Clinical and etiological spectrum of nontraumatic convexal subarachnoid hemorrhage in a South Indian tertiary care centre

Abstract

Background: Nontraumatic convexal subarachnoid hemorrhage (cSAH) is a distinct subtype of intracranial hemorrhage confined to the cortical sulci. Given its diverse etiologies, accurate diagnosis requires careful clinical and radiological evaluation. The present study aims to characterize the clinical profile, risk factors, neuroimaging features, and etiological spectrum of cSAH in a cohort of South Indian patients.

Methods: We prospectively studied 17 consecutive patients with cSAH presenting to our tertiary care centre in Chennai, India, from 2023 to 2024. Data on demographics, clinical features, risk factors, neuroimaging, and etiologies were collected. Findings were compared with international cohorts.

Results: The mean patient age was 46 years, and 47% were female. Headache occurred in 88%, seizures in 41%, and focal deficits in 35%. Parietal (71%) and frontal (65%) lobes were the most frequent hemorrhage sites; 35% had bilateral involvement. Cerebral venous thrombosis (CVT) was the leading cause (71%), followed by posterior reversible encephalopathy syndrome (12%), reversible cerebral vasoconstriction syndrome (6%), and arteriovenous malformation (6%). Compared with other published cohorts, our patients were younger, had a higher seizure incidence, and a predominance of CVT.

Conclusion: In South Indian patients, cSAH most often results from CVT, especially in younger individuals. Prompt MRI with MR venography is critical for early diagnosis and management.