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Subarachnoid haemorrhage of unknown origin: clinical and tomographical aspects
F Cioffi1, A Pasqualin, P Cavazzani
1Department of Neurosurgery, City Hospital, Verona, Italy.
Insights
Patients with negative angiography but subarachnoid hemorrhage symptoms showed better outcomes. This study highlights improved clinical grade, reduced vasospasm, and lower rebleeding rates compared to ruptured aneurysm cases.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Subarachnoid hemorrhage (SAH) diagnosis typically relies on angiography, but some patients present with negative findings despite symptoms.
- Understanding the outcomes and characteristics of patients with negative angiography SAH is crucial for refining diagnostic and treatment strategies.
Purpose of the Study:
- To evaluate the clinical course and outcomes of patients with technically satisfactory negative four-vessel angiography (4-V) after suspected subarachnoid hemorrhage (SAH).
- To compare these outcomes with a control group of patients diagnosed with SAH from ruptured aneurysms.
Main Methods:
- Retrospective analysis of 65 patients with negative 4-V angiography and SAH symptoms.
- CT scans were performed to assess cisternal deposition.
- Comparison with 760 patients with SAH from ruptured aneurysms admitted during the same period (1976-1983).
Main Results:
- The study group had a better clinical grade on admission (Hunt's classification) and less cisternal deposition on CT scans.
- Lower incidence of clinical vasospasm (5% vs. 27%) and rebleeding (12% vs. 25%) was observed in the study group.
- Favorable final outcomes (95% vs. 63%) and lower mortality rates (5% vs. 32%) were achieved in patients with negative angiography.
Conclusions:
- Patients with SAH symptoms and negative 4-V angiography demonstrate a significantly better clinical outcome and lower complication rates compared to those with ruptured aneurysms.
- Negative angiography in the context of SAH symptoms warrants careful evaluation, as it may represent a distinct clinical entity with a more favorable prognosis.
Abstract:
65 patients with negative but technically satisfactory 4 vessel angiography - all admitted to our Department in the years 1976-1983 - were evaluated in the present study. CT scan was undertaken in all cases (in 47 cases within 4 days of haemorrhage). Arterial hypertension was present on admission in 9% of cases. The period of follow-up ranged from 4 to 11 years, with a mean of 5.3 years. The study group was compared to a control group, comprising 760 patients with subarachnoid haemorrhage from ruptured aneurysms, admitted during the same period. Clinical grade on admission (Hunt's classification) was better in patients belonging to the study group. The amount of cisternal deposition on CT scan was less significant than in patients with ruptured aneurysms, and the deposition was often atypical (circumpeduncular, ambiental, and/or tentorial). Clinical deterioration associated with vasospasm was observed in 5% of patients in this study and in 27% of patients in the control group. In patients with a consistent or thick cisternal layer (CT scan "at risk") the incidence of clinical vasospasm was 21%, against 47% in controls. One or more rebleedings occurred in 12% of patients in the study group, against 25% of patients in the control group. A significant ventricular dilatation was observed in 15% of patients in the first group (requiring a shunt in 8%), against 25% of patients in the second group (requiring a shunt in 11%). Final outcome was favourable in 95% of patients in this study group and in 63% of patients in the control group, with a mortality rate of 5% in the first group and 32% in the second group.