Edlow developed a flow diagram for evaluating a patient with possible subarachnoid hemorrhage (SAH). The author is from Harvard Medical School in Boston.
Parameters:
(1) CT scan
(2) lumbar puncture
(3) clinical findings
Clinical findings - one or more of the following:
(1) inability to obtain CSF at lumbar puncture
(2) high clinical suspicion of subarachnoid hemorrhage
(3) presenting more than 2 weeks after the onset of symptoms
(4) ambiguous results from CT scan, lumbar puncture or history
CT Scan
Lumbar Puncture
Clinical Findings
Management
positive
NA
NA
vascular imaging and neurosurgical consult
negative, equivocal, suboptimal
xanthochromic or persistently bloody CSF
NA
vascular imaging and neurosurgical consult
negative, equivocal, suboptimal
normal
present
magnetic resonance angiography (MRA)
negative, equivocal, suboptimal
normal
absent
symptomatic treatment, consult as appropriate
If an aneurysm is found on MRA, then vascular imaging is performed and a neurosurgical consult obtained.
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