Hyperdense CSF
Bronwyn E. Hamilton, MD
DIFFERENTIAL DIAGNOSIS
Common
-
Subarachnoid Hemorrhage (SAH), Traumatic
-
Aneurysmal Subarachnoid Hemorrhage
-
Streak Artifact
-
Diffuse Cerebral Edema (Mimic)
-
Brain Death (Mimic)
Less Common
-
Contrast Material
-
Chronic Renal Failure
-
Ventriculitis
-
Meningitis
-
Metastases, Meningeal
Rare but Important
-
Nonaneurysmal Perimesencephalic SAH
-
Superficial Siderosis
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
-
Subarachnoid Hemorrhage, Traumatic
-
Peripheral sulci, interpeduncular cistern
-
Less extensive than aneurysmal blood
-
-
Aneurysmal Subarachnoid Hemorrhage
-
Typically basal cisterns, may be diffuse
-
Location may indicate causative aneurysm
-
-
Streak Artifact
-
Non-anatomical distribution
-
Due to metal & dense bone interfaces
-
-
Diffuse Cerebral Edema (Mimic)
-
Diffuse low density in supratentorial brain causes “pseudo SAH”
-
Gyri swollen, cisterns compressed
-
“Cerebellar reversal sign”: Density of cerebellum > > hemispheres
-
-
Brain Death (Mimic)
-
Diffuse low density in supratentorial brain causes “pseudo SAH”
-
Gyri swollen, cisterns compressed
-
“Cerebellar reversal sign”: Density of cerebellum > > hemispheres
-
Clinical criteria for confirmation
-
Helpful Clues for Less Common Diagnoses
-
Contrast Material
-
Noncontrast CT follows recent contrast procedure (myelogram, cisternogram)
-
-
Chronic Renal Failure
-
Causes contrast recirculation from recent IV contrast injection
-
-
Ventriculitis
-
Ventriculomegaly with debris level, enhancing ependyma
-
-
Meningitis
-
Normal CT or mild ventriculomegaly
-
May see hyperdense CSF, especially in fungal infections & TB
-
-
Metastases, Meningeal
-
May see hyperdense CSF, effaced sulci
-
Helpful Clues for Rare Diagnoses
-
Nonaneurysmal Perimesencephalic SAH
-
Small volume hemorrhage in basal cisterns
-
-
Superficial Siderosis
-
Atrophy; hyperdensity along brain surface
-
Full access? Get Clinical Tree
