Missed Diagnosis of Subarachnoid Haemorrhage
  • Teiko Kawahigashi
    Department of Emergency Medicine, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
  • Taro Shimiszu
    Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
  • Takashi Kawabe
    Department of Emergency Medicine, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
  • Yoshitoshi Kida
    Department of Emergency Medicine, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
  • Kazunao Watanabe
    Department of Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan

Keywords

Emergency medicine, subarachnoid hemorrhage, diagnostic error

Abstract

A 79-year-old woman presented with left retro-orbital pain, headache and blurred vision. Based on negative radiological tests, life-threatening conditions like subarachnoid haemorrhage (SAH) were ruled out and outpatient follow-up was planned. However, the patient returned to the hospital that night because of progressively declining consciousness and was diagnosed with SAH by head computed tomography. The diagnosis of SAH is often challenging, especially in cases with negative radiological results. We describe some strategies, other than radiological examination, for ruling out SAH, such as performing a lumbar puncture and repeating tests to take account of disease progression, and describe biases which can affect clinical decision-making.

VIEW THE ENTIRE ARTICLE

References

  • Oh SY, Lim YC, Shim YS, Song J, Park SK, Sim SY, et al. Initial misdiagnosis of aneurysmal subarachnoid hemorrhage: associating factors and its prognosis. Acta Neurochir (Wien) 2018;160(6):1105–1113.
  • Vermeulen MJ, Schull MJ. Missed diagnosis of subarachnoid hemorrhage in the emergency department. Stroke 2007;38(4):1216–1221.
  • Kuchiki H, Kokubo Y, Kondo R, Shinya S. Subarachnoid hemorrhage presenting mild headache. Surg Cereb Stroke (Jpn) 2014;42:122–126.
  • Laun A, Tonn JC. Cranial nerve lesions following subarachnoid hemorrhage and aneurysm of the circle of Willis. Neurosurg Rev 1988;11(2):137–141.
  • Kakimoto S, Sakamoto T, Hirosawa T, Shimizu T. How do we diagnose diseases with delayed imaging findings? Poster presentation at the 18th General Assembly of the Japanese Society of Hospital General Medicine, Okinawa, Japan, 2019

    • Views: 782
    HTML downloads: 114
    PDF downloads: 528

    Published: 2021-05-31
    Issue: 2021: Vol 8 No 5 (view)

    How to cite:
    1.
    Kawahigashi T, Shimiszu T, Kawabe T, Kida Y, Watanabe K. Missed Diagnosis of Subarachnoid Haemorrhage . EJCRIM 2021;8 doi:10.12890/2021_002616.