NEW ORLEANS—Early aneurysm treatment can lead to improved patient outcomes, but a recent report indicated that subarachnoid hemorrhage is initially misdiagnosed in nearly 15% of hospitalized patients. Failure to perform a computed tomography (CT) scan is the most common reason for misdiagnosis, reported Joseph E. Bates, research assistant; Daphne L. Copeland, MPH; Stephan A. Mayer, MD; and colleagues from Columbia University, New York.

To investigate the frequency, risk factors, and clinical impact of misdiagnosed subarachnoid hemorrhage, the researchers conducted a prospective study of 202 patients with subarachnoid hemorrhage (60% women, mean age 53) who were consecutively admitted to Columbia-Presbyterian Hospital's Neuro-ICU between July 1996 and December 1998. Demographic characteristics and clinical information of the correctly diagnosed and misdiagnosed patients were compared.

Subarachnoid hemorrhage was initially misdiagnosed in 13% (25/190) of this cohort. Type of initial medical contact varied among misdiagnosed patients with subarachnoid hemorrhage: emergency room (60%), MD office (25%), clinic (4%), hospital admission (4%), and paramedics (4%). Tests performed included CT and lumbar puncture. Initial diagnosis included migraine-tension headache in 11 patients (44%), meningitis in two (8%), viral syndrome in one (4%), myocardial infarction in one (4%), no diagnosis in five (20%), or other—Lyme disease, sinusitis, temporal arteritis, hypertension, or changed blood pressure medication—in five (20%). The authors reported that 25% (5/25) of these patients were misdiagnosed by more than one physician.

Reporting their findings at the 25th International Stroke Conference, the researchers noted that 48% (12/25) of the misdiagnosed patients deteriorated (six had lower Hunt and Hess scores, four experienced aneurysm rebleeding) before they were correctly diagnosed. Because good grade patients are at the highest risk for misdiagnosis, the authors advised that physicians, especially emergency room physicians, should maintain "the highest index of suspicion for subarachnoid hemorrhage, especially in mildly symptomatic patients."

—Kathryn Blair
Associate Editor

Return to table of contents