Central nervous system disorders

IV./4.5.: Differential diagnosis

IV./4.5.1.: Subarachnoid hemorrhage could be independent of aneurysm rupture

15-20% of the subarachnoid hemorrhage develops independently from aneurysms. The leading cause is head trauma – at the admittance of a subarachnoid hemorrhage patient the possibility of recent head injury should be clarified. Among the other etiologies, intoxication (cocaine, amphetamine) or infection (herpes virus, Dengue-fever, malaria) should be mentioned. The frequency of amyloid angiopathy related subarachnoid hemorrhage is higher in elderly patients. The development of perimesencephalic subarachnoid bleeding is usually attributed to the disturbed venous circulation of the brain. This type of bleeding has a benign course, the recovery often complete and it has no other symptoms than the headache.

IV./4.5.2.: Thrombosis of the venous sinuses

Sudden, severe headache with seizure, focal neurological sings and altered consciousness might be the consequence of a thrombosis in the venous sinuses. This etiology is more common among young, obese, smoker, oral contraceptive user females and young mothers in the first three postpartum weeks. In the first group, the cause of the disease is often some type of coagulopathy, mostly Leyden-mutation (activated factor V deficit). The first choice of diagnostic method in both patient groups is the cranial MR, which could prove or exclude equally with high specificity the subarachnoid bleeding or the sinus thrombosis. Meanwhile, it is important to emphasize that sinus thrombosis could lead to secondary subarachnoid hemorrhage.