiagnosed as circulatory organ disease, and type 3 cases were misdiagnosed as digestive organ disease.
  
  
  CONCLUSIONS
  Type 1 cases were mild, and diagnosis required detailed medical history analyses. Type 2 cases were severe and were diagnosed based on electrocardiographic and echocardiographic changes characteristic of SAH. Symptoms of type 3 cases included vomiting, and diagnosis required recognition of meningeal irritation syndrome and detailed medical history analyses.
authors.affiliation: Department of Emergency Medicine, Iizuka Hospital, Fukuoka, Japan. tyamadah4@aih-net.com
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Yamada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Natori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003139:Common Cold / Q000175:diagnosis; D003951:Diagnostic Errors; D004066:Digestive System Diseases / Q000175:diagnosis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis*; D014839:Vomiting / Q000209:etiology; D055815:Young Adult