Hyperdense CSF



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


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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Hyperdense CSF

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