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  • Misdiagnosis of the Aneurysmal Subarachnoid Hemorrhage (Incidence, Cause and Clinical outcome of the Misdiagnosis)

    Final Number:

    Young Jin Jung; Chul Hoon Chang; Byung Yon Choi; Min Su Kim

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: It is not known what percentage of the patients with aneurysmal subarachnoid hemorrhage (SAH) is misdiagnosed at initial medical presentation and the reasons of misdiagnosis.

    Methods: We reviewed medical records of consecutive patients managed by our institution recent five years. Clinical symptoms and hospital course and reasons of misdiagnosis were analyzed.

    Results: January 2006 to December 2010, five hundred nineteen eight patients were treated due to aneurysmal SAH in our institution. Thirty one patients (31/598, 5.2%) were misdiagnosed at initial medical contact. Among patients with misdiagnosed, appropriate diagnostic image test (computed tomography (CT) scan or magnetic resonance (MR) image etc) was not performed in twenty three patients (23/31, 74.2%) at initial medical contact. Image interpretation errors occurred in six patients (6/31, 19.4%). When diagnostic image showed negative finding with clinically suspected, further examination (lumbar puncture, MR image etc) was not performed in two patients (2/31, 6.5%). Misdiagnosis occurred non-teaching hospital in twenty six patients (26/31, 83.9%) and in five patients (5/31, 16.1%) in teaching hospital.

    Conclusions: In this study, misdiagnosis of aneurysmal SAH occurred in 5.2% (31/598) of patients. Unfavorable outcome (Glasgow outcome scale,1 to 3) was in 29.0% (9/31). More detailed examination and a low threshold for diagnostic image test such as CT scan of patients with mild symptoms that suggestive of aneurysmal SAH may reduce the frequency of misdiagnosis.

    Patient Care: Yes, we can reduced the misdiagnosis.

    Learning Objectives: For reduce misdiagnosis. First, a high index of suspicion for the aneurysmal SAH is recommended through the teaching program about headache targeting not only referring doctors but also patients. Second, properly performed and correct interpretation of CT scan is necessary in physician. And, some patients with negatively finding on previous study should undergo neurological consultation and perform the lumbar puncture or vascular image by MRI or conventional angiography.


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