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Asian J Neurosurg. 2019 Apr-Jun;14(2):510-512. doi: 10.4103/ajns.AJNS_11_19.

Bilateral Chronic Subdural Hematoma Presenting with Pseudo-Subarachnoid Hemorrhage Sign on Computed Tomography.

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Department of Neurosurgery, Shima Neurosurgical and Orthopedic Clinic, Kanto Rosai Hospital, Kawasaki, Japan.
Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan.
Department of Neurology, Kanto Rosai Hospital, Kawasaki, Japan.



On rare occasions, cisterns are demonstrated as high-density areas on computed tomography (CT) and misdiagnosed with subarachnoid hemorrhage (SAH). This false-positive finding is called pseudo-SAH.

Patients and Methods:

From April 2014 to August 2018, a total of 161 patients with chronic subdural hematoma (CSDH) were treated in our hospital. For these cases, the existence of a pseudo-SAH sign on CT was retrospectively examined.


One patient with bilateral CSDH showed pseudo-SAH and a further examination to evaluate vascular abnormalities causing true SAH was necessary. In three patients, the Sylvian fissures were demonstrated as high-density areas due to an atherosclerotic middle cerebral artery; however, the condition was not misdiagnosed with SAH.


In cases of CSDH, there is a possibility that CT demonstrates a pseudo-SAH sign. In such cases, close examinations to exclude true SAH are mandatory.


Bilateral; chronic subdural hematoma; computed tomography; pseudo-subarachnoid hemorrhage

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