gms | German Medical Science

Objective: Morbidity and mortality can be reduced by a straightforward diagnosis and treatment in aneurysmal subarachnoid hemorrhage (SAH). Little is known about the occurence and circumstances of initially misdiagnosed aneurysmal SAH. To determine underlying factors we analyzed our population with preliminary misdiagnosed aneurymal SAH.

Method: Patients with aneurysmal SAH were entered into a prospectively collected database. We selected patients with an initial misdiagnosis of SAH over the period from September 2009 until September 2013. Misdiagnosis was defined as failure to correctly diagnose aneurysmal SAH at a patient' s initial contact with medical professionals. Outcome was assessed by the modified Rankin Scale (mRS) into favourable (mRS 0-2) and poor (mRS 3-6) at 6-12 months.

Results: 10 from 200 patients (5,0%) with aneurysmal SAH were initially misdiagnosed. In 5 affected patients (50%) a rebleeding occurred with clinical deterioration resulting from delayed diagnosis. As preliminary misdiagnosis were mentioned syncope with head trauma (3 patients), migraine (2 patients), pneumonia, vasculitis, seizure, transient ischemic attack, and myocardial infarction. Seven patients (70%) were at admission to hospital in a good clinical condition (Hunt and Hess grade 1-2), 3 patients (30%) in a poor condition (Hunt and Hess grade 3-5). Five patients (50%) had a favourable outcome (mRS 0-2). Five patients (50%) died (mRS 6).

Conclusions: In our population, the occurrence of preliminary misdiagnoses after aneurysmal SAH is about 5%. Clinically mild cases with variable symptoms, patients with concurrent falls (trauma), and patients in a poor clinical condition seem to be at risk of being misdiagnosed. The delay in diagnosis and treatment could lead to an increase of morbidity and mortality.