The recently published description of CT findings in pseudosubarachnoid hemorrhage (1) has, unfortunately, omitted to include neuropathologic correlation, despite the authors noting that subarachnoid hemorrhage was excluded on the basis of autopsy in three of the seven cases described. Despite this, the authors suggested that one possible cause for their findings—increased attenuation in the basal cisterns—was superficial vascular engorgement and dilatation (1). If this were true, enhancement following the administration of intravenous contrast medium could prove to be a useful method for confirming this diagnosis, as occurred in one of their cases. In, to my knowledge, the largest published series with this condition with detailed neuropathologic correlation (2), all five cases demonstrated increased attenuation in the basal cisterns, with (at autopsy) histologic evidence of congested and dilated subarachnoid and pial vessels in each, in addition to cerebral edema. Although Given and colleagues may be excused for omitting the latter article in their comprehensive literature review as the journal in which it was published was not—at that time—indexed by Medline, it indicates that the main cause for the CT appearances is vascular engorgement. Future studies should be directed toward determining whether head CT following the administration of intravenous contrast medium is a means of confirming this diagnosis when it is suspected clinically.

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