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Aneurysmal Subarachnoid Haemorrhage: An investigation of the utility of MRI as a non-invasive diagnostic tool and its acceptability as an alternative to lumbar puncture

Lansley, Joseph Alexander; (2020) Aneurysmal Subarachnoid Haemorrhage: An investigation of the utility of MRI as a non-invasive diagnostic tool and its acceptability as an alternative to lumbar puncture. Doctoral thesis (M.D(Res)), UCL (University College London). Green open access

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Abstract

Background Aneurysmal subarachnoid haemorrhage (SAH) is a potentially devastating but treatable condition, the seriousness of which is not always immediately apparent. An invasive test: the lumbar puncture (LP), is considered a mandatory part of the diagnostic pathway according to guidelines but is frequently omitted in clinical practice. Aims 1. To establish the extent to which current clinical practice diverges from recommendations. 2. To investigate the beliefs that inform clinician behaviour and establish if the demands required of a diagnostic test for SAH are best achieved by MRI or lumbar puncture. 3. To establish whether MRI has the potential to improve detection of spontaneous SAH compared to CT. Method 1. The use of LP in cases of suspected SAH was audited at three major teaching hospitals in London. 2. A survey was conducted at major neuroscience centres in London to investigate clinicians’ experiences of SAH investigation and their expectations of diagnostic test performance. 3. A prospective imaging study compared the relative locational sensitivities of CT and MRI to detect subarachnoid haemorrhage in a group of clinically well patients. Results LP was performed in a minority of patients undergoing CT as an investigation for suspected acute SAH (33%). Clinicians demonstrate wide-ranging opinions about the risks and benefits of SAH investigation strategies, with Emergency Medicine clinicians reporting significantly higher risk tolerances compared to Neuroscience clinicians. Blood-sensitive MRI sequences detected more regions of SAH compared to CT in a cohort of neurologically intact, treatment naïve, spontaneous SAH. Conclusion Low adherence to the recommended diagnostic pathway exists in UK practice. This may reflect different risk-tolerances of clinicians and legitimate concerns about the utility of LP. Future guidelines should consider patient and doctor risk-tolerances when making recommendations. MRI has potential value as an alternative non-invasive test and could reduce time, cost and patient discomfort.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: Aneurysmal Subarachnoid Haemorrhage: An investigation of the utility of MRI as a non-invasive diagnostic tool and its acceptability as an alternative to lumbar puncture
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
URI: https://discovery.ucl.ac.uk/id/eprint/10118395
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