Contrast extravasation after bilateral inferior petrosal sinus sampling masquerading as venous subarachnoid haemorrhage

Ho FLW, Cunanan EC, Wang SC, Mukherjee JJ
Correspondence: Dr Jagat J Mukherjee, jjmukh@nuh.com.sg 

ABSTRACT 
When performed properly, bilateral inferior petrosal sinus sampling (BIPSS) for adrenocorticotropic hormone (ACTH) is rarely associated with complications. Major complications reported to date include thromboembolism, brain stem infarction, pontine haemorrhage, isolated sixth nerve palsy and venous subarachnoid haemorrhage. We describe a rare case where a predominant contrast extravasation into the subarachnoid space, admixed with a small quantity of venous blood, occurring during BIPSS in a 58-yearold woman with ACTH-dependent Cushing’s syndrome, was misinterpreted as venous subarachnoid haemorrhage.