Diagnosis of a subarachnoid hemorrhage with only mild symptoms using computed tomography in Japan

Syuichi Tetsuka, Eiji Matsumoto

Japan is currently an aging society, with a huge proportion of elderly citizens. Consequently, the incidence and severity of subarachnoid hemorrhage (SAH) is predicted to increase in the future. Computed tomography (CT) is very important in the initial diagnosis of SAH. The proportion of hospitals owning CT systems in Japan is around four times greater than the mean number of systems owned by hospitals in other countries belonging to the Organisation for Economic Co-operation and Development. Because CT is readily available in Japan, it follows that this technique, with its impressive diagnostic power, might be more in demand in Japan compared to other countries. However, misdiagnosis of SAH is a relatively common problem and is associated with increased mortality and morbidity, even in individuals who initially present in good condition. We describe a patient with subtle clinical and CT signs of SAH. A 39-year-old Japanese man visited our hospital with a 3-day history of mild headache, shoulder stiffness, and a feeling of dizziness. His physical examination was normal aside from mild neck stiffness. Although CT did not reveal obvious abnormalities, we noticed subtle signs of SAH on CT images, which have been observed in SAH patients with mild symptoms. Thus, we diagnosed our patient with SAH and provided appropriate treatment (aneurysm clipping). Following this, the patient progressed without development of the initial complications, and he was subsequently discharged from our hospital without sequela. Thus, physicians should be able to recognize subtle characteristics of CT imaging in case of SAH patients with low grade symptoms, as this can facilitate early diagnosis.